Understanding Myofascial Pain Syndrome and Trigger Points
Myofascial pain syndrome is a common, chronic condition characterized by sensitive points in your muscles, known as trigger points, which can cause pain not only in the affected Muscle but also in seemingly unrelated parts of your body.
It's important to realize that this condition is often misdiagnosed, making it crucial to receive the correct diagnosis for effective treatment. One common misdiagnosis, for instance, is attributing back pain to disc degeneration or herniated discs seen on an MRI that are a normal part of aging, which can result in unnecessary back surgery, which fails to relieve pain and often makes things worse.
How Muscles Function and Develop Trigger Points
Let's take a closer look at how muscles work. They have the ability to contract, relax, and stretch. Muscles "learn" specific ways of functioning and tend to default to these patterns. However, various factors such as use, overuse, misuse, fatigue, posture, and more can cause muscles to gradually shorten over time.
When muscles become excessively contracted, trigger points can develop. These points can generate pain patterns that differ from those resulting from an injury. Pain from an injury is felt where the body is injured. A a shortened muscle is not damaged; it has simply learned to function from a tight position. Unique to trigger points however, is that where you feel the pain (site) is rarely where the tight muscle trigger point is located (source). The trigger point refers pain to a medically documented area (If anyone has the same trigger point as someone else, they will both feel the pain in the same referred pain area of the body.
. Muscle Pain site Muscle Main Site
causing pain causing
pain
For example, if you frequently lean forward, slouch, or adopt certain postures, the rectus abdominus (6-pack muscle in the front of your body) shortens, referring pain to the back. You feel pain because your abdominal muscles have "learned" to function short. The short functioning length/position becomes the default place the muscle rests when you quit using it. Resulting trigger points referring pain will continue in the back until you teach the abdominal muscles to stretch and function long again .You need to change that learned pattern by using stretch movements to teach the muscle a new, elongated position. Then will you begin to function without pain.
Addressing Myofascial Trigger Point Pain
To effectively address myofascial trigger point pain, it's essential to understand how and why muscles become short. Consider factors like movements, habits, and activities that may contribute to muscle tightness. It's crucial to identify and reverse these patterns to return the muscles to their relaxed, full-length state.
For example, when you shorten these muscles as you lean forward slouch, or curl, over time you will experience back pain.
When we address chronic myofascial trigger point pain, we must ask questions, such as how did the muscles get short? What is keeping them short? What movements have you changed or added recently that would result in the muscles being so short? What movements or muscle habits do we need to reverse these patterns and return the muscles to a relaxed full-length position? These questions necessitate looking at the source of the muscle dysfunction and pain -not just the pain site where you now feel the pain.
It is helpful to note that chronic pain seldom comes from a single trauma. That pain is instant and lasts during the healing process. More often, tension, however, accumulates in the muscles from everyday use. Consider carpal tunnel syndrome. How many tasks require gripping or bent finger positioning? The culprits can be everything from brushing your teeth, combing hair, holding eating utensils, pens and pencils, steering wheels, and telephones, using keyboards or picking up briefcases and groceries. If you do nothing to reverse the curled finger position, (curled because those finger muscles are shortened all the way up the forearm to the elbow), the muscles will gradually "learn" to function in a shortened range of motion. They don't relax with the fingers straight, they don't hurt, so you just leave them curled. Do those movements every day and the muscles of the forearm get shorter and shorter until they are not just tight, they elicit referred pain in the wrist and fingers.
A Comprehensive Treatment Protocol
A thorough treatment protocol is essential for addressing myofascial trigger point pain and dysfunction. This protocol, developed by Dr. Janet G. Travell, includes these essential steps:
- Medical Diagnosis: This involves a detailed examination of your medical history, ruling out any underlying pathology, and differential diagnosis.
- Patient History: This encompasses aspects of your family, work, social life, hobbies, and any history of illnesses or accidents.
- Pain Pattern Documentation: Describing (by patient) and diagramming (by therapist) your pain patterns aids in understanding the areas affected.
- Range of Motion Evaluation: This assesses the range of motion in the pain site, functional unit, and related areas.
- Identifying Perpetuating Factors: These factors can encompass mechanical, postural and psychological stressors. Mechanical issues may include Dudley Morton's foot, leg length discrepancy, joint dysfunction, and hypermobility. Postural issues may include insufficient physical activity, poor ergonomics, demanding work hours, and infrequent breaks. Psychological stressors may include job dissatisfaction, financial pressures related to treatment costs, reduced family activities, limited social interaction, depression, anxiety, a lack of respite from pain, or insufficient relaxation time. Metabolic or endocrine dysfunction may also be factors. This highlights the importance of behavior change to achieve long-term relief!
- Trigger Point Therapy Source and Site: Utilizing techniques like ischemic compression, intermittent cooling with stretching, and passive stretching.
- Specific Muscle Stretch Retraining: This involves targeted stretches: 2 reps, hold for duration of 2 deep breaths, and performed every 2 hours. Frequency is Mastery in changing learned muscle patterning
Embracing the Journey to Pain-Free Living
Retraining muscles to regain their full range of motion by addressing perpetuating factors constitutes 75% of treatment success and is the most key aspect of treatment. Dr. Travell's protocol emphasizes the absolute necessity of addressing ALL perpetuating factors. Even one left unattended will allow the muscle pain process to return. Just like a puzzle, you need all the pieces for a complete picture.
Strengthening exercises should only be introduced once full range of motion and freedom from pain have been achieved and maintained for at least one week.
A Holistic Approach to Treatment
Addressing perpetuating factors and implementing the comprehensive treatment protocol is essential before hands-on treatment is applied. By retraining muscles and establishing new patterns of movement and posture, long-term relief from myofascial trigger point pain can be achieved.
Remember, this approach not only alleviates current pain but also serves to prevent future tension build-up and trigger points. This comprehensive, patient-centered protocol offers a promising path to a pain-free life. Dr. Janet G. Travell's decades of experience in treating myofascial trigger point pain has provided invaluable insights that continue to help patients find relief and regain functional efficiency.
Nancy L. Shaw has been the director of the Myofascial Pain Treatment Center in Springfield, VA, for the past 42 years. 13 of those years were spent in study and development directly with Dr. Janet G. Travell. She founded the National Association of Myofascial Trigger Point Therapists in 1984. See her provider profile HERE
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This post first appeared on Alternative Pain Treatment Directory, please read the originial post: here
