Myofascial pain is extremely common. Surprisingly in the past it received little attention from the medical profession but is now receiving increasing recognition among many health professional groups, particularly the complementary and alternative medical groups. It is a complex condition,
generally causing severe the pain from which is usually the affected individual’s main concern.
Myofascial pain is usually associated with localised injury or a strain to the affected muscle. It mostly occurs within a muscle. When it occurs it mainly affects the ‘postural’ muscles of the trunk, i.e. those muscles responsible for maintaining the upright posture of the body. Once it has begun the pain may be of variable intensity but, without treatment, is often long lasting.
The characteristic lesion of Myofascial Pain itself is the ‘trigger point’ which develops in the affected tissues and which leads to severe pain and dysfunction in the region. This is usually found within the fibres of the muscle but can also be found in the fibrous tissues as well
The relevant ‘trigger point’ can usually be determined by careful examination Within the muscle it is felt as markedly tender, circumscribed spot or ‘knot’ in a tight band lying within the softer muscle in line with its fibres. Electron microscope studies have shown small areas of contraction of the internal elements (sarcomeres) of the muscle fibre at these sites.
There are two types of ‘trigger points’; ‘active’ trigger points and ‘latent’ trigger points.
‘Active’ trigger points’ are spontaneously’ painful and usually give rise to the severe pain. The intensity of the pain is usually related to movement or the position of the body or limb but it can, at times, be continuous. When present, the pain can be both localised within the muscle and/or radiate into the surrounding areas of the trunk or into the adjacent limb. Because of this radiation the affected individual may experience the greatest pain at a distance. For example, ‘trigger points’ within the muscles of the upper back may present with headache and those in the lower back or buttock may present with pain in the thigh or leg. These ‘active trigger points’ are very tender to palpation, and pressure on it, after it has been found, may cause the muscle to ‘twitch’. Pressure on the ‘active’ trigger point may also reproduce the pain in the area in which it is normally experienced. The presence of an ‘active’ trigger point can give rise to a pain-induced weakness as well as ‘autonomic’ symptoms such as abdominal pain. Frequently the movement of the affected portion of the trunk or limb is restricted because the ‘trigger point’ causes shortening of the involved muscle. It is important that this ‘active’ trigger point be found as the pain and dysfunction arising from it is likely to continue if it is not treated.
‘Latent’ trigger points’ are often more numerous than the ‘active’ trigger points. They too may be found in the muscles by palpation. They are tender to pressure but they are not usually ‘spontaneously painful. Similarly, pressure on them does not cause the muscle to ‘twitch’. The ‘latent’ trigger point, however, can be activated by a number of factors and change to an ‘active trigger point’ giving rise to the characteristic symptoms of this condition.
The pain from a ‘trigger point’ has often been misdiagnosed as arising as a result of a number of other conditions, e.g. as a symptom of a tension headache, a frozen shoulder, epicondylitis, a carpal tunnel syndrome, and prolapsed intervertebral disc, to mention a few. Nevertheless, it must be remembered that a trigger spot may develop in association with an underlying lesion of the underlying nerves, muscles or joints and can, in fact, co-exist with these more serious conditions. This being so it is important to seek an opinion from a qualified medical practitioner if the pain is overly severe, prolonged, and/or is accompanied by frank neurological deficits or other constitutional symptoms.