Myofascial Pain Syndromes

by Dr. Greg Fors

Sore Spots or Muscle Knots
Myofascial pain syndromes (MPS) are where certain areas of the body contain "sore spots" or "muscle knots" that create pain, deep ache, and/or stiffness in that area and refer pain to other areas of the body. For example, a low back myofascial pain syndrome (MPS) would have "sore spots" or myofascial trigger points in the muscles of the low back that cause pain, deep ache and stiffness in the low back region. These myofascial trigger points in muscles, tendons and/or ligaments of the low back could also refer pain into the buttock, hip or even down the leg to the foot. Another example would be a myofascial pain syndrome of the shoulder area with trigger points causing pain, deep ache and/or stiffness of the shoulder and neck area. These trigger points in the muscle, tendons and/or ligaments of the shoulder region could also refer pain down the arm even to the hand, into the mid-back and up into the neck and head.

Pain Signals to your Nervous System
People with myofascial pain syndromes usually have a history of an injury, (slip fall, car accident, etc.) or repetitive muscle strains at work or at play, (e.g. computer work, data entry, golf). A myofascial pain syndrome is often made worse or brought to the person’s attention whenever they use the region involved. or when a healthcare provider examines them and finds the “muscle knots” in that. These "muscle knots" are the myofascial trigger points in muscles, tendons and or ligaments that cause and maintain pain and stiffness in the musculoskeletal system. These myofascial trigger points are spots of hyperirritable tissue that fire pain signals into your nervous system. These myofascial trigger points need to be removed if one is to ever regain their freedom from pain and freedom of movement again.

Myofascial pain syndrome is equally present in both the male and female populations, whereas fibromyalgia syndrome (FMS) strikes women at least 10 times more than men. Also fibromyalgia causes a "sore all over" feeling with fatigue, whereas, myofascial pain syndrome is a more regional complaint. However, myofascial pain syndrome is extremely more common and can be quite disabling, at times it can even lead to fibromyalgia syndrome. Furthermore, Meyer HP (2002) reported in a study on myofascial pain syndromes, "Failure to recognize myofascial pain syndrome often leads to over-investigation, unnecessary medical intervention, and iatrogenic (physician caused) harm with serious cost implications."

Get a Proper Diagnosis
Because an individual with myofascial pain syndrome can have an underlying pathological process or disease, it is mandatory that all individuals with myofascial pain syndromes or fibromyalgia receive a proper diagnostic work-up by a competent doctor. Once pathology is ruled out, it’s important to discover the underlying dysfunctional metabolic processes that are maintaining chronic myofascial syndrome.

Trigger Point Therapy
Once an individual knows that their musculoskeletal pain of the back, neck, shoulder, hip or wherever has a myofascial trigger point component it is beneficial for them to start on a program of deactivating these triggers of pain.
Since the early and mid-fifties researchers, such as Dr. Janett Travell, Dr. Raymond Nimmo, have found that deep manual pressure applied to these myofascial trigger points had a dramatic therapeutic effect by quickly eliminating the pain. This became known as Trigger Point Therapy and is practiced around the world now by MDs, Chiropractors, Physical Therapists, Occupational Therapist, and Massage Therapists.

People generally find electric massagers and heating devices to be relaxing, it feels good, so it makes them feel better for a short while. Because of this massage lotions and electric massagers, some even with infra-red heat, are extremely popular with people. Research has not shown these approaches, of rubbed in lotions and electric massagers, to release or deactivate pain-causing myofascial trigger points, commonly called "muscle knots." This is important to realize if we really want to end the suffering caused by myofascial trigger points in ourselves or those we love.

The respected pain researchers Melzack and Wall (1988) have reported in their studies that myofascial trigger points are a key element in the cause and/or maintenance of chronic pain. Also numerous research studies (Garvey, 1989/Hong 1993) have found deep manual pressure called trigger point therapy to be one of the most effective ways to rid oneself of myofascial pain. Furthermore, a recent research study by Hanten (2000) found that a doctor supervised home-care program of trigger point therapy following by a sustained stretch to the muscle, was as effective as in-office treatment. This research was conducted on 40 adults with neck and upper back pain.
At the Pain And Brain Healing Center we utilize a comprehensive approach to your myofascial pain disorders. Utilizing the latest advances in functional laboratory medicine, chiropractic neurology and nutritional science our goal is to uncover the hidden root causes of your myofascial pain and effectively correct them. Working with your diet, nutrient levels, eliminating toxins, correcting digestion, removing food allergies and balancing brain function can radically change your life, unlocking the full potential of your life or your child’s life! See the doctor who wrote THE BOOK on chronic pain and fibromyalgia, “Why We Hurt”, a Board-certified chiropractic neurologist and a trained DAN! Doctor in the treatment of autism, Asperger's and ADHD. We also utilize the FENIX Rehab System as a home therapy devise to further recovery and reduce your visits the office.    

Identifying Trigger Points
To identify trigger points to treat click on this link How to Find a Trigger Point, or go to the main menu for Pain Help. There are five different articles on myofascial pain syndromes for different regions of the body.
Low Back Pain
Neck Pain & Chronic Headaches
Shoulder, Arm & Mid Back Pain
Hip Pain & Sciatica
Fibromyalgia Syndrome

Choose the one that relates to you to find valuable information this on myofascial pain syndrome. Each article contains some back ground information on that particular regional myofascial pain syndrome. The articles then go on to explain and describe some of the primary myofascial trigger points or muscle knots involved in that particular myofascial pain syndrome, whether of the back, neck or extremities.

Not all the possible myofascial trigger points are covered in these articles but can be found in a comprehensive myofascial examination, for any muscle, fascia, tendon and/or ligament can form trigger points or adhesions and cause local and referral pain. However, there are some primary trigger points (TPs) in each region that tend to be more common in that particular region, and many, but not all, of these primary myofascial trigger points are discussed.