Myofascial pain syndrome

Myofascial pain syndrome is a painful musculoskeletal condition, a common cause of musculoskeletal pain.

It refers to a specific form of soft tissue rheumatism those results from irritable foci [trigger point] within skeletal muscles& their ligamentous junctions.

Myofascial pain syndrome is characterized by development of myofascial trigger points that are locally tender when active& refer pain through specific patterns to other areas of the body

Most muscles have characteristic myotomal patterns of referred pain, this feature form the basis of the clinical recognition of myofascial trigger point.

Women may be more susceptible because of reported difference in the elasticity of their connective tissue. Middle aged women have the highest incidence. Almost everyone develops atleast one trigger point in their body at some point in their lives.

ANATOMY

Fascia is the soft tissue component of connective tissue system that permeates the human body.It interpenetrates and surrounds muscles; bones; organs; Nerves; blood vessels and other structures.

Fascia is an uninterrupted,three dimensional web of tissue that extends from head to toe from front to back,from interior to exterior

ROLE OF FASCIA IN THE BODY:

It is responsible for maintaining structural integrity.

It provides support and protection.

It acts as a shock absorber and stabilizer helping our body to stand erect and move fluidly.

Fascia has an essential role in haemodynamics and biochemical processes and provides the matrix that allows for intercellular communication.

Fascia functions as the bodys first line of defence against pathogenic agents and infections.

After injury it is is the fascia that creates an environment for tissue repair.

THE FASCIAL NETWORK

The fascia comprises one connected network –from the fascia attached to the inner aspects of the skull to the fascia in the soles of feet there exists only one fascial structure

If any part of this is deformed or distorted there may be negative stresses imposed on distant aspects and on the structures which it divides, envelops, supports and with which it connects.

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In Healthy conditions, the fascial system is relaxed & wavy in configuration. This provides a cushioning and supporting mechanism allowing us to move safely without restriction or pain.

But in abnormal conditions, the fascial system is tensed & can lead to pain & malfunction throughout the body.

TRIGGER POINTS

Trigger points are discrete, focal, hyperirrtable spots located in a taut band of skeletal muscles.

They produce pain locally & in a referred pattern and often accompany chronic musculoskeletal conditions.

Acute trauma or repetitive micro trauma may lead to the development of stress on muscle fibres& the formation of trigger points.

DEVELOPMENT OF A TRIGGER POINT

Trigger points develop as a result of muscular injuries, strains and trauma. Additionally structural imbalances, improper body mechanics, poor nutrition and mental or emotional stress are all factors.

When muscle fibres, fascia, ligaments or tendons become weakened, overstretched or inflamed, tiny tears in the associated soft tissue can occur.

As the tissue heals it contracts, becoming twisted & knotted. These knotted fibres restrict the fresh blood supply needed by the muscle cells.

In addition there is often a shortening of a muscle fiber to protect itself from further injury.

In effect, the muscle learns to avoid pain & guards against it by limiting its movement.

This results in a loss of range of motion of the joint & the probability that the muscle & associated structures will develop trigger points.

Causes Muscle injury or trauma

to musculoskeletal system

Excessive strain on a particular muscle or muscle groups.

Poor posture Malpositioning /Maladjustments/Poor biomechanics.

Repetitive stress and overuse injuries

Prolonged constriction of soft tissues

Ligamentous injury to intervertebral disc.

Lack of physical activity.

Nutritional/Vitamin deficiencies

Nervous tension or stress.

SIGNS

Trigger Point

A Taut Band.

Jump Sign.

Pain.

Restricted R O M.

Muscle Weakness.

SYMPTOMS

Numbness in the extremities.

Popping or clicking of the joints.

Dizziness and Headaches.

Disturbed sleep.

Balance problems.

DIAGNOSIS5 MAJOR CRITERIA

Regional pain complaint.

Pain complaint or altered sensation in the expected distribution of referred pain from a trigger point.

Taut band palpable in an accessible muscle.

Spot tenderness at one point along the length of taut band.

Some degree of restricted range of motion

3 MINOR CRITERIA

Reproduction of clinical pain complaint or altered sensation by pressure on tender spot.

Elicitation of a local twitch response by transverse snapping palpation at the tender spot.

Pain alleviated by elongating the muscle.

FLAT PALPATION It is the most useful diagnostic technique for the majority of

muscles in the leg & foot.

Flat palpation refers to a moving fingertip that employs the mobility of the sub cutaneous tissues to slide the patients skin across muscle fibres.

This movement permits the detection of changes in the underlying Structures.

The skin is pushed to one side of the area to be palpated& the

finger slide across the fibres to be examined allowing the skin to bunch on the other side.

Any ropy structure [taut band] within the muscle is felt as it is rolled under the finger.

PINCER PALPATIONPalpating the gastrocnemius and soleus

muscle.

Grasping the belly of the muscle between thumb &finger and squeezing the fibres between them with a back and forth rolling motion to locate taut bands.

When a band is identified it is explored along its length to locate the spot of maximum tenderness in response to minimum pressure.

TRIGGER POINT THERAPY – Myofacial Release Therapy:

Aims to free constructions or blockages in the fascia, thereby alleviating problems with connective tissue scarring or injury.

It involves working on-light, contracted muscles and trigger points to release or stretch out the problem areas.

Techniques

The goal of treatment is to identify areas of greatest restriction, local & general patterns and then to relase tightness..

Disruptions of the fascial network are freed & tension on bones, muscles, joints & nerves is relieved.

Myofascial release therapy utilises gentle kneading, manipulation that softly stretches, softens, lengthens & re-aligns fascia.

DIRECT TECHNIQUE

Addresses the agonist muscle.

Moves body tissues and or joints closer to the restrictive barrier i.e., fascia.

Use of knuckles, elbows or other tools to slowly sink into the restricted fascia applying a few kilograms – force & then stretch the fascia.

INDIRECT TECHNIQUE

Address the antagonist muscle.

The restrictions to the point of ease & moves body tissues / joints away from the restrictive barrier.

Involves gentle stretch, the pressure is in few grams, the hands tend to go with the restricted fascia, hold the stretch, and allowing the fascia to “Unwind” itself.

SPRAY & STRECH TECHNIQUE

Gebauers spray & stretch is a vapocoolant intended for topical application.

Commonly used sprays include Fluorimethane & Ethyl chloride.

Direct the spray in parallel sweeps a part at the rate of aprox. 10cm /sec.

Continue until the entire muscle has been covered.

STRETCHING Passive stretch the muscle during spray application &

gradually increase the fascia with successive sweeps.

It is necessary to reach the full normal length of the muscle to completely inactivate the trigger point.

Stretching the muscle out of its full range of motion to decrease pain.

Rewarm muscle.

Apply moist heat for 10-15 min following treatment.

ISCHAEMIC COMPRESSION

Essentially it involves applying sustained pressure to the trigger point with sufficient force & for long enough to slow down the blood supply& force the tension out of muscle.

The patient must be comfortable and relaxed and the compression is gradually applied with the finger, thumb or elbow.

The pressure is gradually applied , maintained

and then gradually released .It can be held for as long as 60 sec , but mostly the desired effect is achieved in 10-20 seconds.

DEEP FRICTION MASSAGE

The direction of movement is transverse that is across the long axis of the structure to be treated.

Massage is given tip of thumb or pad of index finger, middle finger directly over trigger point.

Initially light pressure is applied & patient should feel mild- moderate tenderness.

Duration of treatment is 5 min

KNEADING

This action affects the muscle belly by stretching the spindle cell & the muscle feels stretched & less stressed.

This stroke softens & creates space between the fascia layers covering all tissue & help reduce adhesions.

Repeat the movement several times in one spot

SELF TREATMENT A] Electric massagers B] ICE C] Exercises

ELECTROTHERAPEUTIC MANAGEMENT FOR PAIN

- Heat packs & Paraffin wax - Therapeutic ultrasound - TENS - LASER

Conclusion

It has been proposed that myofascial pain syndrome is common when working on a computer or in desk workers sitting in bad posture.

Postural advice plays a crucial role in prevention as well as to make working more comfortable.

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It is concluded thus, that myofascial pain syndrome can be overcome conservatively by physiotherapeutic means. It can be prevented by taking some preventive measures and home advices to avoid recurrence