Myofascial Pain Syndrome (MFPS)

Myo Fascia Myofascial pain = = = muscle the thin tissue around a muscle pain coming from muscle and surrounding tissue.

MFPS is a medical diagnosis of a painful condition. The pain comes from trigger pints in the muscles and fascia. A myofascial trigger point is a small spot in a muscle that is extremely sensitive. Pressing on this spot causes pain in a particular pattern. For example, a trigger point in a back muscle may cause pain to shoot down into the buttock or leg. A trigger point in a neck muscle will send pain into the chest, back, arm, or face. There may also be tenderness in the area where the pain is felt. Some trigger points do not cause pain but will cause a muscle to be weak and shortened. This might make an arm or leg, for example, feel weak and stiff. Normal muscles do not have trigger points.

Who gets MFPS?

Men and women of any age can get MFPS. It seems to be more common in middle aged people who are not very active. It can also be the result of an accident or can be caused by chronic strain or overuse in a task such as typing for very long periods.

What are the symptoms?

A trigger point in a muscle is tender and also causes pain that is located away from the point itself. This is called REFERRED PAIN. The referred pain is dull, aching, often deep and can range from a mild discomfort to very severe. The pain may be present at rest, or it may happen only when the person moves. A person may be very aware of the pain pattern and at the same time may not have discovered the actual trigger point. When you press on the trigger point, the person will feel the pain in a distinct pattern. The pressure will either bring on the pain or make it worse if the pain is already present.

Many things can make a trigger point active. These include: overloading the muscle (such as lifting something too heavy). working too long at one task (such as typing, carrying groceries). direct trauma (a fall). getting a chill. arthritis. illness. emotional distress. There may be other symptoms than pain. Trigger points can cause sweating, changes in skin temperature, discharge of tears, salivation, goose bumps, dizziness, poor balance, ringing in the ears, or blurred vision. Some people have a trembling in the arm or leg, particularly as they go to use a limb. While it is possible for a trigger point to develop in one muscle only, it is more common to have trigger points in a cluster of muscles. Myofacial pain often starts in one muscle and over time may spread to include several muscles in an area of the body. After an injury, muscles tighten up automatically to protect the injured part. Long after the injury has healed, a muscle may have forgotten how to relax. This is the muscles that develop a trigger point. Sudden stretching of the muscle (as in reaching for an object on a shelf) will cause and increase in pain. The person begins to avoid such motion, which encourages the muscle to stay shortened and the trigger point in the muscle remains sensitive. Not all people with trigger points have suffered an injury. Chronic muscular overload resulting from poor posture at work or at home can also cause trigger points. If the pain has continued for years, it is not unusual for a person to develop depression, difficulty sleeping and lowered activity levels. These problems aggravate the trigger points, causing a vicious cycle. Treatment is often geared towards increasing activity, improving posture, dealing with depression and treating the sleep disorder.

Lab Tests
There are no routine laboratory tests or x-rays that will show MFPS to be present or that will show how much pain is present.
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Dealing with Myths

The pain from MFPS is not all in your head. MFPS is a condition that can be difficult to diagnose and many patients will see a variety of care-givers before it is recognized and treated. Frustration is inevitable until help can be found. MFPS does not simply go away on its own. There are treatments and they go hand-in-hand with ideas as to what you can do to help yourself. MFPS can be severe and must be taken seriously. It is a major source of disability for those who do not get proper treatment. Occasionally myofascial pain that is temporarily relieved by treatment may be caused by underlying disease. Your doctor may want to order tests to rule out other diseases.

Treatment Techniques
Spray and Stretch
A cold anesthetic spray or ice is applied to the muscle. Then the muscle is stretched. This is repeated several times until the muscle lengthens and the trigger point goes away. Then the muscle is warmed with a heating pad and care is taken not to overload the muscle.

Ischemic Pressure
A firm pressure is applied with the fingers or a deep massage is given to the trigger point.

Needling
An acupuncture needle can be inserted into the trigger point or an anesthetic may be injected.

Ultrasound
This produces a deep heat and vibration effect that may reduce a trigger point.

Identification of perpetuating factors

What activities are causing the trigger points to return or continue? Once these factors are known, then activities can be changed so as to avoid overloading muscles. It is not uncommon for some treatments to aggravate the condition. Sometimes a variety of approaches must be tried before the most comfortable one can be found. The most important part of the treatment is for the patient to learn how to avoid triggering the pain and how to stretch.

Drawing the Pain Pattern

It can be helpful to both patient and physiotherapist to use a diagram to show where the pain is felt. As treatment progresses, the pain may shift. New diagrams may be needed so that both physiotherapist and patient are clear about the pattern of pain. Sometimes, when a trigger point is treated the pain disappears but a new pain is uncovered from a trigger point in another muscle nearby.

Notes

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Notes

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Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to HTTP://publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia www.cdha.nshealth.ca Prepared by: Pain Management Unit Nursing Staff Designed and Printed by: QEII Audio Visual and Printing Departments PM85-0972 (08/2006)