Myofascial Pain Syndrome Frequently Asked Questions
By: Hal S. Blatman, MD

Muscles can cause many seemingly different pain conditions. Pulled muscles can cause soreness, as well as discomfort that can be quite severe. Old injuries like recurrent back and shoulder problems seem to "act up" after certain physical activities. Other myofascial related conditions include back pain, plantar fasciitis, neck pain, TMJ syndrome, and various forms of headache.

What is Myofascial Pain?

Myofascial is derived from the words “myo” which means muscle, and “fascia” which is the connective tissue that covers and intertwines with muscle. Myofascial pain is generated by hyperactive small areas of irritability in muscle or its associated fascia that are called myofascial trigger points. A trained examiner can usually feel these trigger points. The diagnosis is determined by physical examination, and not by medical tests such as X-ray, CT and MRI scans.

What is a trigger point?

When muscles contract, they shorten. A trigger point is a microscopic part of the muscle that got stuck in a contracted state.

What do trigger points cause?

Trigger points cause continued shortening of a muscle, weakness of the muscle, and pain.

• an example of muscle shortening is when the hamstrings are so short that we can't touch our toes with our knees straight
• examples of muscle weakness can be anywhere a muscle has been previously injured. The weakened muscle is not smaller than normal, just weaker.
• pain from a trigger point can be felt as numbness, tingling, burning, aching, cramping, and sharp or stabbing.
• trigger points also cause referred symptoms. This referred pain can be quite severe and distant from the original source. Examples include pain that radiates down the leg from the lower back and buttocks, or goes down the arm and into the hand from the neck, or goes into the head from the neck and upper shoulders.
• trigger points also cause headaches. They cause all kinds of headaches, including tension headache and migraine headache.

What is myofascial pain?

It is generated by myofascial trigger points in muscle tissue. Trigger points can be felt as nodules or knots of tightness within a muscle. Trigger points form in muscle tissue as a response to injury. They generate pain patterns that are felt as aching, numbness, tingling, and cramping. This pain pattern may be felt in a muscle or a nearby joint. The trigger point will also restrict motion, cause weakness and cause tightness in the soft tissue.

What other conditions are caused by trigger points?

Repetitive strain and repetitive motion cause trigger points to form in the overused muscles. Trigger points in forearm muscles cause the pain of tennis elbow and golfer’s elbow. They also cause wrist pain and tenderness. Trigger points in buttocks muscles cause symptoms that are often diagnosed as bursitis and inflammation of the hip joint.

Trigger points also cause growing pains. These typically occur in children, and are usually located in their legs and sometimes relate to joints like the knees.

Trigger points also cause phantom limb pain after amputation. They are mostly located in the muscles of the stump and the shoulder or hip joint. They cause radiating pain that goes into the missing hand or foot. It can be burning, aching, sharp, numbing or tingling. Sometimes it seems like all these sensations occur at the same time.

What can be done to help the person with this diagnosis?

There are many things that can be done to help adults and children with myofascial pain. These include body work that such as myofascial release, Chiropractic, acupuncture, stretching and myofascial trigger point injections. Other injection techniques include prolotherapy and neural therapy. Pain, stress, and tension can be treated with Acupuncture, Thought Field Therapy, BioFeedback, and EEG BioFeedback. Other helpful modalities include Healing Touch, Environmental Detoxification, Aroma Therapy, Photon Therapy, and Massage Therapy.

Nutrition is also important for reduction of pain, relief from fatigue and improvement in total body wellness. Nutritional supplementation and various therapies can make a tremendous difference in giving the body support for healing. Since nutritional change is likely to be very important for a change toward health, we provide one on one sessions under Dr. Blatman's direction to help our patients make these changes as easily as possible. In addition, food allergy testing can be added to the healing program for further reduction of bowel problems, headache, pain, fatigue and mental cloudiness.

Another consideration is stress management. There are central nervous system mechanisms that make muscles generate more discomfort when we are under more stress. Since we do not live in a stress free environment, we can often be helped by techniques that change how we respond to stress. A good night's sleep is also very important in healing our bodies. Sleep deprivation in normal people causes fatigue and diffuse pain patterns to occur. Medication that is not addictive may be prescribed to help restore normal sleep patterns. This often has a beneficial effect on the pain level and fatigue of fibromyalgia.

Is there hope?

Of course there is hope.

Research is helping doctors to understand more about body mechanisms involved in causing myofascial pain. Also, more and more doctors and therapists are learning to treat the pain patterns caused by trigger points.