Myofascial Pain and Trigger Point Therapy
Help for Myofascial Pain in Midtown Toronto, Ontario
Myofascial pain is a very prevalent condition that involves the disuse, overuse, and or strain of muscles, fascia, and their connective tissues. When pain is felt in a muscle as well as in a nearby area, it may be referred pain associated with myofascial pain syndrome.
What are Trigger Points?
Trigger points are characterized by:
- Highly irritated nodules found in tight/stretched bands of skeletal muscles
- Painful when pressure is applied and/or refers pain in distinct patterns
- Can be latent (only felt when it is pressed) or active (there most of the time)
- Pain that reduces when pressure is applied to trigger point
- Can be acute or last for many months or years
You may have noticed a sore spot near a muscle or joint that when pressed, twitches, is painful and may refer pain to other areas.
Although precise diagnostic criteria are lacking in the literature, clinically identifying trigger points is common.
During your examination, the doctor will palpate muscles (use her fingers), to identify tight areas in your muscles and, when pressed, note if a given muscle refers pain to another location.
A latent trigger point means that you only feel discomfort when pressure is applied to the muscle. An active trigger point means that you feel discomfort in a location near a tight muscle, even when the muscle is not being pressed.
In one study, it was found that approximately 46% of people with muscle pain had an active trigger point, meaning it was referring pain even before being pressed.
The exact reasons for myofascial pain syndromes and trigger points is still unknown. Pathological changes are often found when trigger points are biopsied and viewed under a microscope.
- microtears of myofascial tissue
- pain and chemical receptors become stimulated as prostaglandins and cytokines are released during inflammation, in response to the low oxygen levels at the muscle fibers.
- Muscle fiber contraction restricts blood supply, reduces waste removal, and causes pain
- Nerve signals from affected muscles create central pain signals that spreads pain to nearby areas
Research by Fernández-De-Las-Peñas and Dommerholt shows that trigger points and central sensitization can promote the activation of trigger points.
What Does a Trigger Point Feel Like?
- Muscle stiffness, tenderness, and spasms
- Reduced range of motion of muscles and joints
- Headaches
- Dizziness
- Irritability, depression, disturbed sleep
- Reduced energy and motivation
- Reduced motivation at work or in completing tasks
The Importance of Finding and Healing Trigger Points:
Since trigger points and myofascial pain often refer pain or discomfort to distant areas, only a thorough examination by a musculoskeletal doctor, such as a Doctor of Chiropractic, will pinpoint the source of your pain. Otherwise, you could waste precious time and money treating the wrong areas. Some examples of muscles that cause myofascial pain syndromes include:
Infraspinatus muscle: (one of the rotator cuff muscles of the shoulder) typically refers pain to the front shoulder area, side of the arm, and towards the thumb.
Suboccipital muscles: refer to the base of the skull, head, and behind the eyes.
Scalene muscles: refers pain to the side of the arm
Quadratus lumborum muscles: refer pain into the buttocks and sacro-iliac joint
Tibialis anterior and Extensor Digitorum longus muscles (shin): refer pain towards the front of the foot and ankle
There is currently a lack of randomized controlled trials (RCTs) to evaluate the use of non-steroidal anti-inflammatories and muscle relaxants for treating myofascial pain syndromes.
Long-term use of pain medications (Non-steroidal anti-inflammatory drugs) for myofascial pain can be dangerous, due to the risk of developing gastrointestinal bleeding, kidney and liver disease, and other side effects.
Trigger Point Massage for Myofascial Pain:
Once a doctor accurately locates a trigger point and confirms its referral pattern, a trigger point can be removed using drug-free methods, such as:
- Shiatsu-style deep massage with focused pressure
- Progressive muscle relaxation
- Ultrasound and heat therapy
- Interferential current
- Manual manipulation of a related joint
When a trigger point is pressed, pain is temporarily reproduced. Sustained pressure is thought to cause a momentary reduction in blood flow and stimulation of sensory receptors.
Once pressure is released, blood flow to the muscle increases, helping it heal.
With proper treatment and ergonomic changes made at home and work, trigger points are quick to resolve.
What are the Goals of Trigger Point Therapy?
- Relieve pain and muscle tension
- Increase joint mobility
- Identify and eliminate contributing stressors
- Improve blood flow and oxygen supply to tissues
Preventing Trigger Points from Recurring:
- Ergonomic changes by learning how to set up your workplace and computers properly
- Postural awareness and changes
- Stress management techniques such as relaxation exercises and mindfulness meditation
- Incorporating brisk walking into your daily routine
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