Tuesday, March 31, 2009


Myofascial Pain Syndromes
Have you found making it through the day seems to be harder and harder because of muscle stiffness, soreness and pain? You may be suffering from a myofascial pain syndrome. Myofascial pain syndromes (MPS) are a growing problem in the United States and beyond. There are quite a few variations of this malady; nearly as many as there are people who suffer from the symptoms. A general presentation might (but, then again, might not) include an inflammation of the thin covering over a muscle or muscles (fascia), muscle pain, joint pain, focal tenderness and muscle tension. These are frequently made worse by stress (physical, emotional or spiritual), weather changes, physical activity, injury to an internal structure or organ, repetitive motion and/or inactivity.

One Important Form of MPS
One feature frequently found in MPS is the existence of trigger points (TP).
These small, tender nodules can be found by palpating (touching) the skin with a firm pressure. They often occur in predictable locations and have the ability to create pain patterns that have little to do with the location of the trigger point. For example, a trigger point found near the place where your neck connects to your body can create pain in your forearm. A trigger point in a low back muscle is quite capable of creating pain that seems to be coming from your foot.

A number of techniques have been developed over the years to treat trigger points. These include a variety that run from gentle non-invasive through aggressive non-invasive to frankly invasive procedures. Gentle non-invasive techniques might include electrical muscle stimulation and moist heat. More aggressively, therapeutic massage that focuses on trigger points has been shown to relieve pain and dissipate trigger points. A more invasive technique is trigger point injections to help break up tenacious TPs that refuse to dissolve as described by Dr. Janet Travell in her book, “Myofascial Pain and Dysfunction: The Trigger Point Manual”.

What is a trigger point?
Trigger points are frequently created as a result of the natural activities of your own body. During normal muscle activity, waste products are created (lactic acid and other materials). Your body wants to rid itself of this noxious waste and usually does so by having it removed by the blood and lymphatic systems. But if, for example, tight muscles prevent normal blood and lymphatic flow, the waste can accumulate in small pools near the muscles. These are trigger points.

Treatment expectations
Pain referral patterns of trigger points can sometimes mimic other conditions. I have treated patients with diagnoses of carpal tunnel syndrome and sciatica who were concerned about recommended surgeries. Using trigger point therapy those symptoms were frequently resolved without surgical intervention. This is no guarantee that your symptoms will respond in a like manner, but it is usually a good idea to treat from least invasive to most invasive one step at a time. As you progress through your program, the specifics of treatment will change based upon your progress. This takes time so you should have patience and stick to the treatment instructions to move from elimination of the trigger point to rehabilitation of the muscles.

Treatment results are less predictable than we’d like and they must be created for each individual patient and change as you move through the healing process.. It is a “hit-and-miss” situation while looking for the ideal strategy. Currently, the “Best Guess” method in determining an appropriate treatment protocol is our only option. I have found that a large majority of patients respond well to a combination of chiropractic adjusting and therapeutic massage. If the symptoms and findings don’t resolve completely, referral to a pain management physician for injections is appropriate. Manipulation under anesthesia can also be beneficial in treating MPS. Finally, a surgical consultation is available if all else fails.

Some forms of MPS do not involve trigger points. I will explore some of these in the next part of our discussion.

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