Background
Musculoskeletal (MSK) pain is common. It affects up to 80% of the general population, with 10-20% being chronic. In 2008 the direct and indirect costs of chronic MSK pain was $5.8 billion, and it is a leading burden of illness in Canada. Myofascial pain syndrome (MPS) is one of the most common forms of chronic MSK pain seen by chiropractors. Its prevalence in the clinical population varies widely from 9-85%. Conservatively assuming a 9% prevalence, it contributes an estimated $522 million to the financial burden of illness in Canada.
What is Myofascial Pain Syndrome
Myofascial pain syndrome describes regional pain persisting for more than three months. Regional pain is limited to a body region such as the neck rather than widespread throughout the body. MPS is characterized by the presence of one or more hyperirritable nodules within the muscle. These nodules are called myofascial trigger points (MTrP) and are commonly known as
muscle knots. Further symptoms may include weakness, reduced range of motion and pain with movement.
Myofascial trigger points can be either latent or active. Latent MTrPs are tender to touch and can cause referred pain when pressed firmly. Referred pain is felt away from the injured area. For example, pressing a muscle in the neck can cause pain felt around the eye. Active MTrPs cause pain without being touched. When assessed clinically, referred pain from active MTrPs is often more intense.
What Causes MPS
The cause of MPS is not fully understood. Local injury from trauma or repetitive micro-trauma causes a chemical called acetylcholine to be released within the muscle. This causes increased muscle activity, localized muscle contraction and the formation of MTrPs. On-going muscle contraction leads to inflammation that contributes to local muscle pain. Further, persistent pain leads to increased sensitivity of the nervous system known as central sensitization and may cause more MTrPs to form in muscles even without local injury. Other factors such as stress, poor posture, repetitive activities, and joint pathology can lead to an increasing number of MTrPs. These may worsen and prolong symptoms.
Treatment
While there is no best treatment for MPS, many treatment options are available such as various massage techniques, therapeutic ultrasound and acupuncture. An essential factor in the management of MPS is identifying and reducing aggravating factors. For example, ergonomics education and intervention can help reduce poor postures and repetitive activities that may worsen symptoms. Exercise and stretching also play a significant role in restoring range of motion. Graded strengthening should follow to help prevent a recurrence.
Simple Strategies to Start Feeling Better Today
1. Identify and reduce causal and aggravating factors
In my experience, sustained postures or light repetitive strain most commonly contribute to MFP. This is not limited to the workday as leisure activities may also contribute.
Examples: cradling the phone between your head and shoulder, all-night exam cram sessions, and weekend gaming marathons.
Being aware of bad habits that contribute to MFP and taking steps to reduce them is key to long-term success.
2. Move more
Simple light-moderate physical activity can help reduce muscle pain.
Walking is a great start, but make it brisk. If your arms are not swinging naturally, you are walking too slowly.
If you sit through the workday, try a 30-second micro-break every 30 minutes.
3. Stretching and self-massage
Simple light stretching can help reduce pain. Hold a light stretch for 30 seconds rather than an aggressive stretch for only a few seconds.
Rolling can help reduce pain and increase flexibility. I recommend a light stretch after rolling a muscle for even better results.
4. Do not underestimate the effects of stress
Stress can contribute to ongoing muscle activity and contribute to the formation of MTrPs, or worsening of MFP.
Mindfulness meditation can improve pain and depression symptoms and quality of life. There are many free videos online. Below are a few sample links to try.
Guided meditations
Apps (find more at mindful.org)
If you or someone you know are experiencing muscle pain,
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This article is for information purposes only. If you are experiencing pain, consult a health care professional, such as a chiropractor, to assess your needs and identify a course of action that’s right for your specific condition.
References:
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Barbero M, Schneebeli A, Koetsier E, Maino P. Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care. 2019 Sep;13(3):270-276. doi: 10.1097/SPC.0000000000000445. PMID: 31313700.
Saxena A, Chansoria M, Tomar G, Kumar A. Myofascial pain syndrome: an overview. J Pain Palliat Care Pharmacother. 2015 Mar;29(1):16-21. doi: 10.3109/15360288.2014.997853. Epub 2015 Jan 5. PMID: 25558924.
Weller JL, Comeau D, Otis JAD. Myofascial Pain. Semin Neurol. 2018 Dec;38(6):640-643. doi: 10.1055/s-0038-1673674. Epub 2018 Dec 6. PMID: 30522139.
Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. doi:10.1016/j.pain.2010.09.030
Fricton J. Myofascial Pain: Mechanisms to Management. Oral Maxillofac Surg Clin North Am. 2016;28(3):289-311. doi:10.1016/j.coms.2016.03.010