Muscle Pain Treatment and Myofascial Pain Syndrome

About Syndrome and treatment

Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy include:

Scar tissue and fascia adhesions
Neurogenic inflammation
Joint edema
Inflamed soft tissues

Myofascial trigger points
Compressed or entrapped nerves
Tendons that have degenerated and lost their elastic properties
Compensation patterns developed post-injury

Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.

Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

Obstacles to physical therapy success include:

Scar tissue and fascia adhesions
Neurogenic inflammation
Joint edema
Inflamed soft tissues
Myofascial trigger points
Compressed or entrapped nerves
Tendons that have degenerated and lost their elastic properties
Compensation patterns developed post-injury

Muscle Pain Vs. Myofascial Pain

In order to understand muscle pain we first need to define the function of skeletal muscle. Most patients, doctors and therapist would describe muscle as an organ, which moves bones. This however is only a portion of function of muscle as an organ. Muscle is not only a mover but also is a sensory organ as well as an organ of pain.

Is Muscle Pain the Same as Myofascial Pain?

Not really. Muscle pain could be any kind of pain triggered by different mechanisms of over stimulation of pain receptors located in the in the muscle fibers. The term myofascial pain is often used loosely to say that the origin of pain is somewhere in the muscle.

Myofascial pain on the contrary is a very specific phenomenon in which local painful muscle knot (trigger point) gives rice to nonciceptor (pain) activity. A trigger point is a contracture of a sacromere (a functional muscle unit). The pathophysiology of a trigger point could be explained by endplate dysfunction. So what is end plate and what happens at end plate to cause pain?

An endplate is a junction of the nerve ending and a muscle fiber. The local energy crisis (ischemia) at the endplate causes release of pain sensitizing substance. This substance inhibits reuptake of calcium back into the muscle fiber cells, which results in vicious circle of pain-spasm-pain.

What Causes Myofascial Pain?

Trigger points are found in most people, however painful trigger points are more common to people who engage little in physical activity throughout the day, but have occasional intervals of muscular low grade strain.

The most common cause of trigger points is sprain and strain, particularly repetatative postural strain. Other causes of myofascial pain include:

Biomechanical insufficiency

Nerve interference

Stress

Internal disease

Nutritional deficit

Hormonal disorders

Psychological and psychiatric disorders

Latent response to trauma

Lack of sleep

Also trigger points are concomitant to almost all disorders of musculoskeletal system such as radiculopathy, disc disorders, osteoarthritis, nerve compression syndromes, postural anomalies, complex pain syndromes and other trigger points.

What Kind of Pain Is Caused by Trigger Points?

Trigger points can cause local or referred pain. Since trigger point pain is often coupled with joint or nerve pain it could be felt as deep or superficial depending on location.

Is Trigger Point Pain Harmless?

Most often when no underlying cause such as herniated disc or pinched nerve is found the myofascial pain is dismissed as non serious. This however is big mistake as there is a long term sequela if trigger point pain persists for longer then six month. This trigger point pain can turn into irreversible muscle tissue damage, which becomes very resistant to treatment.

How Is Myofascial Pain Diagnosed?

In the past majority of doctors did not believe that myofascial pain exists. If you cannot see it, it does not exist. Fortunately, with development of technology myofascail trigger points could be visualized on high- end ultrasound machines. However, these machines are not yet affordable for an average clinician. Besides, the scanning technique is quite cumbersome. The good news is that you don’t need a high- end technology to diagnose existence of trigger points. A good clinical palpation skill and knowledge of myofascial anatomy is all that is required. At DNR we supplement palpation skills with ESWT (extracorporeal shockwave therapy) devise for diagnosis of trigger points, which are located deep inside the muscular tissues.

Regenerative Technologies
for Hyper Mobile Joint Pain

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Focused Shockwave Therapy

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Electromagnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

HIGH ENERGY INDUCTIVE THERAPY (HEIT)

INDIBA CT9 Radiofrequency Device

Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to lower back pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Ultrasound Guided Injection
Therapies

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.

Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.

The myofascial pain specialists at NYDNRehab embrace new technologies and innovative therapies to treat muscle pain.

Your treatment protocol may also include:

Cupping therapy

Cupping creates negative pressure, the opposite of massage, to improve circulation, relieve pain and relax tense muscles.

Trigger point massage therapy

A massage therapist specially trained in trigger point pressure release technique can successfully help relieve trigger point pain.

At NYDNRehab, our goal is to relieve pain and restore function, so you can enjoy the very best quality of life.

Clinical Case Studies
NYDNRehab

Case Study: Dry Needling for Medial Knee Pain

Knee pain is a widespread and complex problem, and finding solutions for targeted pain treatment and rehabilitation presents a challenge.

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Case Study: Genu Valgum (Knock Knees)

Our patient is a 31-year-old female experiencing knee pain during standing and walking. The patient presented with a Genu Valgum angle of 15-20 degrees.

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Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika revolutionized foot and ankle care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with with gait and motion analysis technology. Dr.Kalika’s motion and gait analysis lab is the only private lab in the US that features research-grade technology found only at top research universities, made available to patients in his private clinic.

Our Specialists

Dr. Mikhail Bernshteyn MD (Internist)

Dr. Michael Goynatsky DPT

Dr. Daniela Escudero DPT

Dr. Michelle Agyakwah DC

Dr. Tatyana Kapustina L. Ac.