Myofascial Pain Syndromes and Perpetuating Factors
Skeletal muscle accounts for more than 40% of the total body mass. Throughout life, macro and micro traumas can cause us to develop taut bands within skeletal muscle. Within these bands are more sensitive regions known as myofascial trigger points.
Approximately 70% of all pain is primarily myofascial in origin. While the remaining 30% has other causes, it is often associated secondarily with myofascial pain.
Sports and other Injuries
Injuries are almost always due to taut bands. Muscle tearing is sometimes present as an associated event, causing transient inflammation, but this is usually self-limiting.
Treatment should be directed at the taut band, not at the tear.
The Pain Management Industry
Conventional medicine generally focusses on 30 % of the problem. This is why it is called a pain management industry. Most physicians are not trained to evaluate and manage myofascial pain, therefore they focus on managing pain rather than eliminating it.
A perpetuating factor is any physical, chemical or psychological factor that can increase trigger point activity. These can be:
6. Sleep disorders
7. Dental problems
Leg Length Discrepancy (LLD) is a common factor that can disrupt the integrity of the kinetic chain, causing muscles to shorten. This can affect alignment and movement. Trigger points in the quadratus lumborum muscle can affect leg length, so must be released before an accurate measurement of LLD can be made.
If a LLD is diagnosed, an initial trial correction can be made trying a heel raise, starting with 1 mm and then moving upward if necessary.
A small hemipelvis is a condition where the pelvis is asymmetrical; this is identified in the seated position and can be managed by releasing the quadratus lumborum muscle, as well as using a “butt lift” while sitting e.g. a folded towel
When looking at nutrition as it relates to myofascial pain, is important to remember that this is not a deficiency, but an inadequacy. Inadequacies can result from low intakes, greater demands (e.g. lifestyle, illness, age etc) and poor diet (e.g. high in processed and refined foods).
The rationale behind prescribing nutritional supplements is primarily to improve the efficiency of the body to neutralize free radicals. Damage by free radicals is thought to impair the capacity of the body to repair itself.
Anti-oxidants are substances that counter the oxidative process and formation of the potentially highly toxic free radicals. The main anti-oxidants are vitamins A, C, E, Selenium and Zinc.
It is generally accepted that most people should be on a basic multiple vitamin/mineral. For those with recalcitrant myofascial pain, the following should be added daily:
- Vitamin C 1gm
- Vitamin E 400 IU
- Zinc 20-30 mg
- Selenium 200 mcg
- Additional B complex
- Magnesium 150 to 200 mg
- Vitamin D if deficient
- Iron in menstruating women
Metabolic & endocrine inadequacies
There are two main endocrine inadequacies that can perpetuate myofascial pain:
- Low estrogen and progesterone
These conditions can be easily identified by blood work and managed by hormone replacement
Stress is the one of the most important perpetuating factor. Under stressful conditions, the body secretes catecholamines (e.g. adrenalin). Catecholamines can adversely affect muscle tension as well as deplete the body of nutrients needed to deal with the stress. They can also disrupt sleep patterns and digestion.
Both environmental and food allergies can act as perpetuating factor. An elimination and challenge diet is the best way to diagnose adverse food reactions; however, a blood test can also provide clues and serve as a starting point.
Common food reactions that can perpetuate pain can include: Dairy, gluten, tomato, coffee, alcohol, peanuts, refined/processed foods and sugar.
Active myofascial trigger points can disturb sleep. Sleep disturbance increases trigger point activity and lowers general health. A vicious cycle can develop.
There are numerous natural sleep aids (e.g. melatonin, tryptophan, valerian root) and lifestyle modifications that can help to normalize sleep hygiene. Acupuncture also works for some.
Dental malocclusions can affect tension in the jaw muscles, neck and potentially the entire kinetic chain.
Anyone with chronic head and neck pain should have their TMJ evaluated and treated both myofascially as well as possible by a dentist if a splint or appliance is indicated.
Myofascial Pain is extremely prevalent. Aside from causing pain, it can affect athletic performance as well as cause symptoms mimicking many chronic unexplained problems that are generally managed palliatively by medications.
Effective treatment involves
- Deactivation of the point by dry needling, deep massage or other manual therapies
- Home corrective exercises
- Identification and management of perpetuating factors