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Trigger Points
Myofascial Pain Syndrome
Muscles, ligaments and their coverings can become sore and irritated from
repetitive or over use. 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. Activities such as typing, data
entry or other frequent use of keyboards are common causes. Triggered muscles
also come from accidents, from poor posture and sometimes from sustained level
of lifestyle stress.
Though common, myofascial pain syndrome can be difficult to recognize and
distinguish from underlying entities. It is often confused with fibromyalgia.
Diagnosis hinges on the identification of painful muscle trigger points that,
when palpated, create local twitch responses and refer pain in predictable
patterns. With appropriate treatment, such as stretch and spray, trigger point
injections, or massage therapy, prognosis is good.
Myofascial pain is a common, but poorly understood, source of pain for many
patients. Janet Travell, MD, developed the concept of myofascial pain syndrome
in the 1950s. According to Simons and Travell , the syndrome is defined by the
presence of trigger points. These taut bands of muscle fibers are "ropy" and
tender and, when pressed, create a local twitch response that is an involuntary
shortening of the fibrous muscle band.
Prevalence
Myofascial pain syndrome is common. In one study of patients with pain
complaints, 31% had acute trigger points. Trigger points have been described in
all age-groups and in both sexes. The syndrome most often occurs between the
ages of 30 and 60 years; prevalence declines with advancing age. A 1950s study
of asymptomatic Air Force recruits found tender spots indicative of latent
trigger points in 54% of the women and 45% of the men. The study also noted
referred pain with palpation in 5% of the recruits.
To accurately diagnose myofascial pain syndrome, a thorough history and
physical evaluation are essential. The history should include a detailed pain
history, including when and how the pain started, the exact location of the
pain, what it feels like, which treatment modalities have been attempted (and
their results), and any history of trauma, overuse, or concurrent illness. The
patient should point to the exact location of the pain, rate the pain on a scale
of 0 to 10, and review what makes the pain better or worse.
Fascia
All of the structures in the body are surrounded, protected and supported by
connective tissue. This matrix connects the body's organs and systems, and at
the same time provides compartmentalization between them. This is what is known
as "fascia". The fascia is a continuous elastic sheath that provides structural
support for the skeleton and soft tissues (i.e., muscles, tendons and organs).
It surrounds the muscles and is known as the fascial envelope.
Trigger Points
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. Often people who've been
suffering from headaches, "TMJ," neck and back
pain, have 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 acceleration / deceleration
during the accident. We think it is this sudden stretch/contraction that creates
the stuck, shortened and painful muscles.
This syndrome 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.
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