Myofascial pain syndrome is a chronic pain condition affecting the musculoskeletal system.
Most people experience muscle pain at some time that typically resolves on its own after a few weeks. But for some people, muscle pain persists.
In people with myofascial pain syndrome (MPS), sensitive spots are known as trigger points. These areas develop in the taut, ropey bands of the muscles (the fascia). When pressure is applied to these trigger points there is pain (called referred pain) in a different part of the body.
Common symptoms of MPS include:
- deep pain in localized areas of muscles
- pain that gets worse when the affected muscle is stretched or strained
- muscle pain that gets worse or fails to improve with time
- presence of painful knots in muscles that when pressed produce intense localized or referred pain
- muscles that are weak, stiff, inflexible, or have reduced range of motion
- mood or sleep disturbances
Most people with pain and fatigue in their skeletal muscles have either fibromyalgia or MPS. Fibromyalgia is a disorder of widespread muscular pain. It can be felt throughout the entire body. But, people with MPS feel localized pain in regional groups of muscles, like the lower back, neck, or jaw.
MPS is characterized by a few localized trigger points in the taut ropey bands of the muscles. These trigger points are tender and can produce localized pain. But their defining characteristic is that they trigger referred pain. Fibromyalgia is associated with multiple, more widespread tender points. These differ from trigger points because they don’t produce referred pain.
Most points occur because of muscle overuse, muscle trauma (injury), or psychological stress. Trigger points often arise from sustained repetitive activities, like lifting heavy objects at work or working on a computer all day. No single factor is responsible for the development of myofascial trigger points. A combination of contributing factors may include:
- poor posture
- sitting for a long time in awkward positions
- nutritional deficiencies
- serious lack of exercise or movement
- any injury to the musculoskeletal system or intervertebral disks
- generalized fatigue
- lack of sleep
- hormonal changes (menopause)
- intense cooling of muscles (such as when sleeping in front of an air conditioner)
- emotional problems (depression, anxiety)
- other pain or inflammation conditions
Your doctor will perform a physical exam to look for myofascial trigger points. Your doctor will look for tender nodules in the taut bands of your muscles and press them to find a pain response. When pressing a trigger point, your doctor will feel for a twitch in the muscle (also called a “jump sign”).
There are no other tests that can show the presence of MPS. Your doctor will rely on you to describe where and how you’re experiencing pain. It’s important to tell your doctor about all your current symptoms and any past injuries or surgeries.
There are several different types of myofascial trigger points that your doctor may find, including:
- active trigger points: These trigger points are nodules within a taut band of muscle. They’re typically the source of muscular pain. They’re very tender, cause referred pain, and produce a twitch when touched.
- latent trigger points: These nodules do not cause pain when touched. They can remain dormant for years and become active when there is stress or trauma.
- secondary trigger point: This is a painful point in the muscle that becomes active when you stress another muscle.
- satellite myofascial point: This is a painful spot that becomes active because it’s located near another trigger point.
Myofascial pain syndrome requires a multipronged treatment plan. Many people combine medications with other therapies that relieve muscle stiffness and pain.
There are several medications that can ease the symptoms of MPS, including:
- nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter drugs like acetaminophen (Tylenol) and ibuprofen (Advil) can relieve pain and swelling.
- analgesics: Pain relievers such a lidocaine or diclofenac patch, tramadol, COX-2 inhibitors, and tropisetron (not available in the United States) may be considered.
- muscle relaxants: Benzodiazepines and tizanidine (Zanaflex) can reduce muscle spasms.
- anticonvulsants: Gabapentin (Neurontin) and pregabalin (Lyrica) may relieve pain and reduce muscle spasms.
- tricyclic antidepressants: These are indicated to treat chronic pain, fibromyalgia, and nerve pain, which are conditions that resemble MPS.
- Botox injections: Botulinum type A is a potent neurotoxin that prevents muscle contractions and may have pain-relieving effects.
Dry needling is one of the quickest ways to inactivate myofascial trigger points. Your doctor will insert a needle directly into your trigger point, move it around, and poke it in and out. It can be quite painful, but it’s one of the most effective ways to inactivate a trigger point and reduce the pain. Some clinicians use acupuncture needles, which are smaller and less painful than hypodermic needles. There are a number of key differences between dry needling and acupuncture.
Trigger point injections
Trigger point injections are like dry needling, but only a solution is injected into the tissue. Typically, doctors inject saline or a local anesthetic like lidocaine. The effects are comparable to dry needling, but the procedure may cause less discomfort. Trigger point injections with steroids are also an option.
Ultrasound machines transmit sound waves into tissue through a sound-conducting gel applied to the skin. The sounds waves can heat up and relax muscles, improve blood flow, and remove scar tissue. The pain-relieving effects may be minimal. But, this treatment may reduce stiffness and increase mobility if done before stretching. Ultrasound therapy has been successfully used for pain associated with rheumatoid arthritis, so it may be worth discussing with your doctor.
There are several types of massage treatments that can relax myofascial trigger points. These include:
- passive rhythmic release
- active rhythmic release
- shiatsu (acupressure)
- trigger point pressure release
Massage therapy increases blood flow and warms up muscles. This can help reduce stiffness and ease pain. The massage therapist may use their thumb to put pressure on your trigger points, which will aggravate pain and then release the muscle tension.
Spray and stretch
Stretching helps many people with MPS. Some physical therapists apply a cold, numbing spray to the muscle area before leading someone through stretches. There are also some gentle exercises and stretches you can try at home to reduce pain.
There are several steps you can take at home to reduce pain and improve your quality of life.
- Choose a better chair at work and improve your posture.
- Try adjusting the height of your computer so that it falls in your natural eye line.
- Try a new mattress, or adjust your sleeping position.
- Practice yoga, Pilates, or another stretching technique. These Pilates exercises for people with fibromyalgia symptoms may also help your MPS symptoms.
- Wear a back brace when doing heavy lifting.
- Use a personal massager or vibrating device.
- Start an exercise program and get your muscles moving every day.
- See a mental health professional and reduce your stress level.
- Use an ice pack immediately after any muscle injury.
- Use moist heat to treat muscle inflammation. Learn how to make your own heating pad.
- Take a hot bath.
- Use a traction device.
- Practice mindfulness to manage pain.
Myofascial pain syndrome can affect your quality of life. You may not be able to participate in physical activities that you used to enjoy. This could lead to depression and isolation. MPS can also impact your mobility. Seeking treatment when symptoms first develop, finding a support group, and talking with friends and family can help.
MPS can be a challenging condition to live with. The key to managing your pain will be comprehensive treatment. There’s no single treatment that works best for everyone, so don’t be discouraged if one treatment doesn’t work. But with some form of treatment and healthy lifestyle choices, the pain of MPS can be managed successfully.