Myofascial syndrome: Cause of your pain? (6 treatments)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

Myofascial syndrome often refers to a chronic condition, and generally causes referred pain. More specifically, pressure exerted on a sensitive point at the muscular level causes local discomfort distant from the painful point.

This syndrome usually occurs after a muscle-type injury or condition (traumatic or repetitive). It is also related to stress. Sometimes the pain appears without any particular cause.

Several types of treatment can help treat the symptoms. After explaining myofascial syndrome in detail (symptoms, causes, diagnosis), we will discuss treatment options to provide relief.

Definition and anatomy

Myofascial syndrome is a painful condition that affects muscles and fascia. "Myo" comes from muscle and "fascial" means fascia.

What is a fascia? It is a type of thin connective tissue that surrounds muscles. It can be muscle fibers, individual muscles or a group of muscles.

Le role of fascia is to hold the muscles together, allowing the contraction and stretching of the fibers that compose them. Due to its smooth surface, the fascia also allows optimal sliding of the fibers without friction, avoiding possible tears.

Myofascial pain is a common syndrome. It is manifested by pain and tenderness in the muscles of a certain area of ​​the body. The pain is explained by the presence of “trigger points” at the muscular level. Before going into details, it should be noted that this syndrome is not unanimous from a scientific point of view, and that other studies are required to better understand its origin and its manifestations.

According to the theory, a trigger point is a localized and blocked contraction within a muscle. A stretched band similar to a knot is often felt under the fingers on palpation. This mini-muscle spasm reduces blood flow, leading to decreased circulation and oxygenation to tissues locally. Metabolic waste is therefore formed at the trigger point, and the result is a nerve message sent to the brain which generates a pain signal.

This pain appears locally, but can also occur at a distance from the painful point. It is qualified as referred pain, and all muscles tend to refer pain according to a precise distribution (for example, a trigger point in the gluteal muscles can cause pain to radiate behind the thigh to the calf).

Regardless of the location, it usually follows a vicious circle where the damaged muscle is not used optimally. Contracture develops, along with possible loss of strength and long-term atrophy. The related joint stiffens, and a loss of movement may be felt. The other muscles, on the other hand, have to work harder to compensate for the loss of function of the injured muscle.

Trigger points can develop in any muscle, and even in multiple muscles at the same time. Please note that not all trigger points are problematic. These are present in several regions of the body, and their presence does not systematically translate into a painful phenomenon. What interests us here are the so-called "active" trigger points, that is, which reproduce the patient's symptoms.

Symptoms of the disease

The signs and symptoms of myofascial syndrome vary from person to person, but there are following features in several cases:

• A deep, dull ache in a muscle
• A knotting sensation in the muscle
• Pain on movement involving contraction of the affected muscle
• A feeling of stiffness
• Loss of range of motion
• Cervical pain or lumbago
• Headaches
• muscle weakness
• General tiredness

As mentioned, any muscle can be the site of a trigger point. Some of the muscles most likely to cause myofascial syndrome include:

• the sternocleidomastoid
• the trapeze
• the levator scapula
• the infraspinatus
• the rhomboids
• the breastplate
• the squares of the loins
• glutes (small, medium large)
• psoas
• the tensor fascia lata

Causes

Myofascial syndrome is much more common than one might imagine. Some experts estimate that around 85% of individuals will suffer from it at some point. It usually occurs after:

• trauma involving a muscle
• overuse (such as with repeated movements)
• an episode of significant stress or anxiety
• lack of sleep or an awkward position
• a sedentary job
• a lack of physical activity
• certain associated pathologies (such as fibromyalgia, diabetes, hypothyroidism, etc.)
• a vitamin deficiency (such as vitamin D or folate)

Often, myofascial-type pain can be confused with migraines or headaches, sciatic ou cruralgia, or even the fibromyalgia. It is therefore thought to be an underdiagnosed syndrome.

It should be noted that the myofascial syndrome does not come from a inflammatory damage. It is therefore not considered an autoimmune disease (such as lupus, multiple sclerosis, ankylosing spondylitis, etc.).

Diagnostic

We mentioned that myofascial syndrome was underdiagnosed. This is because there is no imaging test, blood test, biopsy or other to make an accurate diagnosis.

If we add to that the fact that this affection does not leave no visible mark (such as redness, swelling or warmth), it is understandable why scientific studies have difficulty pinpointing myofascial syndrome.

Most often, a doctor or healthcare professional will make a clinical examination to confirm the diagnosis. The latter will be based on your medical history, the presentation of your symptoms, and the response to certain clinical tests (range of motion, muscle contraction, reproduction of symptoms on palpation, etc.).

Treatment and cure

Here are the treatment options that currently exist to relieve myofascial syndrome:

Medication

Like myofascial syndrome rarely comes from inflammation, it is not uncommon for patients to report not feeling any progress after taking anti-inflammatories.

For this condition, patients generally respond best to muscle relaxants and pain relievers. If the cause is partly psychological, anti-depressants might also help.

If sleep is greatly affected by myofascial syndrome, painkillers may be prescribed before sleep.

Your doctor will prescribe the appropriate medications for your condition, taking into consideration your medical history and your symptoms.

Physiotherapy (physiotherapy)

The physiotherapist (physiotherapist) will be able to help you relieve your symptoms, in addition to helping you return to your daily activities. From tools that are part of his therapeutic arsenal, he can use:

• Various techniques related to thermotherapy
• Electrotherapy (TENS and others)
• Manual techniques
• Therapeutic exercises (stretching, progressive and controlled contractions, etc.)
• Cupping therapy
• Needles under the dermis (a modern alternative to acupuncture)

Tennis ball

Trigger points can be treated with something as simple as a tennis ball. As explained above, these pain points are sort of mini-contractures in the region of a muscle that can cause pain to radiate when pressure is applied.

The idea with the tennis ball is to apply a specific and sustained pressure on sensitive points to cause relaxation at this level. For example, the points of tension causing low back pain are generally found around the lumbar region and the pelvis.

Basically, just position the ball on the painful spot and apply pressure using the wall or floor. The sensation should be strong but tolerable. If you wince in pain, you should definitely reduce the pressure.

Myofascial osteopathy

Osteopathy uses manual techniques aimed at correcting the dysfunctions of the human body. Multi-systemic and holistic management, although limited from a scientific point of view, generally brings a lot of relief to patients.

In the case of myofascial syndrome, the osteopath can apply myofascial release techniques and other massage techniques to reduce muscle tension, regain fluid movement and reduce pain.

Trigger point infiltration

Infiltration is a treatment option sometimes used by doctors. On the one hand, it can be diagnostic aim. This involves the doctor injecting cortisone (or another solution) at the site of pain to determine if the symptoms improve post-infiltration.

If so, it will be assumed that the trigger point was the cause of the symptoms, and other subsequent infiltrations could be considered depending on the evolution. It should be noted, however, that research shows inconsistent and often temporary results from trigger point injections.

Psychology

As mentioned, stress and anxiety are potential causes of myofascial syndrome. If the symptoms vary greatly depending on your emotional state, it would be appropriate to call on a mental health professional (such as a shrink) to help you.

Prevention

Although there is no formal scientific evidence on this subject, several preventive advice would potentially reduce the incidence and the chances of aggravating myofascial syndrome:

• Maintain good sleep hygiene.
• Control your stress (for example by practicing exercises of breathing or meditation).
• Exercise as regularly as possible
• Warm up before exercise
• Avoid muscle overload (carrying heavy loads, repetitive movements, etc.)