Behavioral Medicine Associates, Inc.

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Understanding Chronic Pain: Myofascial Pain Syndrome

Muscles, ligaments and their coverings can become sore and irritated from chronic use or overuse. This soreness can develop into disabling pain,which can reduce or eliminate a person's ability to perform jobs which involves the affected muscle groups. This condition, termed Myofascial Pain Syndrome (MPS) often occurs in persons who perform repetitive tasks involving the muscles of the forearms, upper arms, shoulders and neck, such as typing, data entry or other frequent use of keyboards. Triggered muscles also come from accidents, from poor posture and sometimes just from chronic tension. Think of triggered areas as "stuck spots" which must be loosened up. The condition is marked by inflammation, tenderness and eventually weakness in the muscles, ligaments, fascia and joints. Usually,small areas of extreme tenderness can be identified by pressing on the affected muscles. These spots are called "trigger points" - in addition to being tender, they feel like hard, usually round areas or knots. Trigger points can be thought of as areas of stuck, tangled muscle fibers which don't release in the normal way, even when the muscle is relaxed. Sometimes these trigger points are joined together along the length of the muscle and feel like tight, hard bands, rather than like individual hard spots in the muscles.

Motor vehicle accidents and falls, particularly when "whiplash" type injuries occur, are major sources of triggered muscle. These accidents also can cause mild traumatic brain injury or "post concussional syndrome." This is a set of very upsetting cognitive and emotional changes resulting from mild injury to the brain.

We often see people who've been suffering from headaches, temporomandibular joint dysfunction (TMJD), neck and back pain that is traceable to motor vehicle accidents,sometimes years and years ago. In an accident your muscles are very suddenly stretched.This invokes a powerful "stretch reflex" in which the muscles contract just as powerfully as they were stretched by the sudden accelleration / decelleration during the accident. We think it is this sudden stretch/contraction that creates the stuck, shortened and painful muscles.

Myofascial pain is also usually associated with carrying excess tension in and around the affected muscles. This excess tension may become worse as the pain increases and the person begins to unconsciously "guard" or attempts to immobilize the sore area. This is a natural response, but unfortunately it makes matters worse. Tension around the triggered areas make the triggering and the pain worse. The increased pain then creates more tension and a vicious cycle is established. MPS can be associated with or even mistaken for arthritis or carpal tunnel syndrome.

Trigger Point Release

I routinely evaluate for myofascial pain syndrome by asking questions, taking history and pressing on common spots that are sore in the neck, shoulder and back to identify trigger points. If you aren't being treated here, at Behavioral Medicine Associates, Inc., you should talk with your physician about it the possibility that you have myofascial pain caused by "trigger points" in your muscles. Trigger points are sore, hard, inflamed spots in your muscles caused by injury or chronic tension. These spots are easily identified by palpation - gentle but firm pressure, but they do not appear on X-rays or MRI scans and so are often missed in medical diagnosis. Trigger points refer pain and dysfunction to other parts of your body, as well as causing local pain. The method of correcting trigger points was first described by Janet Travell, M.D. and later taken to a highly developed treatment process by Bonnie Prudden. Find out if it is practical for you to learn to self-administer myofascial release. Pain is a warning, and you should make sure nothing more serious is causing your pain. Also make sure it is safe for you to do deep stretching of the affected areas of your body.

A simple and easily self-administered method for controlling and preventing MPS exists. The steps in myofascial release are

The above procedure is called "trigger point release" and is commonly used by sports medicine physical therapists. It will not give permanent relief unless it is done regularly.You also have to learn to relax your muscles as a matter of habit. If you have a lot of fairly strong trigger points in your muscles, make a plan to compress then stretch the areas twice a day, before going to work and after coming home. The whole process of compressing trigger points and stretching can take about twenty (20) minutes. One big challenge in doing this is to decide that you have to commit this much time to taking care of your own needs and nobody else's each day. There are a couple of great tools for getting at your own trigger points: the Theracane and the Back Knobber. There are also numerous small hand-held devices that are great for squashing trigger points on other people or on parts of your own body you can reach without the larger Theracane or Back Knobber.

Myofascial Trigger Point release will work best if you also learn to notice and switch off unnecessary muscle tension. This skill can best be learned by practicing with an audio instruction on an exercise called "Progressive Relaxation." In Progressive Relaxation you make yourself more aware of tension and better at controlling it. The process is simple. You listen to the instructions on the tape, which asks you to tense slightly one muscle group at a time, study or observe the feelings of tightness in the muscles, then switch off the tension and notice the pleasant feelings of relief and release. By working through each major muscle group in the body this way, you can become a much more relaxed person. Many people eliminate headaches, back and neck pain, and pain from overuse of the muscles in the arms and shoulders

If you learn the above methods and use them to eliminate the worst of your pain, it is important to follow through. You should take several short breaks during the work day. During these few minutes it is not necessary to compress triggered areas, but simply to do the stretches. This should take only about three (3) minutes per break.

If you think in terms of restoring muscles to their normal length, you're on the right track. Muscles that are lengthened and relaxed are easier to strengthen. Triggered muscle can be incredibly sensitive. If doing the above procedure makes you worse the next day, YOU DOING IT TOO HARD! It should "hurt good" while you're doing it, but don't get over-enthusiastic. If you have a really bad pain problem, ask your physician about finding a physical therapist (sports medicine types usually know this method) and get going on it.

Once you're feeling less pain, it is very important to develop a habit of regular exercise! Muscles that have been triggered and painful for a long time are weak. You have to develop strength to stay more pain-free and healthy. Strength training and aerobic conditioning are beyond the scope of this page, but I suggest you get professional consultation from a qualified exercise trainer and get going today.

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