Myofascial pain syndrome rehabilitation assignment help

 

Myofascial pain syndrome is normally a chronic condition that ends up causing severe pain in the musculoskeletal system. It is a type of pain that is confined to a particular area like the neck or shoulder. This kind of pain is usually associated to trigger points in the muscles. These trigger points then radiate the pain to the affected area when the pressure is applied to them and sometimes the pain just starts with no pressure.

Myofascial pain syndrome rehabilitation assignment help

Myofascial pain syndrome rehabilitation assignment help

Everyone at one particular time has experienced myofascial pain.  The kind of discomfort associated with myofascial pain syndrome can be persistent or may worsen. Treatment options include physical therapy and trigger point injections. The use of relaxation techniques and pain medications can also help.

Symptoms of myofascial pain syndrome

The signs and symptoms of myofascial pain syndrome include:

  • Pain that persists or worsens with time
  • Presence of a tender knot in a muscle
  • Deep aching pain in the muscle
  • Difficulty sleeping due to pain
  • Presence of trigger points that activate the pain
  • Localized muscle pain
  • Muscle stiffness, tenderness, or soreness
  • Fatigue
  • Postural abnormalizes like forwarding head posture, hunching, and shoulder rounding
  • Headache
  • Stress, anxiety, and depression
  • Reduced range of motion in the affected areas e.g. you may be unable to rotate your shoulder
  • Weakness in the affected area
  • Trigger points which include a bump, nodule, or a knot inside the muscle that causes pain when touched

Causes of myofascial pain

 

Sometimes sensitive areas of tight muscle fibers may form in your muscles after overuse or an injury. These sensitive areas are known as the trigger points. A trigger point is a muscle that causes strain and pain throughout the muscle. Causes of myofascial pain include:

  • Muscle strain or repetitive muscles use like hammering
  • Injury of the muscle
  • Poor posture
  • Lack of muscle activity or weakness eg. a leg in a cast cannot get enough movement
  • Living in or working in a cold environment
  • Pinched nerve
  • Emotional stress which can cause muscle tension
  • Metabolic or hormonal problems such as thyroid disease or diabetic neuropathy.
  • Vitamin deficiencies which include vitamin D and folate
  • Presence of chronic illnesses.

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Risk factors for myofascial pain

 

Myofascial pain syndrome is caused by a stimulus such as muscle tightness which then sets off trigger points in the muscles. Factors that increase the risk of muscle trigger points include:

  • Stress and anxiety- people who regularly experience stress and anxiety are at a higher risk of developing trigger points in their muscles. Such people may be more likely to clench their muscles, which is a form of repeated strain that leaves the muscles susceptible to trigger points.
  • Muscle injury- continual muscle stress or an acute muscle injury may lead to the development of trigger points. A spot within or near the strained muscle may become a trigger point. Poor posture and repetitive motions increase the risk.
  • Poor sitting or sleeping posture.
  • Having nutritional deficiencies
  • Serious lack of exercise or movement
  • Sitting for a long time in awkward positions
  • Having an injury to the musculoskeletal system or intervertebral disks
  • Having generalized fatigue
  • Lack of sleep/insomnia
  • Hormonal changes especially during menopause
  • Smoking
  • Being overweight/ obese
  • Emotional problems like depression and anxiety

Trigger points for myofascial pain

 

The following are the types of myofascial trigger points:

  • Active trigger points- these are nodules within a taut band of muscle that are typically the source of muscular pain. They are usually very tender causing referred pain and producing a twitch when touched.
  • Latent trigger points- these nodules do not cause pain when touched and they can remain dormant for years. They only become active when there is stress or trauma.
  • Secondary trigger point- this is a pain point in the muscle that becomes active when you stress another muscle.
  • Satellite myofascial point- it is a pain point that becomes active because it is located near another trigger point.

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Where does myofascial pain occur?

 

Trigger points and myofascial pain can occur in any muscle in the body the most commonly affected muscles in the body include the ones in the neck, shoulder, or upper back. These muscles include:

  • Sternocleidomastoid: this muscle helps you to rotate your head to the opposite side while flexing the neck. This muscle is located on both sides of the neck and runs from the skull behind the ear area to the collarbone and the breast bone.
  • Trapezius- it is a large, broad, flat triangular back muscle that tilts and turns the head and neck, shrugs, and steadies the shoulders while twisting the arms. This muscle extends from the base of the skull to the middle of the back.
  • Levator scapulae- it is usually a pair of strap-like muscles that help raise and rotate each of the shoulder blades. They run from the first four cervical vertebrae to the top edge of your shoulder.
  • Infraspinatus- it is a triangular muscle located on the backside of each of the shoulder blades which helps to rotate and stabilize the shoulder joints. It is one of the muscles of the rotator cuff.
  • Rhomboids- they are a pair of upper back muscles that pull the shoulder blades together when they contract and attach the upper limbs to the shoulder blades. They run diagonally from the neck and chest vertebrae of the spine down to the back of the shoulder blades.

Diagnosis for myofascial pain

 

Myofascial pain cannot be identified through a lab test. instead, the syndrome is diagnosed by conducting a thorough exam which includes:

  • A physical exam whereby the physician applies gentle pressure to feel for any tight muscle bands or twitches.
  • Through imaging and diagnostic tests to rule out other conditions that may be causing the pain.
  • Conducting a visual exam to look for postural abnormalities
  • Asking questions about when, how, and how often you experience the pain and if there are things that make it better or worse.
  • The doctor will also ask questions about repetitive activities or any recent injuries that may be contributing factors.

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Treatment for myofascial pain

 

The treatment of myofascial pain includes trigger point injections, medications, physical therapy, etc. there is no conclusive evidence that supports the use of one therapy over another. Exercise is considered to be an important component of any treatment program. The others include:

  • Medications- the medicines used to treat myofascial pain are:

Pain relievers- over-the-counter pills such as ibuprofen, Motrin IB, and naproxen sodium.  Others come in patches that you can place on the skin where there is pain.

Antidepressants- help to relieve pain and improve sleep. Eg amitriptyline

Sedatives- like clonazepam helps treat anxiety and poor sleep that sometimes occur with myofascial pain. It must be used with care because it can be habit-forming and cause sleepiness.

  • Therapy- a therapist can devise a plan that can help relieve pain based on the signs and symptoms. Physical therapy may involve-

Stretching- the physical therapist can lead the patient through exercise to ease the pain in the affected muscle. In case of a trigger point pain, the therapist may spray a numbing solution on the skin.

Posture training- improving your posture can greatly help to relieve myofascial pain, especially in the neck.  Exercise strengthens muscles surrounding trigger points to avoid the overworking of some muscles.

Massage- massaging your affected muscle may help relieve the pain. Using long hand strokes along with the muscle or placing pressure on specific areas of the muscles can help relieve pain.

Heat- applying heat through a hot shower or hot pack can help relieve muscle pain and tension.

Ultrasound- this is a therapy that uses sound waves to increase blood circulation and warmth which promotes healing of the affected muscles.

  • Needle procedures- this is injecting a numbing agent or a steroid into a trigger point to help relieve pain. Sometimes the act of inserting the needle into the trigger point can help to break up muscle tension. Dry needling involves inserting a needle into several places around the trigger point

Prevention of myofascial pain syndrome

 

Managing the risk factors for myofascial pain may not prevent you from developing the syndrome but can help to reduce the severity of the condition. Some of the prevention mechanisms are also pain management strategies. Prevention strategies include:

  • Reducing stress
  • Being active by engaging in physical exercise
  • Reducing stress levels
  • Maintaining proper sleep hygiene
  • Eating a healthy diet like the Mediterranean diet
  • Practicing relaxation methods
  • Preventable muscle injury eg. shoulder bag.

Foods to avoid because they cause inflammation include:

  • Dairy milk, cheese, and yogurt
  • Fried foods which include chips
  • Refined carbohydrates with refined flour eg. pastries, white bread, pasta, breakfast cereals
  • Vegetable oil, margarine
  • Sugary foods and beverages like sodas
  • Red meats like steaks and burgers
  • Artificial sweeteners and general additives and processed foods like candy, fruit flavors, ice cream
  • Processed meats like hot dogs, sausages, etc

 

Complications related to myofascial pain

 

Complications related to myofascial pain include:

  • Sleep problem- the signs and symptoms of myofascial syndrome make it very difficult to fall asleep. You may also find it difficult to find a comfortable position to sleep.
  • Fibromyalgia- at some point myofascial pain may develop into fibromyalgia in some people. Fibromyalgia is a chronic condition that features widespread pain. The brains of people with fibromyalgia tend to become more sensitive to pain signals over time which doctors belie myofascial pain may have played a role in starting this process.

 

Myofascial release

 

It is a massage treatment of the soft tissue used to increase myofascial mobility used to reduce pain within the musculoskeletal system. Myofascial is a connective tissue that is situated under the skin and surrounds the muscles, bones, ligaments, and tendons. Soft tissues in the body can therefore be restricted due to overuse, injury, and inactivity hence resulting in pain, tension, and reduced blood flow.

Types of myofascial release

 

Myofascial release can be categorized as passive or active. They include:

  • Passive myofascial release- this is where the therapist’s movements are guided by the patient’s body. The therapist is trained on how to find and identify tension in the patient’s fascia while observing how the patient’s body responds to treatment. All these inform the therapist’s course of action affecting where they stretch the patient’s fascia, how much pressure they apply, and for how long.
  • Active myofascial release- it involves the patient is directed to contract certain muscles under the guidance of the therapist. One session may combine passive and active myofascial release techniques or may one use one approach.

Benefits of myofascial release

 

Myofascial release therapy helps the body in the following ways:

  • Trauma- trauma and painful emotions are stored in the fascia in the form of tension and knotting. By helping relax and reduce stress in the fascia, myofascial release can affect the amount of strain on the musculoskeletal system and the organs covered by the fascia. This helps to reduce the pressure the body is experiencing and can have significant pain relief.
  • An increase in range and quality of emotion
  • A reduction in pain
  • Restoration of the optimal myofascial length-tension relationships
  • Improves the range of mobility hence maximizing function
  • Neutralization of posture and alignment
  • Reduces soreness
  • Helps with overall relaxation
  • Increases the body’s ability to heal naturally
  • Greatly improves circulation

Helps to relieve tress

Side effects of myofascial release

 

  • Muscle fiber release sensation- it is a common mild side effect. There is usually a momentary discomfort when myofibrils are released and this sensation varies with each individual. Mostly, patients describe this feeling as a burning, tugging, pulling, electrical, or simply weird sensation. Others may feel like a heat release or a muscle twitch.

Muscle twitches can either be observed or felt and are mostly clear indications that muscle fibers are releasing. A twitch reaction is also a good indicator that the treatment will have good results. The more the twitching the more the fibers are being released.

  • Bruised sensation- most of the patients experience a bruised feeling at the treatment sites. This sensation is usually experienced over a short time and usually disappears within a day or two after treatment.
  • Fatigue- patients who may experience a sign of muscle release may feel extremely tired and need longer sleep hours following the treatment. This is largely a phenomenon following the first treatment and it doesn’t seem to occur after subsequent treatments.
  • Pain migration and flare-ups- after treatment, patients get pain relief in the treated areas and may also experience a migration of pain in new areas. Pain migration is usually an indication of two positive results:

-It indicates that muscle fibers treated have been released and pain is resolved at that specific site. Patients can have other longstanding muscle fibers in sustained contradiction which were subordinate to or eclipsed by pain from the treated areas. So, when the dominant painful area is resolved, the other muscles in sustained contraction become dominant and the patient feels pain in new areas.

-Other times, new pain can result from a realignment of the interrelated muscular framework resulting from the newly relaxed muscles.

  • Lightheadedness or dizziness- it results in someone who has had a previous history of symptoms following immunization or visualizing blood. Patients need to report to their doctors in case they feel dizzy or nauseated immediately after treatment.

Some of the rare side effects of myofascial pain include:

  • Nausea- some patients may experience nausea during or immediately after treatment. This symptom only occurs in those who have had such medical procedures before.
  • Infection- the risk of infection increases for patients with diabetes, those with immune-compressed states, or if the treatment included may separate insertion sites. Any increased pain that begins several days after the injection may be a sign of an infection and it may suggest cellulitis or infection of soft tissues.
  • Shortness of breath or chest pain- this kind of symptom may suggest a pneumothorax. If this occurs, the patient should seek immediate treatment. They can call the clinic to speak with the doctor who treated them or seek medical treatment at urgent care or the emergency room. This kind of complication can occur when treatment was applied on the skin over the lung fields most likely in the upper back or lower neck area.

Conclusion

 

Myofascial pain is widely prevalent in patients with regional musculoskeletal pain. The challenging nature of myofascial pain is usually its complex interaction of underlying biochemical, psychological and neurologic factors that requires a well-trained clinician for early diagnosis and effective treatment. Patients with myofascial pain in most cases tend to do worse than those with discreet musculoskeletal pathology like disk herniation. In cases where a patient is not able to participate in an active functional rehabilitation program due to the limits of pain, then a comprehensive approach can be considered.  The approach may be psychological counseling for coping strategies, relaxation techniques biofeedback, and cognitive-behavioral therapy.

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Myofascial pain syndrome rehabilitation assignment help

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