What is Myofascial Pain?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

The fascia is a tough, web-like connective tissue that’s comprised of collagen fibers and covers the entire musculature of the body and lies directly under the skin. Its function is to: 

  • Facilitate movement between the bones and the muscles   
  • Maintain internal organs in their designated locations   
  • Enclose nerves and blood vessels   
  • Maintain smooth mobility

Sometimes, due to trauma, the aging process, illness and other factors, the fascia will become sticky and stiff. When this occurs, pain is often the result as is limited mobility, adhesions, and inflammation. Sometimes, a surgical scar can interfere with the smooth function of the fascia and cause pain and mobility issues. Repetitive use can trigger MPS pain as can muscle tension that’s caused by stress.

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More About Myofascial Pain

lumbar foraminotomy

The deep fascia is typically the layer that is involved in myofascial discomfort. The prefix “myo” means muscle so myofascial pain is associated with the fascia that covers the muscles, or the deep fascia. Not only does this layer of fascia surround the entire musculature, it surrounds and divides the individual muscles. This tissue is very elastic by nature which enables it to maintain the smooth mobility of the muscles. Reduced friction between the muscles means easier movement and increased blood flow to the muscles. The deep fascia is rife with sensory receptors and blood vessels which enable it to minimize injury and maximize healing. 

Chronic myo-fascial pain, also referred to as CMP, is sometimes called myo-fascial pain syndrome, or MPS. It usually presents as one or more trigger points in the body and the trigger points can occur anywhere in the body usually as a knot in the fascia. The trigger points can indicate that the pain is in the area of the knot or they can occur as referred pain from another part of the body. Referred pain occurs in one part of the body but the pain is felt elsewhere. The trigger points appear to be the symptom rather than the cause of the pain and the actual cause of myofascial pain isn’t fully understood at present. It can be the result of a systemic disease, a psychological disturbance, a result of poor posture, or the result of a neurophysiological issue. Regardless of the cause, the pain is real and can be alleviated with proper treatment and care.

What are the symptoms?

Myofascial Pain (MPS) can occur anywhere in the body, in a single isolated area or it can occur in multiple areas. The back is a common area for MPS pain to appear and it usually presents as a deep, steady ache that can range from mildly uncomfortable to excruciating, and it doesn’t abate on its own. Knots may be present and can sometimes be palpated or seen under the skin. MPS pain can sometimes interfere with sleep quality due to the intensity of the pain. It may not improve and may actually worsen even though treatments such as heat, ice, rest, and palpation are applied. Many times those with MPS pain have a tendency to drop items due to muscle weakness caused by pain. Those who have chronic back pain are particularly susceptible to this condition as are those who have fibromyalgia. Those with fibromyalgia are thought to experience more myofascial pain than other individuals which researchers believe may be, in part, because those with fibromyalgia are more sensitive to pain.

How Myofascial Pain is Diagnosed?

Diagnosing back pain and muscle pain can involve several different procedures depending on the type of pain involved. In order to diagnose MPS pain, a doctor may apply pressure to the area that is experiencing pain. The response can help determine the type of pain as well as the most efficacious treatment. Trigger points that occur as a result of MPS pain are different than those that occur with fibromyalgia, in part because fibromyalgia tends to affect the body overall whereas MPS is more likely to target specific areas. A physician’s observations are often verified by use of electromyography, or EMG. 

Causes of Myofascial Pain

low back pain

Although the exact cause of MPS pain isn’t known at present, it can occur as a result of several factors.

  • Aging: Aging muscles and aging fascia can lose elasticity, making them vulnerable to injury from both trauma and overuse. Some diseases such as fibromyalgia can present in a manner similar to MPS, and those with hypothyroid disorders seem more likely to develop MPS.
  • Poor Posture: This can adversely affect many different muscles and cause knots and trigger points which may present as MPS, and psychological upheavals can cause knots and trigger points due to muscles that remain tense and stressed.
  • Inflammation: This can trigger the onset of MPS because inflamed muscles become tense, which causes knots that can accompany trigger points.

How is Myofascial Pain Treated?

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

Calculate how much you've spent on back pain this year.
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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used to Diagnose and Treat Myofascial Pain

Ultrasound therapy is often used to treat the pain of MPS. Although not appropriate for all types of chronic pain, it has shown to be effective in treating the chronic pain of MPS. Ultrasound therapy uses either thermal or mechanical sound waves to promote tissue regeneration.Thermal ultrasound techniques use the heat and friction generated by its more continuous sound waves to encourage blood flow to the area and thus promote healing. Mechanical ultrasound therapy penetrates the inflamed tissues through pulsing sound waves that reduce inflammation and swelling, thereby reducing pain. The type of ultrasound used will depend on the type of MPS pain being treated. Both types of treatments are painless, some patients experience a slight warming of the skin, some feel a minor pulsation, others feel nothing, but none have reported any pain sensations. 

Although ultrasound treatments are used only in a professional setting, some MPS pain sufferers have found that a personal TENS, or transcutaneous electrical nerve stimulation, unit can provide pain relief between ultrasound sessions. 

How Does Myofascial Pain Compare to Similar Conditions?

The closest pain-inducing condition to MPS pain is that of fibromyalgia but the two conditions can present concurrently. Both fibromyalgia and MPS pain cause tightness and pain in the muscles and both generate an increased pain response when stimulated. Both can be accompanied and aggravated by other physiological occurrences such as: 

  • Arthritis   
  • Chronic fatigue
  • Headaches, including migraines   
  • Degenerative disc disease

MPS pain is frequently associated with chronic lifestyle triggers such as stress, poor posture, poor diet, trauma, or age related issues. Trigger points from MPS can be directly felt, or traced if they are referred pain, and respond better to treatment. MPS doesn’t usually affect balance or thought processes like fibromyalgia does, and there is less incidence of depression, hearing and vision impairment, and perception. Adaptation of lifestyle so that the triggers are eliminated or reduced will usually alleviate the pain of MPS.

Analogy: Blow-Out vs Flat Tire

A bulging disc is like a flat tire, a slipped disc is like a blowout. When you have a flat tire, the wheel’s material loses its shape, but it stays more or less together. In a blowout, the inside of the wheel becomes exposed to the outside.

Both conditions can cause pain, and both should be professionally evaluated. And don’t forget: a bulging disc (flat tire) can progress to become a slipped disc (blowout).

Blow-Out

Blow-Out = Instant Rupture

Flat Tire

Flat Tire = Slow Leak

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