StressLess Body Therapy: Myofascial Pain Syndrome

Many people complain of aches and pains of the musculoskeletal system. This is often a result of myofascial pain syndrome, a concept developed by Janet Travell, MD in the 1950’s. According to Travell, trigger points form in the muscle and fascia causing either local or referred pain. This pain is myofascial pain. According to Taber’s Cyclopedic Medical Dictionary, superficial fascia is the subcutaneous (below the skin surface) tissue that connects skin to the muscles, and deep fascia is a fibrous membrane that covers, supports and separates muscles. Trigger points are formed due to some form of trauma to muscle fibers and fascia. A trigger point is a taut band of muscle fiber that is tender to the touch and causes a jump reflex in the client when palpated. Trigger points may be active or latent. An active trigger point causes either local or referred pain. The client may not feel a latent trigger point; however, upon palpation, it causes local pain. Both active and latent trigger points cause stiffness and weakness of the affected muscle as well as preventing full lengthening of the muscle that restricts the muscles range of motion.

There are a variety of factors which may cause myofascial pain, such as: overuse due to excessive exercise or repetitive motion, sudden trauma from an accident, inflammatory diseases or other systemic conditions, nutritional deficiencies, chilled areas of the body, nervous tension or stress. Although similar, myofascial pain syndrome is not the same as fibromyalgia. However, many people with fibromyalgia (FMS) also have myofascial pain syndrome (MPS). According to Fibroworld, fibromyalgia pain is more diffuse whereas myofascial pain is more local, fatigue and morning stiffness are common in FMS but not in MPS, sufferers of FMS have tender points versus the trigger points of MPS, and FMS is chronic whereas MPS is relieved with treatment. The difference between a tender point and a trigger point is the pain pattern. Possibly a tender point is the same as a latent trigger point.

There are multiple forms of treatment for myofascial pain syndrome:

Trigger point therapy, which includes myofascial release, deep stroking massage, and myotherapy.
Spray and stretch, which involves the use of a vapocoolant spray followed by stretching of the affected muscle
Trigger point injections where a local anesthetic is injected directly into the trigger point
Dry needling or acupuncture
Chiropractic manipulation
Exercise
Medication

With regard to massage therapy, the best treatment plan seems to be a combination of techniques. First, the affected muscles are identified through palpation, and then trigger points are released either through deep pressure massage, myofascial release or use of both techniques. This should be followed by moist heat either immediately or when the client returns to their home. In Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch , Donna and Steven Finando suggest moist heat be applied to the trigger point area for 20 minutes a day for 3 days following the massage. Additionallly, the client should be shown stretching exercises to perform at home and which should be performed on a daily basis, particularly if the trigger point is due to a repetitive motion. Finally, once the client is pain free for approximately a week, the client should be shown strengthening exercises to recondition the muscle. The Finando’s also believe poor breathing patterns directly affect myofascial problems and recommend the client be shown how to breath properly from the diaphragm instead of the chest.

Written by Kathy Millspaw
June 11, 2002

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