Muscle Pain Treatment
and Myofascial Pain Syndrome

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
Myfascial 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.

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.

What Is the Best Treatment for Myofascial Pain?

The best treatment always starts with elimination of causative factors whether they are structural like herniated disc or functional such as postural disorder or emotional such as in the case of stress.

What Treatments Do We Use at DNR?

To be successful myofascial therapy must be comprehensive and diagnostically precise. We have come a long way from the original concept of manually release by mere pressure. At DNR we use a combination of: ESWT (extracorporeal shockwave therapy) and manual therapy. But most importantly we begin with a thorough diagnosis to establish the underlying pathology. We use diagnostic ultrasonography and elastography to localize deep trigger points as well as tendinopathies and enthesiopathies without which the trigger point therapy would never be effective. Fascial component of the treatment is provided by radial shockwave and manual facial therapy.


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