Muscle Pain Treatment and Myofascial Pain Syndrome

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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.

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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.

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What Causes Myofascial Pain?

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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:

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Biomechanical insufficiency
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Nerve interference
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Stress
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Internal disease
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Nutritional deficit
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Hormonal disorders
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Psychological and psychiatric disorders
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Latent response to trauma
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Lack of sleep
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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.

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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.

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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.

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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.

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Regenerative Technologies
for Myofascial 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 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.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

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.

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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.

Focused Shockwave Therapy

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.

Electromagnetic Transduction Therapy (EMTT)
Ultrasound Guided Dry Needling

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to pain syndromes and motor dysfunction. 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.

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 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.

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

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

HyunJu YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar DC
Dr. Michelle Agyakwah DC
Dr. Mikhail Bernshteyn MD (Internist)

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    Research at NYDNRehab

    Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. DRY NEEDLING UNDER ULTRASOUND GUIDANCE DECREASE NEUROPATHIC COMPONENT AND INCREASE LEVEL OF MOTION IN PATIENT WITH LOW BACK PAIN.
    Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. DRY NEEDLING TRIGGER POINTS IN RECTUS AND OBLIQUUS CAPITIS INFERIOR MUSCLES UNDER ULTRASOUND GUIDANCE IS EFFECTIVE FOR CHRONIC HEADACHE.
    Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. TREATMENT OF HAND PAIN AND CARPAL TUNNEL SYNDROME USING PRECISE DRY NEEDLING UNDER ULTRASOUND GUIDANCE – RELEVANCE OF SUPINATOR SYNDROME.
    Conference paper. 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018), At Paris, France. MULTILEVEL EVALUATION OF MOTION AND POSTURE PATTERNS IN LOWER EXTREMITY AND SPINE USING DYNAMIC ULTRASOUND.
    Conference paper. 21st European Congress of Physical and Rehabilitation Medicine, At Vilnius, Lithuania, 1-6 May, 2018. EFFICACY OF DRY NEEDLING UNDER ULTRASOUND GUIDANCE FOR NEUROPATHIC PAIN TREATMENT.
    Kalika, L. and R,V, Bubnov. Pain Practice 18(S1) (2018). INTEGRATIVE LOWER EXTREMITY MOTION POSTURE ANALYSIS USING M-MODE ULTRASOUND.
    [R.Ya. Abdullaev, R.V. Bubnov, V.I. Tsymbalyuk, O.I. Grechanyk, L. Kalika, Z. Pilecki], Fact, 2017.pp. 150-163 Book chapter: “Novel approaches of physical therapy and pain management.” in Ultrasound of the spine, peripheral nerves and for pain management
    FASCIAL ULTRASOUND THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN POSTURAL IMBALANCE FASCIAL ULTRASOUND THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN POSTURAL IMBALANCE
    MYOFASCIAL PAIN AND TARGETED PHYSIOTHERAPY IN PATIENTS WITH COPD AND ASTHMA MYOFASCIAL PAIN AND TARGETED PHYSIOTHERAPY IN PATIENTS WITH COPD AND ASTHMA
    FASCIAL ULTRASOUND THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN POSTURAL IMBALANCE FASCIAL ULTRASOUND THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN POSTURAL IMBALANCE
    Ultrasound Mapping of Subscapular Multifidus Muscles to Boost Efficacy of Dry Needling under Ultrasound Guidance for Myofascial Pain Ultrasound Mapping of Subscapular Multifidus Muscles to Boost Efficacy of Dry Needling under Ultrasound Guidance for Myofascial Pain
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    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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