When our skeletal muscles are in good condition, they work effectively. However, exercising muscles with trigger points (TrPs), will make pain worse. Those who do not understand myofascial pain syndrome think we are non-compliant, and we become frustrated. The truth is, until we get those knotted up pieces of muscle fiber, TrPs, back to their normal resting length, exercise compounds the problem, the fibers recoil further, and TrPs develop in other muscles making pain worse, not better. Knowing what to do is paramount to relieving myofascial pain.
Identifying Perpetuating Factors
It takes someone with special skills to detect myofascial TrPs and treat myofascial pain syndrome, but it is our job to identify any perpetuating factors. Perpetuating factors can be broken down into two groups, things we can’t change and things we can.
Things We Can’t Change
We can’t change anatomical deformities, such as disproportionate extremities, curvature of the spine, or defects from injury or surgery. We can’t change the diseases mentioned in the post “Myofascial Pain Syndrome.” But, we can do a better job managing them, especially once we realize mismanagement can make our pain worse.
Things We Can Do to Manage Perpetuating Factors
- Improve poor posture
- Avoid ill fitting shoes or clothing
- Treat trigger points before conditioning the involved muscle
- Eat a healthy diet
- Breathe properly
- Avoid overloading unconditioned muscles
- Avoid repetitive movement or static positioning
- Move with purpose
- Manage co-existing conditions and known triggers
- Use orthotics or other devices to improve body alignment
- Use devises to minimize TrPs, such as a night guard for TMJ or teeth grinding
- Identify medications that can cause muscle pain
- Address sleep problems and sleep posture
- Therapeutic myofascial trigger point treatment by a qualified massage therapist
- Trigger point injections (TPIs). Steroids do not improve outcome and limit the number of injections. There are alternatives to steroids, such as Sarapin, a botanical anti-inflammatory
- Ultrasound guided TPIs help locate and safely treat TrPs
- Dry needling
- Acupuncture or acupressure
- Spray and stretch or ice stroking (within the muscle’s comfort zone)
- Myofascial release or active release therapy
- Ultrasound to promote healing
- Trigger point wand for treating internal pelvic floor muscles (Intra-vaginal TPIs have also been used.)
- Transcutaneous electrical neuro-stimulation (TENS) units, such as micro-current stimulators, interferential stimulation, neuromuscular electrical simulation, galvanic stimulation, and more as suggested by your practitioner
- Medications for pain, muscle relaxants or sedatives to promote sleep (These may help, but the only thing that will affect a TrP is hands-on therapy.)
The Right Provider
The right provider is one that understands myofascial pain syndrome. Better yet, they studied the work of doctors Janet Travell and David Simons, the pioneers of myofascial medicine. These care providers include physicians, chiropractors, physical therapists, and/or massage therapists who are specially trained in MPS.
The treatment goal is always the same—return the knotted up muscle fiber, TrP, to its normal resting state.
- Apply pressure at 70-80% of maximum pressure (Garbage collector blood cells need to get in to do their work.)
- Hold for 30-60 seconds
- Use static pressure (above) or stroking of the involved muscle (in the direction toward the heart) as often as you can, allowing rest periods of at least 60-90 minutes
- If the muscle is too tight, massage and/or pre-warm to help with relaxation and improve location of the TrP.
- Ice after treatment to reduce inflammation
Drs. Travell and Simons suggest stretch after TrP treatment, but keep it gentle. Think like a mechanical engineer and ask yourself, “How far does this muscle stretch with normal movement.” Aggressive stretching can cause the same recoil as exercise, and it can activate latent trigger points that were missed during treatment.
Tools for Self-Management
- A self-treatment book that identifies TrPs by location and referral patterns
- Tennis Balls
- A swim noodle cut in 18-24 inch sections (The swim noodle is good for massage and stripping. Use it between your back and the wall, or put a broom handle in the hole and use it to stroke muscles, such as the calf. Always use a sweeping motion toward your heart to help with blood and lymph circulation.)
- A therapeutic ball
T’ai Chi, a meditative dance-like gentle exercise, helps with circulation, gait, and balance, difficulties often identified in MPS. Meditation helps stress, and minimizing perpetuating factors is extremely important. However, many factors may influence total recovery versus maintenance. If you have MPS, start treating today, it will change your tomorrow.