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Myofascial Pain Syndrome


Myofascial Pain Syndrome (MPS) is characterised by the presence of myofascial trigger points (TrPs), which are tender, hypersensitive points in skeletal muscles contained within palpable taut bands. This pain pattern is usually similar from patient to patient and is typical of each muscle. In fact, a specialist in the treatment of myofascial pain can usually predict the location of active TrP's from the patient's symptoms, without even touching the patient. Such a TrP hurts whenever you use the involved muscle, e.g., driving, eating, and combing the hair. An active TrP causes symptoms even when the muscle is at rest. A latent TrP doesn't hurt at all, unless you press it and you might not even know it's there.

Symptoms

  • TrPs typically cause muscle weakness, incoordination and dysfunction before they cause pain.
  • poor grip strength,
  • buckling knees,
  • weak ankles,
  • TrPs can compress blood vessels, lymph vessels and nerves, because these structures pass through the fascia ("the endless web"), leading to numbness, tingling, burning, electric shock like sensations, coldness, skin discolouration and swelling.
  •  Other associated symptoms may include stiffness, muscle tightness, muscle cramps, localised sweating, chest pain, dizziness, tinnitus, pelvic pain, diarrhea, nausea, goose bumps, runny nose/eyes, eye strain, jaw pain and headaches.
The vast majority of Repetitive Strain Injuries (RSI) in IT professionals is accounted for by MPS. However MPS can affect anybody, including housewives, children, and the elderly.

Aggrevating Factors

  • Strenuous use of the involved muscle. Judging the precise movement that produces pain is one way of diagnosing Myofascial Pain Syndrome (MPS). This may indicate the muscle harbouring the TrP's.
  • Forcible, passive stretch of the muscle, e.g., traction, conventional stretching
  • Sustained or repeated contraction of the involved muscle, e.g., while lifting weights or doing isometric or strengthening exercises
  • Local pressure on the TrP's, e.g., a vigorous massage
  • Keeping the affected muscle immobile in a shortened position for a long time, e.g., after sitting in a fixed position, driving, sleeping, and by using neck collars, back belts/corsets and braces
  • Sitting under the cold draft of the air conditioner or an open window
  • Cold, damp weather
  • Viral infections, sore throat, respiratory infections, etc.
  • Chronic allergies, including food allergies
  • Excessive, uncompensated emotional stress or psychological tension
  • Depression
  • Sleep disturbances
  • Hypothyroidism
  • Nutritional deficiencies, especially folic acid and pyridoxine deficiency
  • Smoking, caffeine, and alcohol
  • Anaemia
  • Recurrent bouts of hypoglycemia
  • Hyperuricaemia (high uric acid levels)
Some situations when TrP's suddenly get activated include accidents, falls, direct blow to the muscle, sudden lifting of heavy weight, twisting movements, appendicitis, heart attack, being bed bound for a prolonged period, operations and infections. An interesting observation is that muscles supplied by a compressed nerve following a slipped disc can develop TrP's (post-disc syndrome). Unless these TrP's are identified and treated even surgical removal of the disc (discectomy) may be unsuccessful in relieving pain.
Gradual development of TrP's is usually due to incorrect posture, abnormal bone structure (short leg, tilted pelvis, short upper arms, etc.), poor body mechanics and ergonomic issues related to work station set up, job design, etc.

Myofascial TrP pain is decreased by the following modalities:

  • Short period of rest.
  • By slow, steady passive stretching of the involved muscles, with warm fermentation
  • By application of moist heat on the TRP
  • By short periods of light activity with movement (not by isometric contraction or strengthening exercises).
  • Specific manual therapy or myotherapy: Trigger point pressure release, Myofascial release (MFR), Muscle Energy Techniques (MET) and Positional Release Techniques (PRT).
  • Clinician administered Spray and stretch.
Trigger point pressure release (or TrP therapy) is done as a painless but uncomfortable barrier-release technique to release the contraction knot in the muscle. The amount of pain felt by the patient should not exceed 7 on a scale of 10 at the time of treatment (0 = no pain; 10 = maximum pain). Digital pressure or tools can be used to achieve TrP release; however, a very high order of manual skill and experience is required to achieve this. This technique relies entirely on accurate identification of MTrP's by means of palpation.
Having evaluated where a restricted area exists, Myofascial release (MFR) techniques can be added to improve flexibility and restore musculoskeletal balance. MFR is a hands-on soft tissue technique that facilitates a stretch into the restricted fascia.
Muscle Energy Techniques (MET) are soft tissue manipulative methods in which the patient, on request, actively uses his muscles from a controlled position, in a specific direction, with mild effort against a precise counterforce.
Positional Release Technique (PRT) involves positioning an area or the whole body in such a way as to invoke a physiological response, which helps to resolve musculoskeletal dysfunction. The beneficial results seem to be due to a combination of neurological and circulatory changes, which occur when a distressed area is placed in its most comfortable, its most easy, most pain free position. (As described by Chaitow, 1996).
Clinician-administered spray and stretch involves sweeping a stream of vapocoolant spray over the muscle in a series of parallel sweeps that start at one end of the muscle and continue over the muscle belly to include the referred pain pattern. This is followed by a myofascial release maneuver or sequential isometric contraction and relaxation (Lewit technique). Spray and stretch produces an immediate increase in pain threshold accompanied by improved range of motion. Travell and Simons state, "Spray and stretch is the single most effective non-invasive method to inactivate acute trigger points (TrP’s).

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