What is Myofascial Pain Syndrome?

Myofascial pain syndrome is a chronic pain disorder. In this condition, pressure on sensitive points in your muscles (trigger points) causes pain in the muscles and sometimes in seemingly unrelated parts of the body and this is referred as pain. Myofascial pain can develop in any muscle of the body. The most commonly affected muscles are the upper back, shoulders, and neck [1].

Normal Healing cycle

The normal Healing cycle is divided into the following stages that are inflammation, proliferation, and maturation stage.

1. The first stage is the inflammation stage which is followed by redness, temperature, swelling, and increased pain. This stage is important as swelling prevents the nearby tissues from being damaged, increased temperature causes the disposal of pathogens and it also alerts the white blood cells to start the healing cycle.
2. Then the second stage is the proliferation stage in which the affected area starts the formation of scar tissues, which is important to continue the healing cycle.
3. The third and final one is the maturation stage in which the scar tissue is replaced by normal skin cells and the completion of the normal healing cycle occurs [2].

What is Fascia?

Fascia is connective tissue layers that support, wrap and surround all organs, bones, blood vessels, and nerves. Fascia helps in functional movements by reducing friction between the structures. Fascia has nerves that make it as sensitive as skin. It is the very thin layer under the skin that protects and separates the body [3].

Functions of Fascia

Functions of fascia are as follows:

1. It separates the muscles from bones and other organs from each other.
2. Secondly, it supports the body to be in a certain position and attains the vital organs to be in shape.
3. Moreover, it protects the body by resisting mechanical stress internally and externally [3].

Fascia layers

Layers of fascia are as follows:

1. Superficial fascia:

Superficial fascia is the lowermost layer of the skin in nearly all of the regions of the body, that blends with the reticular dermis layer. It consists mainly of loose areolar, and fatty adipose connective tissue and is the layer that primarily determines the shape of a body. It separates the skin from the musculoskeletal system allowing normal sliding and gliding in the muscles [3].

2. Deep fascia:

A deep fascia is a dense connective tissue that is commonly arranged in sheets that form a stocking around the muscles and tendons beneath the superficial fascia. The deep fascia consists of four layers.

1. The first one is the aponeurotic fascia that surrounds the group of muscles. It consists of two to three layers of collagen fibers and its function is that it connects the muscles with their movers. An example of this fascia is palm aponeurosis.
2. The second one is the epimysium fascia that surrounds the entire muscles. It covers one layer of the muscles.
3. The third one is perimysium fascia. It is the bundle of fibers inside the muscles which is surrounded by epimysium fascia.
4. The last one is the endomysium fascia layer that surrounds or wraps each fiber [3].

What causes fascia restrictions?

Fascial restrictions can be caused by scar tissue, injuries, repetitive motion, stress, surgery, bad posture, bad body mechanics, trauma, disease, inactivity, and inflammation. These restrictions can change your body alignment, posture, and range of motion [4].

Symptoms of Myofascial Pain Syndrome

The symptoms of fascia restrictions include headache, pain, and pressure throughout the body, decrease flexibility, decreased range of motion, joint pain, joint stiffness, muscle weakness [4].

1. Muscle pain
2. Muscle weakness
3. Decrease joint range of motion
4. Joint stiffness
5. Painful muscle knots
6. Taut, ropey bands in the muscle
7. Sleep disturbance

Which patients have fascia restrictions?

Patients having the following disease have fascia restrictions:

1. A patient who has tendonitis, which is the inflammation in the tendons, will have fascia restrictions.
2. A patient who has shoulder bursitis, which is swelling and redness between the top of the arm bone and the tip of the shoulder, will have fascia restrictions.
3. Patients having arthritis, which is the tenderness of joints, will have fascia restrictions.
4. The person having shoulder impingement in which the tendons of the rotator’s cuff of the shoulder are pinched will have fascia restrictions.
5. Moreover, the person having fibrosis, neck pain and shoulder pain will have fascia restrictions [4].

Current treatments for Myofascial Pain Syndrome

Current treatments for myofascial pain is based on massage therapy. Massage of fascia can be of two types which are described as follows:

Superficial fascia: Superficial fascia is the lowermost layer of the skin in nearly all of the regions of the body that blends with the reticular dermis layer. It consists mainly of loose areolar, and fatty adipose connective tissue and is the layer that primarily determines the shape of a body. It separates the skin from the musculoskeletal system allowing normal sliding and gliding in the muscles [5].

Deep fascia: Deep fascia is a dense connective tissue that is commonly arranged in sheets that form a stocking around the muscles and tendons beneath the current treatment for myofascial pain but it is said that no evidence shows that shows massage therapy is much effective in improving functional status related to neck and shoulders pain. The second one is a self-myofascial release (SMR) but it is said that there is conflicting evidence whether self-myofascial release can improve flexibility long term [5].

What is the solution?

To treat myofascial pain, ASTR instruments are properly designed by the therapist to reduce the pain because it was impossible to release and detect it by only by hand [6].

Conclusion

Myofascial pain syndrome is a chronic pain disorder. In this condition, pressure on the sensitive points in your muscles (trigger points) causes pain in the muscles, which is treated by the therapist by using ASTR instruments. Myofascial pain is a chronic pain disorder. In this condition, pressure on sensitive points in the muscles (trigger points) causes pain in the muscles, which is treated by the therapist by using ASTR instruments.

References 

1. Fricton J. Myofascial pain: mechanisms to management. Oral and Maxillofacial Surgery Clinics. 2016 Aug 1;28(3):289-311. https://pubmed.ncbi.nlm.nih.gov/27475508/
2. Aredo JV, Heyrana KJ, Karp BI, Shah JP, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. InSeminars in reproductive medicine 2017 Jan (Vol. 35, No. 01, pp. 088-097). Thieme Medical Publishers. https://pubmed.ncbi.nlm.nih.gov/28049214/
3. Capo-Juan MA. Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment. InAnales del sistema sanitario de Navarra 2015 Jan 1 (Vol. 38, No. 1, pp. 105-115). https://pubmed.ncbi.nlm.nih.gov/25963463/
4. Miernik M, Wieckiewicz M, Paradowska A, Wieckiewicz W. Massage therapy in myofascial TMD pain management. Advances in clinical and experimental medicine: official organ Wroclaw Medical University. 2012 Sep 1;21(5):681-5. https://pubmed.ncbi.nlm.nih.gov/23356206/
5. Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Oksanen A, Seikkula V, Karppinen J, Saltychev M. Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review. Clinical rehabilitation. 2018 Apr;32(4):440-50. https://pubmed.ncbi.nlm.nih.gov/28956477/
6. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best practice & research Clinical rheumatology. 2011 Apr 1;25(2):185-98. https://pubmed.ncbi.nlm.nih.gov/22094195/