What are Myofascial Pain Syndromes and Trigger Points?
Myofascial pain syndromes are intimately associated with what have come to be known as Myofasical Trigger Points (MTPs). These clinical, pain generating entities are typically found in myofascial tissues(the muscle and the fibrous sheath that envelopes the muscle) but they can also be found in cutaneous(skin), ligamentous and even periosteal(bone) tissues. Characteristically, these pain generating points refer pain to remote locations in fairly predictable patterns – similar to a road map. Myofascial pain can be very painful and even debilitating.
Causes of Myofascial Pain and Trigger Points
*Many people, especially athletes, have varying degrees of body and structural imbalances. Postural distortion, forward head, thoracic kyphosis(forward shoulders and rounded upper back), and lumbar lordosis(increased lower back curve) all lead to myofasical restriction and impede blood flow leading to increased intramuscular pressure, pain and trigger points.
*Nutritional deficiencies such as Vitamin C, B1, B12, B6, Folic Acid, Malic Acid and Magnesium can all potentiate myofascial pain. These critical nutrients get depleted when stress, poor nutrition, poor sleep, excessive exercise and isolated areas of repetitive stress occur.
*Hypothyroidism, even when marginal, can produce muscular irritability and perpetuate myofascial pain. When T3 and T4 levels drop, the primary thyroid hormones, this can give rise to energy deficient contractures and trigger points that are violently irritable.
*Hypoglycemia is particularly troublesome for myofascial pain patients and require blood sugar management and therapy to alleviate symptoms and improve function.
*Many drugs can exacerbate myofascial pain and trigger points and can lead to depletion of critical nutrients necessary for normal muscle physiology.
*Impaired sleep and heightened stress levels lead to altered tone of muscle tissue and lower pain thresholds of the body thereby contributing to myofascial pain.
Types of Trigger Points
Active TPs are those that are symptomatic and refer a pattern of pain at rest or during motion (or both). They are always tender, prevent full lengthening of muscle & can cause weakness.
Latent TPs are clinically quiet but can get activated is many of the above mentioned causes do not get addressed.
Associated TPs develop in response to compensatory overload, shortened ranges of motion or referred pain from primary TPs.
Therapeutic Considerations for Myofascial Pain and Trigger Points
*Hyperstimulation Analgesia: Myofascial Cupping, Ischemic Compression (deep acupressure/T-Bar), Dry Needle Therapy, Electrical Stimulation Therapy, Spray and Stretch Therapy and Manipulation Therapy. These types of treatment break the Pain-Spasm-Pain Cycle!!
*Improving Circulation: This decreases the concentration of noxious agents/chemicals in the tissues and improves muscle fiber unlocking via moist heat packs, penetrating ultrasound therapy and soft tissue massage therapy
*Lengthening the taut band of fibers: This is very effective since lengthening via PNF Stretching disengages the tightly woven Muscular Filaments.
*Muscle Stripping: Muscular lengthening coupled with ischemic compression/deep massage facilitates the intramuscular glide effect that is lost with Trigger Points.
*Correcting Postural and Structural Faults: The perpetuating factors must be dealt with and corrected via specific adjustments and corrective, supportive exercises.
*Nutritional Support: Stocking the body with Vitamins C, B1, B6, B12, Magnesium, Malic Acid and in some cases Iron Glycinate to fully supply the muscle tissues with nutrients for normalized muscular function and contractions.
The best treatment regimens are polymodal in that simultaneously addressing several contributing factors while engaging in corrective measures, amping up nutritional support, performing corrective postural habits, exercise/fitness techniques and supportive exercises. Treatment for these conditions is typically indicated to “break the chains” of the stubborn trigger point pain complexes but without the comprehensive approach, MTPs can become recalcitrant.