Before you rush into a stretching program for your myofascial pain be aware of what myofascial pain is, what helps, and what is likely to aggravate it.
What is Myofascial Pain
Myofascial pain is a common source of pain resulting from trigger points that is often seen by chiropractors. In spite of evidence and substantial literature on the identification of trigger points, they often go undiagnosed by physicians and physical therapists. This can eventually lead to chronic pain. Myofascial pain can be the cause of jaw pain, shoulder or neck pain, hip or back pain, or pain in the extremities.
Myofascial pain resulting from trigger points is usually the result of muscle overload, either due to acute trauma, poor postures, or repetitive movements that place abnormal stress on particular muscles. The theory is that if normal healing does not take place, that sensitization of pain receptors can become prolonged causing increases in local tenderness and often a referred pain. This sensitization can also occur at the level of the spinal cord causing a hypersensitivity to stimuli of less intensity.
What is a Trigger Point
A trigger point is a nodule within a taught band in an affected muscle. Pressure on this tender point causes a reproduction of the patient's pain and there is often weakness and a limitation in the muscles stretching range of motion. One theory on trigger points and myofascial pain suggest that trigger points occur at motor end plates where over excitable nerve endings release excessive acetylcholine. This results in prolonged muscle fiber contractions because of excessive calcium intracellularly. These muscle fibers contract around nearby blood vessels causing a local hypoxia so the contracting muscle fibers become deficient in oxygen.
Symptoms of Myofascial Pain
A typical characteristic of myofascial pain is limitation in a muscle's stretch range of motion. Pain increases as it is stretched. This is usually worse first thing in the morning. Patients also complain of weakness. Muscles become accustomed to working within pain limits and will only contract below the pain threshold. Patients with chronic myofascial pain often suffer from depression and sleep disturbances. This also lowers the pain threshold.
- aching, deep, muscular pain
- pain that doesn't improve
- reduced stretching range of motion of the affected muscles
- knots or tight areas within the muscle that are sensitive to touch
- difficulty sleeping
- muscle weakness
Passive and active stretching of muscles experiencing myofascial pain increases pain. Isometric contractions of the muscles experiencing myofascial pain also increases the pain; whereas isotonic contractions of the muscle does not.
Myofascial pain is usually aggravated by the following:
- passive stretching
- contraction of the muscle in a shortened position
- pressure on a trigger point
- maintenance of the muscle in a shortened position for a prolonged period of time
- prolonged or repetitive contraction of the muscle
- cold weather
Treatment of Myofascial Pain Syndrome
Treatment of myofascial pain will include physical therapy, and may include trigger point injections if you are seeing a specialist.
Methods to deactivate trigger points causing myofascial pain are as follows:
- ultrasound followed by stretch by a chiropractor or therapist
- NIMMO performed by Dr. Airhart
- pressure release by a massage therapist or chiropractor
- spray and stretch by a chiropractor or therapist
- dry needling followed by stretching by a chiropractor trained in acupuncture
- massage by licensed therapist
- contract/relax techniques instructed by a chiropractor or massage therapist
- heat combined with slow stretching
- short bouts of light exercise as prescribed by your chiropractor
Any of the above modalities followed by stretching is more effective than stretching alone when trying to manage a myofascial pain syndrome. Stretching alone may in certain instances increase trigger point sensitivity. It is important that your physical therapist determine the cause of your myofascial pain, whether it be postural, or work related. If the mechanical cause is addressed only then can treatment be long lasting.
Medications for Myofascial Pain
Your family doctor may prescribe anti-inflammatories, antidepressants, muscle relaxants, or medication to help you sleep. If you are investigating alternatives in the treatment of myofascial pain be sure to mention them to your doctor as certain herbs, juices, and supplements can interact adversely or affect the absorption of various medications.
Diagnosis of Myofascial Pain Syndrome
If you are experiencing what you believe to be a myofascial pain syndrome see your chiropractor or family physician for a full evaluation. Many of the symptoms of myofascial pain are identical or similar to those of other conditions so it is important to rule those out before embarking on treatment for myofascial pain.
After ruling out more serious conditions your family doctor or chiropractor will determine the source of your pain by palpating for trigger points by applying pressure to the muscles and feeling for tension and nodules. These trigger points may respond to the pressure by twitching and referring pain along specific patterns of distribution.
Dr. Airhart has been trained in the NIMMO Receptor-Tonus Technique. The Receptor-tonus Technique is a systematic approach which uses ischemic compression to remove myofascial trigger points. The doctor is instructed to search for and correct these points which bombard the nervous system and give rise to subluxations by the increased state of continuous muscular contraction they produce in the skeletal system.
Trigger points arise from several causes, such as acute or chronic muscular overload, direct trauma, poor posture, chilling of a muscle and even emotional stress. Once a trigger point has occurred, due to metabolic stasis in the area of the TP, waste products begin to accumulate. These waste products are nerve irritants (bradykinin, serotonin, hyaluronic acid, etc.) which, in turn, produce and perpetuate pain. Due to the accumulation of waste products, the blood supply to the area is decreased and ischemia and resultant pain are felt by the patient.
The treatment consists of sustained pressure for a specified length of time, usually five to seven seconds, but lesser time for some TP’s. The pressure is applied to the patient’s tolerance, always mindful of the pain threshold variances in each patient. Proper spacing of the office visits, and knowing which muscle groups to treat are important factors in determining patients’ responses. It is imperative for the chiropractor to understand that this method of chiropractic technique cannot be learned from reading about it, or in sporadic weekend practice. Attending and participating in three to five Receptor-Tonus seminars will usually prepare the doctor to recognize and successfully remove these causes of subluxations and resultant ill health.