What Is It?

Myofascial pain is one of the most common pain conditions encountered in our society. The main feature of this condition is pain arising from a distinct portion of the muscle, which is called a trigger point. Stimulation of the trigger point by pressure or by stretching the muscle produces pain. Curiously, the pain may be felt in an area that is some distance from the trigger point. Myofascial pain may originate in muscles anywhere in the body, including the back, neck, extremities, head and face. Other symptoms of myofascial pain include intermittent numbness, muscle tightness, pins and needles sensations, tingling, or hypersensitivity.

The condition may be caused by a single injury to the muscle, such as a sprain, strain, or contusion; by repetitive stress; by deconditioning; or by an involuntary tightening of the muscle in response to an injury to an underlying part of the body, such as the spine. Because the pain is often felt in a region of the body some distance from the trigger point, myofascial pain is frequently misdiagnosed as being psychosomatic or as arising from some other source. Sometimes the contracted muscles will compress a major nerve, mimicking the symptoms of a herniated disc in the neck or lower back.

The affected muscles often feel tight and contain ropy bands of muscle fibers, and range of motion is restricted. Physicians and physical therapists can find the specific trigger points within the muscles with a physical examination. Pressure placed on the trigger point will reproduce the pain symptoms.

How Is It Treated?

Myofascial pain is relieved when the local trigger points are de-activated and the muscle relaxes and returns to its normal length. Treatment of myofascial pain involves:

• Local cooling of the muscle to reduce pain
• Active and passive stretching of the muscle
• Heat to promote muscle relaxation
• A home exercise program
• Education to identify and modify factors which may aggravate the condition or cause it to reoccur
• When the condition is severe or chronic, additional treatments may be needed:
• Serotonin re-uptake inhibitor medication
• Muscle relaxant medication
• Needling and injection of trigger points with local anesthetic to break up the affected muscle fibers
• Injection of the trigger point with Botulinum toxin (Botox), a potent, but safe long-term local muscle relaxant

Sometimes there are additional trigger points that may only become apparent after the primary trigger point is treated. For this reason, pain symptoms sometimes change during treatment and slight adjustments in the course of therapy may be added.

Will I Need Physical Therapy?

Physical therapy is usually necessary for the long-term management of myofascial pain, even if you are currently receiving medication or are being treated with trigger point injections. The main goal of physical therapy is to restore the normal range of motion of the muscle and its supporting tissues. Stretching is the basis for treatment to regain and improve range of motion.

What Will The Physical Therapist Do?

The physical therapist and/or exercise physiologist will teach a stretching program to help increase flexibility, increase the level of function and decrease pain. Flouri-methane spray and stretch may be utilized by the physical therapist to help assist with stretching the trigger area. The spray helps to break the pain cycle by giving a cold sensation, which in turn will permit a more comfortable stretch. Once the myofascial trigger point pain is treated, the muscle or muscles involved may be weak. A strengthening program continued at home will prevent recurrence of the pain problem.

If you receive a trigger point injection, it is imperative that the muscle is stretched immediately following the injection. Many times aggressive stretching can only be performed by a physical therapist. Patients are given a home exercise program to maintain the length of the muscles. If the physical therapy routine is correctly followed, the need for trigger point injections will be reduced.