Myofascial pain syndrome is a soft tissue rheumatism (extra-articular rheumatism) or regional pain syndrome characterized by trigger points detected in one or several regional muscle groups and the reflected pain resulting from palpation of these points.
It was first observed in the 1800s that there were more painful, hard nodules inside the painful muscles. These points began to be defined as trigger points in the middle of the 20th century, and in 1942, Travell described the special points and spreading areas of the muscles.
Trigger points due to Regional Myofascial Pain Syndrome are the most common cause of pain in the musculoskeletal system.
Myofascial Pain Syndrome is a condition seen in 12% of the normal population and 30% of the patient population. It is more common in women, and the middle-aged working population is more affected by this problem.
What is a trigger point?
Trigger points are areas within the muscles that are tense, aching, and show pain radiating to pressure, and sometimes a local twitch response is also received. There are two types of trigger points: Active trigger points are areas that cause pain at rest or during movement, and latent (hidden) trigger points are areas that cause pain only with palpation. Latent trigger points can become active in situations such as trauma, stress, muscle overuse, or hip exposure to cold.
The Cause of Myofascial Pain Syndrome
The regions defined as trigger points in the muscles have low regional blood circulation, resulting in muscle spasm, and the developing muscle spasm is caused by regional blood circulation. It is thought to exist as a vicious circle that increases the disturbance in the flow. Repetitive, low-intensity traumas, posture disorders and excessive muscle strain are the most important causes. For this reason, it can develop more in people with spinal deformities such as scoliosis (curvature of the spine), kyphosis (hunchback), and people who disrupt body balance, such as short legs.
Another reason is to do long professional or hobby activities with a fixed posture. In this respect, it explains that it is more common in professions such as desk workers, computer users, tailoring and dentistry.
Aslın. Any cause that causes pain in the body can cause Myofascial Pain Syndrome. Because the person who wants to protect the painful area changes his posture, causing some of his muscles to remain longer and others to remain shorter, and with the muscle spasm that develops, the vicious circle mentioned above is entered. For example, Myofascial Pain Syndrome may develop in the waist area in those with kidney pain, and in the neck and shoulder area in those with arm or elbow fractures.
Symptoms in Myofascial Pain Syndrome
The main symptoms are pain and is a limitation of movement. Patients may also experience complaints such as sleep disturbance, sweating, chills or hot flashes.
Diagnosis in Myofascial Pain Syndrome
The diagnosis of Myofascial Pain Syndrome is actually made by history and examination. The presence of trauma in the history, occupational activities, and reasons that increase or decrease pain should be questioned carefully. Past illnesses, duration of illnesses, and surgeries should be questioned.
During the examination, it is very important to examine the body areas above and below the affected area. It can be confused with pain radiating from the waist or neck. For example, patients presenting with pain in the neck and shoulder girdle must have a neck and shoulder examination. Determination of the spread of pain and limitation of movement, together with local muscle twitching and referred pain helps to make the diagnosis.
The difference between Myofascial Pain Syndrome and Fibromyalgia
These two clinical conditions are often confused with each other. One of the most important reasons for this is that they both affect the muscles and can be seen together. Fibromyalgia manifests itself with general body pain, sleep disturbance, waking up tired in the morning, wandering pains, and occasional swelling and numbness. In myofascial pain syndrome, sleep disturbance may occur due to pain, but the pain does not have a traveling character. The patient states that the pain constantly aches in the same place and that the pain decreases with certain postures, lying down or resting. There is no trigger point in fibromyalgia. But if it is accompanied by myofascial pain, it may be a trigger point
Treatment in Myofascial Pain Syndrome
Purpose; relieving pain, establishing adequate muscle strength, The job is to ensure proper posture of the muscle-related joint and full range of motion. Methods used in treatment:
Drugs: Muscle relaxants, analgesics, antirheumatic drugs can be used to relieve acute pain. However, since the root of the pain is not treated, the effectiveness will be as long as the duration of effect of the drug.
Acupuncture: Acupuncture has been used for many years in muscle pain as a form of treatment that regulates energy circulation in the body. . It is possible to treat both the pain and other problems present in the patient from a holistic perspective. Treatment can be supported especially with electroacupuncture applications.
Neural therapy: It is a method that enables the regulation of the nervous system with local anesthetics.
Ozone therapy: It is a method for myofascial pain due to its antioxidant and circulation regulating effect.
Dry needle therapy: Dry needle therapy is performed with acupuncture needles. However, the targeted area here is the painful muscle area and the area of spread. Needles are placed accordingly.
Physical therapy: Pain-relieving electric currents, superficial and deep heat applications, vacuum treatments, ice packs can be used depending on the patient's benefit.,
Spraying: Cold sprays have been one of the methods used in the treatment of myofascial pain syndrome for a long time. The application is made by stretching or relaxing the muscle depending on the direction of the muscle. It can be preferred in acute situations due to its rapid effect.
Kinesiotape: It is the technique of applying special adhesive tapes to the muscles, taking into account their adhesion and end point. It works by correcting muscle tension, resolving edema in the area and increasing circulation.
Local injections: It is based on injecting the drug into the trigger point using local anesthetic. It should not be confused with neural therapy. In neural therapy, local anesthetics are used and trigger point injections are made, but other areas are also injected and a more holistic treatment is provided by regulating the whole body.
Mobilization: Stretching and relaxing applications can be performed with osteopathic methods.
Exercise: Stretching and posture exercises are recommended as a preventive form of treatment as well as their therapeutic properties in myofascial pain syndrome. The affected muscle should be stretched and strengthened, the muscles it works with should also be stretched and strengthened, and exercises to regulate posture should be added. As in every painful condition, aerobic exercises in which large muscle groups are exercised, such as swimming, running, walking and dancing, should be performed in myofascial pain syndrome.
Preventive treatment: One of the factors that cause pain. It is necessary to stay away from it and take precautions to protect posture during work and sports.
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