What is
myofascial pain?
Myofascial pain literally means pain coming from the muscles (myo
is the latin term for muscle) and the fascia (the thin tissue
that covers muscles.)
Myofascial pain is probably one of the least understood and
most frequently misdiagnosed types of pain. It is also one of
the most common sources of pain and results in a huge number
of GP consultations, days lost from work, and missed sports
activities.
The symptoms of myofascial pain can vary depending on the
location and severity of the problem. People suffering with
myofascial pain often describe deep aching pain which can be
either constant or intermittent. It is usually aggravated by
the use of the affected muscle or muscle group. This can be
accompanied by burning or stabbing pain, weakness, tingling,
increased or decreased sweating, stiffness, sleep
difficulties, or dizziness. Myofascial pain can be made worse
by sitting in one position for too long, repetitive activities
such as typing or working a press, cold or damp weather,
exposure to a cold draught , or psychological stress.
Trigger points
There are approximately 400 muscles in the human body, and any
one of these can develop what is called a myofascial trigger
point (TP). Trigger points are “nervous hot spots” which cause
muscles to become abnormally sensitive. This nervous
excitability results in the development of tight bands of
muscle or fascia that, when pressed, cause local pain, as well
as referred pain to somewhere else in the body.
This referred pain is very important- if the doctor is
familiar with trigger points, he will very quickly be able to
diagnose the problem, as each muscle group has its own pattern
of pain referral. If the doctor knows these patterns he will
be able to discover very rapidly the nature of the problem and
offer solutions.
There are some fundamental and important features of trigger
points. These are;
Trigger points are tender when
pressed firmly
The muscle in which the trigger
point is active will have a restricted range of movement and
will be weaker than normal.
Trigger points in a muscle will
make the muscle shorter than normal- it will have tight bands
which can be felt in the body of the muscle.
When these tight bands are
“plucked” or pressed firmly they usually cause a muscle
twitch, and the person may make a “jump” response i.e. an
involuntary cry of pain or reflex movement away from the pain
Trigger points have a typical
pattern of pain referral
Trigger points are very common
indeed
Trigger points are essentially
areas of nervous excitability within muscle and they may exist
in two different states-
Latent
A latent trigger point does not cause pain at rest, but may
restrict movement or cause muscle weakness. The patient
presenting with muscle restrictions or weakness may become
aware of pain originating from a latent trigger point only
when pressure is applied directly over the point.
Active
An active trigger point does cause pain at rest. It is tender
to palpation with a referred pain pattern that is similar to
the patient's pain complaint. This referred pain is felt not
at the site of the trigger-point origin, but remote from it.
The pain is often described as spreading or radiating.
Causes of trigger points
The TPs of myofascial pain may occur for many different
reasons, however the most common reasons are injury or trauma
to the muscle or acute or chronic overuse causing muscle
damage or dysfunction.
Overload occurs when a muscle is being used in an improper
way, causing stress on the muscle fibres. These muscles will
often respond by developing Trigger points. If this problem
goes untreated for a period of time, compensation in multiple
areas of the body can occur, making the problem more
widespread and complicated. When this occurs, it is may be
referred to as myofascial pain syndrome.
Treatment of trigger points
The most important way of treating trigger points is three
fold;
Stimulation
Stimulation and
Stimulation!
Trigger points need to be stimulated to
be cured.
This stimulation may be in one of many different ways, however
the most important is by stretching the affected muscle group.
The stretching of the muscle may be very painful indeed- in
fact it is often too painful to be able to stretch the muscle
to any meaningful degree. This is where acupuncture becomes
vital in the rehabilitation of trigger point problems.
Acupuncture causes an immediate relaxation of the muscle
because of the effect of the “micro-trauma” to the surface of
the muscle being treated. This relaxation will then reduce a
degree of the muscle spasm and consequently allow further
stretching of the affected muscle group.
“Acupuncture is not the treatment- it is only part of the
treatment”.
Specific stretching exercises are required for long term
rehabilitation of myofascial pain, however the treatment
course can be rapidly accelerated by the incorporation of
acupuncture in the rehabilitation.
There are many other ways of treating trigger points- it is
the belief of Dr Pardoe that acupuncture is the best- for the
simple reason that trigger points are caused by a
hypersensitivity of a specific set of pain nerves, and it is
these precise nerves that are being stimulated by the
acupuncture needles.
Other methods of trigger point
stimulation include;
Trigger point massage- using
firm pressure with hard objects such as a golf ball or a
walking stick handle
Deep tissue massage using firm
hand pressure
Vibratory massage
Injection with local
anaesthetic (such as lignocaine also known as lidocaine)
Stretch and spray- a technique
where the muscle is stretched to its full extent and then
sprayed with a coolant
Simple stretching of the
affected muscle group
Application of hot and cold
packs to the muscles (ideally at the same time of the muscle
being stretched)
This is not a complete list-
there are a number of other techniques that can be applied.
Acupuncture and the treatment of trigger points/ myofascial
pain
Acupuncture for the treatment of myofascial pain has been used
for at least 30 years in the Western Medical setting. In
skilled hands it is safe, effective and frequently gives long
lasting relief of pain.
How acupuncture works in
myofascial pain
Acupuncture treatment of trigger points has been practiced
widely in the UK for over 3 decades. This has been
predominantly by members of the British Medical Acupuncture
society- a society of British doctors who have an interest in
Medical acupuncture. The society now has over 2,000 members,
most of whom practice Western Medical acupuncture. [link to
medical-acupuncture.co.uk]
Acupuncture has a number of local effects and general effects-
many of which have been studied in great detail.
With regard to the treatment of pain and painful conditions it
is clear that the effect of acupuncture on the nervous system
is paramount. If local anaesthetic injections are applied to
nerves prior to acupuncture- the pain relieving effects are
lost. Likewise, if the morphine blocking drug Naloxone is
given to patients prior to receiving acupuncture, again the
effects of acupuncture is neutralized.
This confirms without doubt that acupuncture causes a physical
response in the person being treated- it is not purely placebo
or psychological responses. (Indeed animals respond to
acupuncture as well as humans, which again negates the placebo
effect theory).
The exact mechanism by which acupuncture can relieve the pain
of trigger points has been studied (and continues to be
studied) in great detail.
The technical description below is an extract from Dr Peter
Baldry’s contribution to “Medical acupuncture” by Filshie and
White- the foremost text regarding Western Medical
acupuncture. [isbn 0-443-04976-9]
“The needle induced afferent activity is able to block the
trigger point’s C afferent input to the spinal cord by evoking
activity in the enkephalinergic inhibitory neurons”
What this means in plain English is that the needle stimulates
a nerve that will prevent the pain message from the trigger
point entering the spinal cord. This is by no means the only
effect of acupuncture with regard to trigger points- other
effects may be measured with regard to local blood flow, local
inflammatory responses, immune response, systemic analgesia,
direct effects of muscle tension and many other factors.
Much work continues in the field of pain research, both in
terms of the mechanisms by which pain is felt and to examine
different treatment options. This makes the whole area of pain
research an exciting and stimulating environment with the
potential to ease many peoples suffering.
