Myofascial pain syndrome is an often under-recognized painful condition that affects the muscles — myo — and the connective tissue — fascia — that surrounds muscle.
This syndrome involves sensitive spots in muscles called trigger points. A trigger point is often described as a taut band, or a knot, of muscle fibers that can develop because of muscle injury or overuse. These trigger points are painful when touched, and pain and spasms can spread throughout the surrounding muscle. The pain is often described as deep and aching.
Myofascial pain most often occurs in people 30 to 60 years old and affects men and women equally.
Most who experience typical muscle pain feel better in a few days, but people with myofascial pain syndrome have muscle pain that persists or worsens. Myofascial pain caused by trigger points can be experienced as headaches, jaw pain, neck pain, upper- and low-back pain, and arm and leg pain.
Causes of myofascial pain include poor posture, muscle imbalances and performing work activities using poor technique. Myofascial pain also can be caused by a painful joint. For example, the muscles of the upper back and shoulder blades — which are used to support and coordinate shoulder joint function — can develop trigger points due to painful shoulder conditions such as arthritis or rotator cuff injury.
Doctors who treat myofascial pain usually make the diagnosis by listening to the patient's description of pain and performing a physical exam. Locating and applying pressure over trigger points can reproduce the symptoms and cause a "twitch response."
Treatment can include physical therapy, massage, trigger point injections and medications. Often, a combination of these treatments is necessary.
Trigger point injections are used to inject a small amount of medication in and around a trigger point. An anesthetic can be used to provide some temporary pain relief. Steroids can also be injected to reduce inflammation and pain. Simply inserting a "dry" needle into the trigger point also can bring relief for muscle fiber tension.
If properly diagnosed and treated, the outlook for people with myofascial pain and trigger points is good. Although a complete cure is not always possible, an appropriate treatment plan can at least lessen pain, improve function and control the number and severity of future flare-ups.
Dr. George P. Boucher, a physiatrist, or rehabilitation physician, with Kentucky Orthopaedic and Hand Surgeons, practices at Central Baptist Hospital.