What is myofascial pain syndrome?
It is a condition of the spine characterized by pain coming from muscles and the connective tissues between the muscles. The connective tissues are called fascia. Myofascial pain syndrome can lead to further back and neck problems if left untreated.
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What causes it?
When the back or neck is not functioning properly, the muscles surrounding the weak or injured area go into spasm to protect the spine. If the spasms persist, the muscles become tight and painful. Often the original weak area may be completely healed or only periodically flare up, as in arthritis, yet the myofascial pain persists and is even more disabling than the irritating problem.
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Why does myofascial pain persist?
The spine was designed to work as one unit in harmony with the overlying muscles. If parts of the spine are not functioning properly, the smooth chain is disrupted … other parts of the spine must compensate and work harder, particularly other muscles.
As this process is repeated, muscles become tighter and more restricted, and the myofascial pain cycle spreads. It is common for pain to begin in the low back and spread to the neck. Irritated nerves from an undiagnosed disorder of the spine are sometimes responsible for the persistent pain. A thorough evaluation is necessary to be able to treat an underlying problem which is causing the more painful myofascial pain.
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Who is at risk to get myofascial pain?
Poor general physical condition is a frequent cause. An out-of-shape muscle may get by with ordinary activities such as housework, gardening, or even driving a car. The muscles tighten after an injury, become weaker, and are less able to do work of any kind without fatigue or pain. Emotional factors are often overlooked, yet most people can recall having a tension headache or tense neck muscles as a result of stress. The stress may be from job problems, financial dilemmas, traffic congestion, or poor sleeping habits. Smokers have more difficulty with myofascial pain than nonsmokers. Diet does not directly affect myofascial pain, but being overweight does. A sensible diet and weight control are important steps in reducing risk factors.
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What is the treatment?
The tight, restricted areas of the muscles and fascia must be restored to their normal lengths by stretching. Deep heat relaxes the muscles and allows them to be stretched through specific exercises. Specialized massages are also helpful.
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What are trigger point injections?
The most painful areas are often felt as tender “knots” in the muscles. When pressed, these areas are exceptionally painful and may even cause pain to shoot down the arms and legs. The knots are called trigger points and are the most difficult areas to stretch. Trigger point injections are used to break up the most troublesome areas and to decrease pain. A local anesthetic, such as novocaine, is injected into the trigger points. Pain is quickly relieved, allowing trouble spots to be deactivated and treated more easily with physical therapy.
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What else can be done?
Any factors causing the myofascial pain syndrome to continue must be dealt with in order to effectively relieve the symptoms. Poor sleeping patterns must be corrected. General fitness must be improved. New ways of dealing with anxiety and stress are taught, often through relaxation training and biofeedback.
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Diagnostic Services
Your doctor may order one or more special tests to help confirm your diagnosis, rule out other problems and pinpoint the source of your spine pain.
X-rays show the general condition of your vertebrae (bones) and are very helpful in determining the cause of pain. Although x-rays cannot reveal a ruptured disc, for instance, they may reveal a narrowed disc space which can be an indication of trouble in that area of the spine.
MRIs (magnetic resonance imaging) and CTs (computerized tomography) produce detailed computer images of soft tissues and bones. MRIs are especially beneficial for the study of soft-tissue abnormalities such as disc degeneration, protrusion or rupture. CT scans give a cross-section view of the spine and can show a bulging or ruptured disc.
EMGs (electromyography) measure the electrical activity of your muscles’ contractions. They detect nerve or muscle irritation and damage. Bone scans can reveal abnormal bone activity.
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