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Myofascial pain syndrome
(MPS) 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. It is most common
in people over 30, and usually is a short-term
condition. In some cases, however, it can
be chronic if the underlying cause of the
irritation is not corrected.
The fascia is the tough connective
tissue spread throughout the body that
covers muscles, bones, nerves, and organs.
Myofascial Pain Syndrome is characterized
by the development of “trigger points,” or
sensitive, painful areas in the muscle,
or the junction of the muscle and fascia.
The causes are not clearly known, however,
there are some factors that may be related
to the development of MPS. These factors
include:
- Sudden trauma to muscles, ligaments or
tendons
- Injury to discs
- Repetitive motions
- Lack of physical activity
- Nervous tension or stress
- Chilling of areas of the body such as from sitting under an air
conditioner duct
- Poor posture
Myofascial Pain Syndrome
is often difficult to manage because myofascial
pain can occur in association with many
other conditions. For example, a whiplash
trauma or an overuse injury from athletics
can cause myofascial pain secondarily,
which then persists after the original
injury has healed. In other cases, the
pain persists simply because the diagnosis
of MPS is never made.
People who are sedentary,
or only mildly active may be more likely
to develop MPS. Conversely, athletes who
perform repetitive movements such as serving
in tennis, or a baseball pitcher with poor
technique may develop myofascial pain.
People with poor posture can increase strain
on their spine and supportive muscles,
sometimes resulting in myofascial pain.
In addition, leg length differences can
lead to significant myofascial back pain.
Poor work design and habits such as a receptionist
cradling a phone all day, or a construction
worker lifting heavy loads can cause stress
leading to MPS.
Trigger points (circled)
indicate local pain and tenderness; shaded
areas show referred pain around the points
and down the back of the legs. Myofascial
pain syndrome occurs when muscles that
surround weak or injured areas go into
spasm to protect the spine; tissues between
the muscles become irritated.
Diagnosis
Diagnosis is made by a careful history and
a physical exam. Specifically, the doctor may ask you about recent
activities or accidents that may have precipitated the onset of symptoms.
While there are no lab tests or imaging studies (x-rays, CT scans,
MRIs) that can confirm the diagnosis, these tests may be done to rule
out other medical problems that may be causing the symptoms.
Treatment
There are a number of approaches that may
be used, and often, a combination of these treatments may be the most
helpful in obtaining relief. Some of the most common treatments include:
- Exercise – can help to reduce pain
- Physical Therapy and Massage – may
help stretch the fascia of the muscles
- Heat/Cold Therapy - in some cases may
decrease trigger point sensitivity
- Medications
- Stretch and Spray – passive stretching of the target muscle
while applying a vapocoolant spray
- Trigger Point Injections – a mixture of anesthetic and steroids.
These injections only provide temporary
relief of pain.
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