Bismillahirahmanirahim and this is one
of the common problem that always appears in our human body are call myofascial
pain syndrome or in other name myalgia pain. For info and guideline I would
like to prescribe It is a syndrome characterized by chronic pain caused by
multiple trigger points and myofascial tightening. For the term fascial pertains to the muscle,
and it is a lining composed of the connective tissue that
covers, connects and supports muscles.
Myofascial Tissue in close up |
WHAT
ARE THE MAIN SYMPTOMS ASSOCIATED WITH THIS SYNDROME ?
My patient always show this sign
- Tenderness during palpation with
referred pain to the other muscles of the body or joints
- It will show a limited ROM and
difficulty to relax or fully lengthen the muscle
- some of them associate with longer lasting
muscle pain, weakness and stiffness
- Sleep disturbance
Other than that this syndrome can include many more symptoms,
which are related to the area of the body where the trigger points are present.
ANATOMY
OF MYOFASCIA
As we know the myofascia is composed
of connective tissue, which contains: cells, ground substance and fibers and the
ground substance and the fibers, which are outside of the cells, make up the
matrix, which can be solid and gelatinous with a web-like shape.
In common problem happen, when
myofascia becomes tight and thick it is
difficult to get it back to the
gel-like flexible state without intervention.
So this reaction cause the muscle and
the fascia can essentially be “trapped” together causing inflammation and pain.
The symptom will present a Muscular
dysfunction that can lead to movement
limitation, which can cause a cycle of pain that must be broken. The worse
thing to the patient is This tightening
of myofascia will also affect the neurotransmitter’s ability to send and receive
neural information, whichwill further distress the muscle
WHAT
IS HAPPENING TO MYOFASCIA WHEN IT APPEARS ?
The research show the exact cause of myofacia syndrome is unknown.
However, many factors such as bad
posture, injury, leg length discrepancy, emotional stress, whiplash accidents,
surgery, overuse, inactivity will affect myofascia
tissues, and cause changes such as:
1. diminished elasticity of myofascia
2. thickening and tightening of myofascia
preventing muscle to fully relax
I always explain to my patient to let
them understand ,If the body creates enough sites where the myofascia has
changed then this will affect the quality of movement, making one muscle work
harder to pull against the restriction present in the opposite muscle so this
causes more tension in the muscle and discomfort, which will cause
neuromuscular response known as “guarding” of the painful area. (The reason
there always pain on other area)
We also need to understand that a muscle becomes in a constant tension
that
needs more nutrition and oxygen, and
starts to produce more waste. This creates an area in the
myofascia starving for food and oxygen
and loaded with toxic wastes. Such an area is a trigger point.
WHAT
CAN WE UNDERSTAND A TRIGGER POINT ?
As my understanding as a physiotherapist
I would like to say ,trigger point is a sore point that not only hurts where it
is pressed, but it also “ triggers” a referred pain to the different area of
the body. Have you feel this type of experience ? , when you press some of the
part of muscle another place also feel the pain.
WHAT
IS TRIGGER POINT COMPLEX?
Center of muscle shows tender spot in
a palpable tight band and refers
pain to a distance. The tight band
extends the length of the muscle fibers
to its attachments, where the sustained
tension of the tight band produces
an attachment trigger point on
both sides of the muscle.
WHEN
IT AFFECTED YOU BODY WHAT WILL BE HAPPEN ?
The trigger point will restrict
movement, cause weakens and
prevents full lengthening of the
affected muscle A nerve entrapped between trigger point and the bone, which can
produce numbness in the area of compression.
Most of the time when my patient is
come because of this problem a Simple test can be done to distinguish between
trigger point with nerve entrapment and trigger point
without one.
SIMPLE
TIPS FOR YOU TO PRACTISE AT HOME
·
If
ice makes it feel better that is a sign of nerve entrapment
·
If
ice makes it worse and heat reliefs the pain, then there is no nerve entrapment
It easy right to differentiate of this problem
, Pain from trigger point is usually steady, dull, and deep but If there is
nerve entrapment the pain can be burning, sharp, and lightening-like.
WHAT
IS CHRONIC MYOFASCIAL PAIN SYNDROME ?
The Trigger point may develop
secondary and satellite trigger points.
·
Secondary
trigger point is develop when a muscle is subject to stress because another
muscle with trigger point not properly function or isn’t doing it’s job so Another muscle
compensates for the muscle that is not working and the overworked muscle can develop
a secondary trigerpoint.
·
Satellite
trigger point is develop when a muscle
is in a referred pain zone of another Trigger point.
I always give the explaination to my
patient to be understand if there is without proper intervention the trigger
point can lead to severe and widespread chronic
Myofascial Pain Syndrome, which is
defined as condition of multiple trigger points
present in all four quadrants of the
body for at least 6 months (remember that 6 months )
WHAT ARE IMPORTANT FACTORS IN FACIAL
TRIGGER POINTS ARE:
·
Grinding
the teeth
·
Clenching
the jaw
·
Thumb
sucking
·
Chewing
gum
·
Loss
of wisdom tooth
·
Oral
surgery
·
Mouth
breathing
·
Extreme
emotional tension
·
Smoking-causes
the blood vessels to constrict and decreases blood flow, which limits the
amount of oxygen and nutrients
·
Poor
posture, overuse muscles, immobility, exercising only one side of the body and
promoting muscular asymmetry will cause additional tightening and stress
applied to the muscles. (Common happen in most of my patient)
WHAT
MUSCLES TYPICALLY AFFECTED BY TRIGGER POINTS IN THE HEAD
AND
NECK REGION ARE:
·
Sternocleidomastoid
·
Upper
Trapezius
·
Suboccipital
muscles
·
Splenius
Capitis and Splenius Cervicis
·
Masseter
·
Temporalis
Most of the problem sometime the
trigger points in the muscles mentioned above can cause headache, toothache,
blurred vision and balance problems, eye, ear, sinus, jaw, and neck pain.
Here I want to share the type of the treatment
designed to relief pain caused by trigger points are:
1. Trigger
point injection(info from My orthopaedic surgeon )- directly injecting the mild dose of
procaine (local anesthetic) into the trigger point. It is difficult to
accurately stick the trigger pointwith the hypodermic needle.
2. Spray
and Stretch
(Applying by me almost)- the therapist needs to be absolutely sure that is
stretching the muscle containing the Trigerpoint that is referring the pain,
and just before stretching it is important to chill the skin around the Trigger
point and the area where pain is referred with ice of refrigerant spray to
distract the Central nerve system. It is also important to work quickly so that
the cooling agent won’t cool the underlying muscle. In affected of this
technique , Cooling the muscle will inhibit the stretch rather than
facilitating it. After stretch the skin should be rewarmed with hot pack. If a
patient had a limited movement before treatment I would like perform passive
range of motion to improve their range.
3. Deep
stroking massage
(One of My favourite treatment )-it is safe and effective method applied
directly to the Trigger point . Success with trigger point massage depends ultimately
on your ability to recognize referred pain and to trace it back to the trigger
point that is causing it. Trigger points are not usually found at the place
that hurts. Massage in the wrong place can feel good but doesn’t resolve the problem.
I like to say that the physiotherapist’s
hands are a great tool in searching for the tenderness spots. Try to Use deep stroking
massage with slow, rhythmic, repeated strokes in one direction. Performing a
series of deep strokes across the trigger point will move the blood and lymph fluid
with accumulated wastes from the painful areas. A deep stroking massage is also
bringing relief by activating release of painkilling endorphins. (one of natural
pain relief created in human body)
4. Ischemic
compression-is
one of the traditional practice
regarding trigger points dictates that a therapist must press and hold them
until they release, which is squeezing the blood out of the trigger point.
5. Trigger
Point Release-
Heat up the tissue with using the
electrotherapy such as the ultrasound or hot pack. Apply direct pressure with
your thumb to the trigger point for 60-90 seconds and then stretch. Repeat 3
times, and apply ice. (Ultrasound parameters will depend on how deep the muscle
with Trigger point is located. If it is
a superficial muscles the parameters will be frequency at 3 MHz, transducer
size 5 cm2, duty factor 50%, 2 min. intensity for example on 0.5 depends on how
deep is the Trigger point.
If
you use the Ultrasound as one of the modalities please remember this Contraindications of Ultrasound therapy :
·
directly
on pregnancy,
·
metastasis,
·
lack
of sensation,
·
thrombus,
·
pacemaker,
·
psoriasis.
6. Posture
Re-training:
My advice the key and the easiest way is
to Learning and applying principles of correct posture and body mechanics can
help relieve stress and tension on the affected muscles.
7. Electrical
stimulation-
other alternative is using Transverse electrical nerve stimulation , triggers
points have a decreased resistance to electrical energy so TENS can be
beneficial in treating the pain coming from trigger point
For my advice to people who have this
problem is
·
Trigger
points do not respond to positive thinking, biofeedback, meditation, and
progressive relaxation.
·
Patient with Myofascial pain syndrome should
avoid weight training, swimming in the cold water, and muscle overuse.
·
Using
Tennis ball or back knoober are examples of tools that can be used by patients at
home to relief pain caused by typical nodules or active trigger points. Wallahuaklam.
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