Myofascial pain syndrome. Manifestation of myofascial pain syndrome and its treatment. Pain in the neck muscles and shoulders

Myofascial pain syndrome is a neurological pathology in which reflex muscle pain is manifested in tissues and fascia. According to the international classifier of diseases ICD 10, the syndrome is classified as a class of diseases of the periarticular soft tissues. Pain syndrome is a response of the body to pathological changes in the tissues of ligaments and joints, intervertebral discs or internal organs.

Pathology is directly related to changes in the functions of the muscular apparatus, as well as the membranes covering the muscles (fascia). Myofascial pain syndrome is not recognized as a separate disease, and if characteristic symptoms occur, the doctor diagnoses the patient in most cases with myalgia.

This pathological condition is often observed in the skeletal muscles of the lumbar spine, chest, neck, but can also occur in the muscles of the face, abdomen, upper or lower extremities. A feature of the pain syndrome is the formation of trigger points, which are presented in the form of small nodules located inside the muscles. Such points are constantly in good shape, even when the patient's muscular apparatus is relaxed. You can recognize the presence of points by palpation of a certain area of ​​\u200b\u200bthe body.

For trigger points, the nature of the passive or active state. The activity of the points provokes the appearance of acute and severe pain when you press on a certain part of the body. Palpation of a spasmodic muscle provokes the appearance of a “jump” symptom - when a person literally jumps up from a place from an acute pain syndrome. In addition, the activity of the trigger point helps to reduce muscle contractions, weakens the muscle fiber and prevents it from stretching.

In the process of trigger point passivity, the patient develops minor pain only if the muscle is tensed. A passive state under the influence of negative factors provokes the appearance of trigger point activity. In this case, the provoking factors are stress, hypothermia or overheating (in a steam room, in a bath), physical overwork. A relaxing massage, a warm compress, and emotional calmness can reduce the activity of a trigger point.

Stages of myofascial syndrome

• acute - the intensity of local or distant pain;
• subacute - pain manifests itself in the process of muscle activity;
• chronic (fibromyalgia) - discomfort at the points always persists, but the pain is activated under the influence of negative factors.

Causes

The main provocateur of the development of the syndrome is the overstrain of muscle fibers as a result of the receipt of nerve impulses of a pathological nature from the brain.

Impulsive signals are sent from the brain to the muscles, and then back, as a result of which the muscles contract and relax correctly. With the appearance of pathology, impulse signals become chaotic, which leads to the fact that some muscle groups no longer obey the “orders” of the brain, that is, they are delayed in one position, despite the need of the body, as well as the will of the person. A prolonged relaxed state of the muscles leads to impaired motor function, and prolonged muscle tension (spasm) provokes pain.

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The causes of myofascial syndrome are often pathologies that force a person to take an incorrect and uncomfortable body position and linger in a similar position for a long time.

• osteochondrosis;
• dystrophic or inflammatory changes in the area of ​​the joints;
• pathologies of the spine or bone structures (scoliosis, asymmetric arrangement of the pelvic bones, flat feet, etc.);
• swelling of the joints;
• diseases of the sternum, peritoneum and pelvis;
• rheumatism;
• intoxication as a result of oversaturation of honey. drugs;
• mechanical effect on nerve fibers (a consequence of injuries or prolonged physical exertion).

Myofascial lumbar syndrome

The reason for the manifestation of signs of myofascial syndrome of the lumbar spine and sacral zone is often intense and dynamic physical activity (weight lifting, jerky movements), as well as long-term static stress (long stay at the computer monitor, prolonged driving a car).

Thoracic

Diseases of the thoracic zone of the vertebral region and diseases of the organs of the corresponding department often become provocateurs of the manifestation of pain in the muscles of the anterior part of the sternum, as well as in the area of ​​the small chest.

cervical

Pathology, localized in the cervical spine, is explained by the manifestation of pain in the muscles of the neck, as well as in the upper back. The spasm can spread to the back of the head and the orbital area of ​​the head. The progression of this condition leads to the development of vegetovascular disorders.

Clinical picture

The main symptom of myofascial syndrome is the manifestation of acute and excruciating pain with a specific muscle. The pain is pulling, sharp, pulsating in nature, with physical exertion and palpation of the area of ​​trigger points increases.

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• sensitivity (numbness) of the skin;
• convulsions;
• blanching, cyanosis or redness of the skin over the affected area;
• the appearance of "goosebumps";
• impaired motor ability.

Diagnostics

During the initial visit, the doctor collects a medical history from the patient, reveals somatic pathologies, mental changes, conducts a physical examination of the spasmodic muscular apparatus, and determines the localization of trigger points by palpation.

Neither hardware nor laboratory studies are able to detect pathological changes in the muscles.

Treatment

How to treat myofascial pain syndrome, the doctor decides. But in any case, the treatment is represented by a complex of medical and physiotherapeutic methods.

• Muscle relaxants (Baclofen, Mydocalm);
• NSAIDs (Ibuprofen, Nimesil, Diclofenac).
• With intense pain, novocaine blockades are indicated.
• In case of mental disorders, sedatives are prescribed (Barboval).
• Vitamins of group B (Milgamma).

• Acupuncture.
• Massage.
• Manual therapy.
• Physiotherapy - ultrasound, electrophoresis, electrical stimulation, etc.

Only a doctor is able to prescribe adequate therapy for pain syndrome; treatment with folk remedies for myofascial syndrome is not applied.

Myofascial syndrome (sometimes called "myofascial pain syndrome") is somewhat of a chameleon pathology. It is known in medicine by many names: Adams-Stokes, Adams-Morgagni-Stokes and Spence syndromes. Think the list is too short? No problem, we can continue:

• extra-articular (muscular) rheumatism;
• repetitive trauma syndrome (stress, sprains);
• fasciitis, myofasciitis;
• fibrositis, myofibrositis;
• myogelosis;
• vertebrogenic pain syndrome;
• cervical pain syndrome;
• pelvic floor syndrome;
• overload syndrome.

Agree, very few diseases can boast of such a "track record". The confusion is added by the fact that with such an extensive “pedigree”, one cannot count on the unambiguity of definitions. As a result, rather “funny” situations happen when a doctor treats one problem, a pharmacy gives out medicines for a second one, and the patient, answering the completely natural question “how is your health”, gives out the classic “you can’t wait” just because he himself doesn’t really understand than sick.

Myofascial pain syndrome in the understanding of some narrow-minded inhabitants is, as follows from the beginning of the article, an inexhaustible source for jokes. And the patients themselves perceive pain in the back, lower back and shoulders with a certain humor. “What do I have? All the same, muscles. The usual myofascial syndrome, that's okay." But when a sharp, literally turning inside out pain covers a person, the jokes usually end.

The patient goes to the doctor and begins to “demand” effective and speedy treatment, not at all thinking that he himself is largely to blame for his troubles. After all, the alarming symptoms did not appear yesterday or even the day before yesterday. But, alas, many of us are not used to the fact that health problems are an obvious reason to see a doctor, and not at all a reason to start self-treatment. And if the pathology has gone too far, and the pain has "settled" in literally every muscle of the body (face, back, neck, limbs), it is no longer possible to help a person with harmless rubbing and massage.

The essence of the problem

If we approach the issue formally, then it will be possible to argue that myofascial syndrome (MFS) is a tension of certain skeletal muscles, in which there is a sudden and sharp pain. In the people, this condition is traditionally called neuralgia, but this definition is fundamentally wrong, although the symptoms of both pathologies are very similar. Myofascial pain syndrome (MFPS) is explained, as we have already found out, by muscle tension, and neuralgia - by nerve damage.

The mechanism of MFS development is associated with the formation of local (that is, local) spasmodic zones in skeletal muscles, which are called "trigger points" (TP). They can manifest all kinds of violations of varying severity:

• increased muscle tone;
• significant deterioration in contractility;
• various vegetative pathologies;
• the appearance of foci of reflected (irradiated) pain.

If the first three points are more or less clear, then the last one needs some explanation. Due to the fact that myofascial pain syndrome, by definition, does not have a clearly defined localization (muscles are located throughout the body), its symptoms can appear anywhere:

• cervical spine (most likely site of pain);
• head (face, jaw, sometimes temporal region);
• area of ​​the sternoclavicular joint;
• small of the back;
• peritoneum;
• lower limbs;
• pelvic floor area (less common, but sometimes it happens).

What conclusions can be drawn from this? Firstly, it is pointless to “suffocate” unpleasant symptoms with analgesics in MFPS, since they can hardly do anything with the cause of pain. Secondly, it is also not necessary to count on a quick recovery in this case. Thirdly, when the first signs of MFPS appear, you should not delay a visit to the doctor, since chronic muscle spasm will not only make your life unbearable, but can also provoke severe pathological changes, which, alas, the surgeon will have to deal with.

Types of trigger points

1. Active CT

Such a point on palpation is manifested by an unpleasant compaction, and this applies to both of its states: rest and tension. Active TT is located in the place where the nerve enters the muscle, but the impulses generated by it can propagate over a sufficiently large distance, which is why it is not always possible to determine a clear localization of an attack. Such a trigger not only causes sharp, explosive pain when pressed (the so-called “jump syndrome”), but also performs several useful and important functions:

• prevents maximum stretching of the affected muscle;
• temporarily (until the causes of the attack disappear) weakens its contractility.

Reflected pain, in contrast to acute localized pain, can be aching, intermittent and dull, complementing the symptoms of an attack with tingling, local numbness and goosebumps.

2. Latent TT

Unlike active triggers (points), latent ones are much more common. In a state of muscle relaxation, they may not remind of their existence in any way, therefore, their presence can be determined only at the moment of tension of the corresponding muscle. Palpation of latent TPs rarely provokes the occurrence of a "jump syndrome", but patients feel the reflected pain quite distinctly (symptoms are not as pronounced as with the manifestation of an active trigger, but they cannot be ignored). Unfortunately, a latent trigger under certain circumstances (hypothermia, increased load on the problem muscle, uncomfortable body position) can be transformed into an active one.

Based on this, it can be argued that in the treatment of MFPS, the doctor pursues two main tasks: to remove the pain attack (significantly reduce the severity of the influence of the active trigger) and to prevent the transformation of latent TT.

Reasons for the development of MBS and MFBS

1. Intoxication resulting from long-term use of certain drugs:

• calcium channel blockers;
• beta-blockers;
• amiodarone;
• digoxin;
• novocaine and lidocaine.

2. Various diseases of organs and systems of the body:

• myocardial ischemia with simultaneous involvement in the pathological process of the atrioventricular node;
• diseases of the coronary vessels;
• amyloidosis;
• inflammatory, infiltrative and fibrosing heart diseases;
• hemochromatosis;
• Lev's disease;
• Chagas disease;
• neuromuscular pathologies (Kearns-Sayre syndrome, dystrophic myotonia);
• diffuse connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis).

3. Natural aging processes of the organism.

Risk factors

Symptoms

They entirely depend on the muscle in which the trigger point has arisen. Accordingly, the clinical manifestations of MFPS and the treatment that can help the patient will be different.

Face

1. Mandatory (permanent) symptoms

• dull and aching pain without a clear localization;
• difficulty opening the mouth (no more than 1.5-2 cm versus 4.5-5.5 in the normal state);
• clicks in the temporomandibular joint;
• the spread of pain in the teeth, throat, palate and ear;
• decreased activity of masticatory muscles and their rapid fatigue;
• painful palpation;
• problems with chewing and swallowing.

2. Possible symptoms

• increased sensitivity of the teeth;
• frequent blinking;
• tics of the facial muscles;
• stuffy ears (possibly with noise and ringing).

3. Location of trigger points

• chewing muscles;
• upper section of the trapezius muscle;
• pterygoid bones;
• zone of the temporomandibular joint.

Neck

1. Localization of trigger points and pain

• shoulder girdle and neck;
• scalene muscles;
• middle section of the sternocleidomastoid muscle;
• zone of the scapula and collarbone;
• trapezius muscle.

2. Possible symptoms

• dizziness and fainting;
• various visual impairments;
• noise in ears;
• increased salivation;
• rhinitis;
• distribution of pain to half of the face.

Attention! A patient with MFPS, which is localized in the neck area, requires immediate and qualified treatment in a hospital setting. Ignoring the described clinical manifestations is fraught with persistent asphyxia of the brain!

pelvic region

• subjective sensation of a foreign body in the intestine;
• women may complain of pain or discomfort in the vagina or perineum;
• frequent urination;
• pain when walking, sitting in one position;
• discomfort in the lumbar region and the lower part of the peritoneum.

Shoulder

1. Location of trigger points

• active TPs: upper part of the trapezius muscle;
• latent TT: back and posterior-lower region of the neck.

2. Clinical manifestations are the same as in cervical MFPS.

lower limbs

• muscles of the thigh and lower leg: pain in the knee or thigh;
• hamstring: aching sensations on the back of the thigh;
• tibialis major or minor: pain in the front of the leg or ankle.

piriformis muscle

• pain in the buttocks, thigh, or perineum;
• difficult or painful bowel movements;
• pain when walking or during intercourse;
• discomfort in the intestines.

upper limbs

• localization of trigger points: lower sections of the scapula;
• possible spread of reflected pain in the arm and hand.

Diagnostics

MFBS is one of those few pathologies that are detected as a result of examination of the patient. Certain instrumental research methods in certain situations can confirm or clarify a preliminary diagnosis, but in general their role is minimized. An exception is an ultrasound of the problem muscle, which will allow visualization of the spasm area.

The most important diagnostic criteria for MFPS

• muscle pain occurs after physical exertion, being in an uncomfortable position or hypothermia;
• recurrent referred pain (the result of squeezing or puncturing the trigger point);
• the presence of TT in the absence of muscle hypertrophy or atrophy;
• drug blockade of the muscle eliminates almost all existing symptoms.

Auxiliary methods of instrumental diagnostics (if indicated)

• 24-hour Holter monitoring;
• echocardiography;
• coronography;
• hisography (study of atrioventricular conduction);
• myocardial biopsy.

Differential Diagnosis

• nonspecific violation of cerebral circulation;
• pulmonary embolism;
• stenosis of the aortic mouth;
• vasovagal syncope;
• thrombus in the heart;
• hysteria;
• stroke;
• epileptic seizure;
• pulmonary hypertension;
• orthostatic collapse;
• Meniere's disease;
• hypoglycemia.

Treatment

When MFBS is running (namely, doctors most often encounter it), complex therapy is considered the most effective, and not treatment based on one method:

Goals and objectives of therapy

1. Elimination of the cause that caused pain

• in violation of posture: the formation of a healthy stereotype of movement;
• orthopedic correction;
• treatment (strengthening) of the muscular corset;
• with the syndrome of "shortened half-pelvis": sit only on the "correctly" selected pillow;
• if the cause of MFBS is in the muscles of the ankle: special orthopedic insoles.

2. Drug therapy (pain relief)

• systemic drugs: nurofen, nimesil, diclofenac;
• muscle relaxants: sirdalud, mydocalm;
• GABA-ergic agents: adaptol, picamilon, noofen;
• vitamins of group B: neurobex, neurorubin;
• direct administration of painkillers: novocaine or lidocaine.

3. Complementary (alternative) treatments

• acupressure;
• pharmacopuncture and acupuncture;
• manual therapy;
• massage sessions (best of all - cupping);
• osteopathy;
• acupuncture;
• hirudotherapy;
• Dr. Tkachenko's method (if symptoms persist for a long time).

4. Treatment for facial MFPS

Prevention

• treat any diseases of the musculoskeletal system in a timely manner;
• provide conditions for a normal full sleep (ideally - a special orthopedic mattress);
• avoid prolonged hypothermia, excessive muscle tension and stress;
• remember the benefits of charging: stretching, squatting, sipping, tilting;
• give up effective, but far from such harmless diets that provide rapid weight loss: this has the most negative effect on muscle tissue;
• any clothing accessories that contribute to muscle compression (bags, belts, corsets) should not be used around the clock: give your body a rest.

Muscle pain of various localization is one of the most common reasons for seeking medical help. They arise as a result of physical impact: impact, stretching. But sometimes there is no explanation for the development of such unpleasant sensations. About 65% of patients, mostly women, complain of chronic pain in the back, lower back, neck, and legs. Often, such symptoms make it possible to suspect another pathology (angina pectoris, diseases of the genitourinary system), but the cause of most of them is myofascial syndrome.

The syndrome is a skeletal muscle spasm that causes severe pain. In the international classification of diseases of the 10th revision (ICD-10), this pathology is assigned the code M79.1. The mechanism of the development of the syndrome is associated with the formation of local spasmodic points - trigger zones. Violations of varying severity are formed in them: increased tone, decreased muscle contractility, vegetative disorders, and the formation of foci of referred pain.

Under the influence of pathogenic factors, the transmission of impulses from the brain to muscle tissue is disrupted, complete relaxation (paralysis) or a prolonged spasm is formed. With hypertonicity, myofascial syndrome develops. Foci of compaction are found in the affected muscle near the motor nerve. They are called trigger points.

There are two types of trigger points:

1. An active trigger point is manifested by induration at the site of nerve entry. It can be detected both at rest and at the moment of muscle tension. When stimulated, a convulsive contraction of the affected muscle and a pronounced soreness (“jump syndrome”) follow. The impulses of such a point extend beyond the affected muscle, therefore, even with severe symptoms, it is difficult to determine the exact location. Reflected pains are aching, periodic. Over the lesion, sweating increases, the color of the skin changes, and excessive hair growth is observed. Due to the presence of such a seal, further stretching of the muscle is excluded and its contractility is suppressed.
2. Latent trigger point is formed much more often. Active symptoms appear at the moment of muscle tension. When pressure is applied to it, aching pain is felt, the occurrence of jump syndrome is rare. Under the influence of provoking factors (hypothermia, stress, forced position of the body), the latent point can be transformed into an active one.

The mechanism of formation of trigger points remains not fully understood. It has been proven that inflammatory changes and proliferation of connective tissue occur during the progression of the disease, at the initial stage they do not exist, therefore, they cannot cause myofascial pain and dysfunction.

Causes

The occurrence of myofascial pain and dysfunction of the corresponding muscle is associated with a number of causes of congenital or acquired genesis:

• Anomalies of development and growth (asymmetry of the body, shortening of one of the legs, flat feet, curvature of the spine: kyphosis, scoliosis, lordosis) leads to an unnatural position. Different lengths of the lower extremities are common, but muscle hypertonicity is formed when the length differs by 1 centimeter or more. The normal position of the body when walking is disturbed, this overloads the muscles.
• Diseases of the spinal column (with osteochondrosis of the spine, the nerve of Lutsuk is affected, this causes muscle tension and pain in the paravertebral zone, arms, legs and internal organs, triggers form after a long stay of the muscle in a spasmodic state). With damage to the muscles of the cervical region, pain occurs on the sides of the spine, in the back of the head, and the shoulder girdle. The defeat of the lower back and thoracic region reflects pain in the paravertebral, intercostal and dorsal muscles.
• Static load (prolonged muscle tension during a long stay in a forced position).
• Prolonged inactivity of certain muscles - during deep sleep, in case of immobilization of the arms or legs with plaster, traction apparatus in case of injuries and operations.
• In the rehabilitation period, there is a decrease in mobility and the formation of muscle seals in places of injury.
• Injuries provoke the appearance of triggers, they can remain even after the injured muscle has fully recovered.
• Pathological processes localized in the internal organs lead to the occurrence of myofascial syndrome (angina pectoris is manifested by pain in the muscles of the neck, chest, erosive damage to the stomach and intestines reflects pain in the muscles of the spinal column, gynecological diseases in women are accompanied by discomfort in the lower abdomen).
• Nerve compression by tissues with edema caused by an inflammatory disease.
• Drug intoxication (long-term use of cardiac glycosides, drugs against arrhythmia, anesthetics: lidocaine and novocaine).
• Degenerative or inflammatory damage to the joints causes muscle spasm, this is necessary for the formation of a corset to hold the joint.
• Rheumatoid diseases that cause a pathological process in the connective tissue: systemic scleroderma, periarteritis nodosa and others.
• Psycho-emotional stress increases muscle spasm, especially in the limbs and paravertebral zone.

Risk factors

Not all people are equally prone to developing myofascial syndrome. The presence of one or more disease-causing factors increases the risk of such a condition:

• violation of posture;
• neglecting the warm-up before playing sports;
• hard labour;
• sedentary lifestyle;
• excess weight;
• limb immobilization;
• diseases of the spine and internal organs;
• hypothermia;
• emotional instability;
• squeezing muscles when wearing heavy bags, bandages, corsets, oversized clothes and accessories: belts, ties.

Symptoms

Myofascial syndrome is characterized by alternating exacerbations and remissions. During remission, the patient does not experience pain, but muscle tension persists.

In its course, myofascial pain syndrome goes through three phases:

1. Active trigger points are marked by severe, excruciating pain; having no characteristics, it disappears and renews itself;
2. Pain occurs during movement and is absent at rest;
3. Chronic is manifested by impaired motor function and discomfort in the affected area, the pain subsides, but since the triggers remain dormant, relapses are possible.

The main symptoms of myofascial syndrome:

• the trigger point is clearly localized: when it is probed, severe pain occurs, while a few millimeters from it, the pain is less pronounced;
• painful sensations are localized in the depth of the muscle;
• referred pain is long and dull;
• intensity ranges from mild discomfort to sharp, pronounced pain;
• pain occurs in a relaxed state and with tension;
• trigger point stimulation causes or exacerbates symptoms;
• muscle stretching acts on active trigger points and increases pain;
• characterized by painful muscle spasm;
• over the lesion, sensitivity is disturbed, skin color changes (blanching or redness), sweating increases, hair growth increases;
• when the focus is clamped, a spasm is noted, this is especially noticeable with damage to the superficial muscle.

Increase pain: static load on the affected muscle, stimulation of trigger points, hypothermia. Weaken: rest and change of position, warming the affected area, the use of drugs.

Pain sensations differ depending on the location of the trigger point:

Diagnostics

Myofascial diagnosis is complicated by the presence of referred pain. This allows you to suspect damage to other organs and systems. The diagnosis is established on the basis of complaints and examination of the patient. The survey reveals the dependence of increased pain when exposed to cold, after hard physical labor, sports, nervous overload. During the examination, palpation (palpation of the affected muscle) is performed to detect the site of compaction:

• careful stretching of the affected muscle and palpation of all its sections, the tense tissue is determined in the form of a dense tourniquet;
• rolling fingers over the muscle;
• rolling the muscle between the index and thumb;
• the absence of hypertrophy or hypotrophy of muscle tissue is detected;
• there is a reduced sensitivity over the lesion, a change in skin color;
• during palpation, the most sensitive point is detected, after pressing which there is a sharp pain and a convulsive response - contraction of the affected muscle.

Methods of instrumental and laboratory diagnostics are not able to detect the presence of myofascial syndrome. Trigger points are not detected by ultrasound, x-ray methods of research and tomography. Laboratory examination does not help in establishing a diagnosis: blood and urine tests do not change even during an exacerbation of the disease. These methods are used to exclude pathology that gives similar symptoms: cerebrovascular accident, stroke, thrombosis, hypoglycemia and other diseases.

Treatment

Treatment of myofascial syndrome is complex. The main task is to eliminate the cause and prevent the development of a trigger point. At the same time, symptomatic therapy is carried out to suppress the pain syndrome. During an exacerbation, it is important to minimize physical and static stress, give the muscle maximum rest, in case of severe symptoms, bed rest is prescribed.

The main methods used in the treatment of myofascial pain syndrome:

• drug therapy;
• physiotherapy;
• physiotherapy;
• post-isometric relaxation;
• acupuncture;
• surgery;
• traditional medicine methods;
• homeopathy.

Medical therapy

Myofascial syndrome is successfully treated using drug therapy:

• non-steroidal anti-inflammatory drugs to suppress pain; the course of treatment is no more than 2 weeks, the following drugs are used: Ibuprofen, Nurofen, Ketoprofen, Nimesil;
• psychotropic drugs with severe pain, the patient takes: "Diazepam", "Relanium";
• antidepressants in case of prolonged pain are used: Amitriptyline, Paroxetine;
• muscle relaxants: Baclofen, Sirdalud, Mydocalm, No-shpa;
• ointments, gels and creams containing non-steroidal anti-inflammatory drugs: Diclofenac, Dolgit, Finalgon;
• novocaine or lidocaine blockade - the introduction of an anesthetic into the trigger point area to relieve pain;
• compresses with "Dimexide" for pain relief;
• multivitamin complexes, B vitamins and magnesium for general strengthening of the body and improved muscle nutrition.

Many drugs used for therapy have contraindications, side effects, so the choice of such drugs, the volume, and duration of the course of treatment should be carried out by the doctor who made the diagnosis.

Physiotherapy

A complex of physiotherapeutic procedures is prescribed individually, depending on the severity of the condition and the presence of concomitant diseases. The following types of procedures have proven themselves well:

• electrophoresis;
• cryoanalgesia;
• magnetotherapy;
• electrical stimulation;
• ultrasound therapy.

Physiotherapy

Therapeutic exercise strengthens muscles, improves blood flow in them, corrects posture. Gymnastics can be started only after the elimination of the pain syndrome. A set of therapeutic exercises is developed for each patient, depending on the affected muscle and the severity of the process. The load increases gradually - for an unprepared body, unbearable exercises will be harmful. After a few weeks, the therapeutic and physical culture complex is adjusted.

Massage

Massage allows you to improve mobility, blood circulation, metabolic processes in the affected tissues, eliminates muscle tension. This is important for better drug delivery to tissues. In order for the procedures not to cause harm, massage should be carried out only by professionals.

After the pain syndrome subsides, cup massage can be used. Its frequency is once every three days, the duration of the course is 6-8 procedures. After stimulation, a warming ointment is applied to the skin above the lesion, which relieves pain and reduces the inflammatory process, and is covered with a cloth from above.

Postisometric relaxation

This type of treatment consists in the use of special methods of manual therapy. They help to relax the muscles and eliminate pain. Before the procedure, with the help of a gentle massage and anesthetic ointments, the lesion is warmed up. The muscle in which the trigger point is located is smoothly stretched. During the procedure, for the best effect, the patient changes positions: sitting, lying on his stomach, on his side, on his back. Stretching at the beginning of the procedure is short-term, then the periods of stretching and relaxation increase.

Acupuncture

In the process of acupuncture, stimulation of triggers is created, often their location coincides with acupuncture points. As a result, muscle relaxation is achieved and blood circulation improves. This technique is especially effective in myofascial syndrome caused by spinal pathology, when patients cannot use physiotherapy exercises.

Surgery

The operation is offered to the patient only in advanced cases of myofascial syndrome, in severe cases, when pain and muscle tone are not relieved by conservative therapy. If it is necessary to eliminate the compression of the nerve root by a spasmodic muscle, surgery (microvascular decompression) is resorted to.

ethnoscience

Traditional medicine methods do not eliminate the cause of myofascial pain syndrome, they can only temporarily reduce discomfort. If there are contraindications to taking medications or in addition to them, pain relief can be achieved using the following means:

Homeopathy

The main direction of homeopathic myofascial therapy is the removal of muscle spasms. One of the most effective drugs is "Spascuprel", it must be taken three times a day, 1 tablet. "Rus toxicodendron" helps to get rid of muscle spasm. With pain localized in the lower back, "Brionia" comes to the rescue, in case of damage to the cervical region - "Chelidonium". "Beladonna" has a good effect against reflected headaches.

Complications and prognosis

During a spasm, the muscle is in conditions of oxygen starvation, prolonged hypoxia causes changes in muscle tissue. Without the necessary treatment, myofascial syndrome leads to the development of fibromyalgia. This is a chronic disease that is manifested by pain throughout the body. Patients cannot do household chores, sleep well, have digestive problems, constantly feel lethargic, tired.

In the case of timely diagnosis and adequate treatment, the prognosis for myofascial syndrome is favorable: pain is well relieved by drugs, the cause can be eliminated with the help of medication, physiotherapy and other conservative methods of treatment.

Prevention

In order to avoid the formation of trigger points and the accompanying unpleasant symptoms, you need to take simple preventive measures, this is especially important for those who already had a history of myofascial syndrome:

• exclude hypothermia;
• avoid physical overexertion;
• provide yourself with a good rest;
• in case of a long stay in a forced position - organize breaks for charging;
• timely treat diseases of internal organs;
• maintain correct posture;
• exercise regularly;
• minimize stressful situations;
• control weight;
• wear comfortable clothes.

The effectiveness of the prevention of the recurrence of the syndrome, as well as the treatment, depends to a greater extent on the patient's desire to take preventive steps and follow the doctor's prescriptions: this includes taking medications, performing a set of physiotherapy exercises, and observing motor stereotypes that are taught in the rehabilitation center. If the recommendations are followed, a stable remission is achieved, and if preventive measures are observed, the development of myofascial syndrome is excluded.

Myofascial syndrome is a condition in which a reflex spasm occurs in the muscles of the body and / or limbs, leading to pain both at the point of spasm and along the muscle fibers.

This syndrome can vary in intensity of pain sensations and their prevalence, but one thing remains unchanged: this condition greatly reduces the quality of life of a person and requires a qualified approach to treatment.

Causes of the disease

All muscles in the human body are directed and controlled by the central nervous system. Electrical signals are conducted both from the brain to the muscles and vice versa. The nerves of the peripheral system are directly involved in this process - they play the role of a “trigger”, which, when activated, transmits impulses to the brain.

In the event of any disturbances or malfunctions in the nervous system, these impulses become chaotic and the muscles cease to fully obey the will of the person: reflex muscle spasms occur regardless of the needs and desires of the patient.

One of these conditions is myofascial pain syndrome, which in most cases develops in response to irritation of nerve fibers.

The reasons for this irritation can be:

• Nerve compression by surrounding tissues in inflammatory diseases that cause edema.
• Structural and topographic changes in any part of the body (violations of the correct anatomical shape or location of joints, bones, organs). This may be due, for example, to osteochondrosis, in which deformed intervertebral discs irritate the Lutsak nerve, which is responsible for the innervation of the structures of the spinal column, flat feet, shortening of one of the legs, etc.;
• mechanical effect on the nerve, which is caused by habitual actions (the habit of strongly clenching the jaw, excessive physical exertion, etc.).

The development of myofascial pain syndrome is less common in diseases of the internal organs. In this case, the reflex adoption of a body position that alleviates pain (beveling of the body to the side, half-bent back, etc.) leads to overwork of the muscles and the occurrence of a chronic pain syndrome in them.

disease symptoms

A distinctive feature of myofascial pain syndrome is the presence of so-called trigger points. These are seals that are felt on palpation and are formed by tense muscle fibers.

Pain can be felt not only in such a nodule, but also along the fibers of the entire muscle group in which the trigger point is present.

Such points can be in an active and latent (hidden) state, which determines the intensity of symptoms:

You should know that both types of trigger points can easily coexist in the same person, and latent points can transform into active ones under unfavorable circumstances.

Factors leading to exacerbation of the syndrome

Pain in tense muscles can increase significantly, and the latent point can go into the active category under the following circumstances:

• hypothermia;
• psycho-emotional stress, stress;
• prolonged immobility of the body or, conversely, increased / excessive physical activity;
• anatomical defects, such as shortening of one of the legs, abnormal bite, leading to facial asymmetry, etc.

How does a doctor make such a diagnosis?

Myofascial syndrome is determined at a doctor's appointment, which reveals the characteristic signs of this condition during a patient interview and physical examination.

The main purpose of the examination is to identify the causes of the syndrome, for which X-ray, MRI, CT, ultrasound and other methods of instrumental diagnostics are used.

Important: the treatment of myofascial syndrome without identifying the disease that provoked it is impossible. For this reason, a comprehensive examination is a mandatory step that allows you to determine the cause and, accordingly, to influence the root of the problem during treatment.

Complications of myofascial syndrome

At first glance, it may seem that muscle spasm does not need treatment. It is only necessary to eliminate the pain, which causes more or less pronounced discomfort, and the spasmodic muscle will relax sooner or later.

But everything is far from being so rosy: during a spasm, oxygen starvation develops in the muscle fibers, as a result of which they gradually lose their ability to contract. Prolonged spasm often causes irreversible changes in muscle tissue, which can cause high-intensity chronic pain and even lead to disability.

Treatment

The treatment of this syndrome, given its complexity and various causes, can be dealt with by doctors of various specialties: neurologists, vertebrologists, rheumatologists and other specialists.

Treatment of myofascial pain syndrome is aimed at two goals: elimination of pain and muscle spasm, and ridding the patient of the cause that caused the syndrome to appear.

In the second case, therapy may include a wide range of medications and physiotherapeutic and surgical methods, depending on which disease caused the muscle pain syndrome.

Medical methods for alleviating the syndrome

Depending on the intensity and extent of pain, NSAIDs (non-steroidal anti-inflammatory drugs) may be used on their own. This group is represented by a wide variety of names (Diclofenac, Movalis, Ibuprofen, etc.), each of which has its own list of contraindications and limitations. The choice of a specific drug remains with the attending physician.

With a severe pain syndrome, the treatment of NSAIDs is supplemented with muscle relaxants (Tizanidin, Baclofen, Sirdalud, etc.). These drugs provide muscle relaxation, which allows you to relieve spasm and thereby “turn off” trigger points.

Given the dependence of the intensity of pain on the emotional state of the patient, sedatives may be indicated for treatment. Depending on the severity of disorders of the nervous system, the doctor prescribes herbal preparations (valerian root extract, motherwort tincture) or prescription antidepressants.

Manual therapy

Massage plays an important role in the treatment of myofascial pain syndrome. The impact on tense muscles is carried out according to a special massage technique, which allows you to relieve spasms from a certain area of ​​\u200b\u200bthe muscle group and increase blood flow to it. Simultaneous stimulation of bioactive points helps to improve blood flow to the desired area and, accordingly, the flow of drugs circulating in the bloodstream into it.

One of the most effective methods of manual therapy in the treatment of myofascial pain syndrome is PIR (post-isometric relaxation). With the help of PIR, it becomes possible to relieve tension even from deep-lying muscle fibers, which are inaccessible with conventional massage.

Reflexology

Reflexogenic points are special structures in the human body formed by an accumulation of nerve fibers. With their help, you can control a number of reactions and functions, including muscle tension and relaxation. Acupuncture and acupressure are tools that allow you to influence such points and eliminate pain, often after the first session.

Reflexology is especially important for myofascial syndrome caused by diseases of the spine: thanks to this method, it becomes possible to “turn off” pain points and tone up in patients who, due to limited motor activity, are unable to take advantage of exercise therapy.

exercise therapy

Therapeutic exercise is indicated for myofascial syndrome in the following cases:

• the syndrome is caused by an uneven distribution of muscle loads with asymmetry of body parts;
• pain syndrome developed as a result of prolonged forced immobility of the body (recovery period after surgery, stroke, etc.);
• in any of the muscle groups, atrophic phenomena are observed, which are compensated by other muscles, which causes their overstrain;

Important: in the treatment of myofascial syndrome, any factors matter - from the patient's age to his lifestyle. Therefore, only a qualified specialist can choose a complex of therapy and treatment tactics that are effective in each specific case.

Discomfort in the back and neck can occur under various conditions. Very often the cause lies in myofascial pain syndrome. It is manifested by pathological tension in the skeletal muscle (or in the muscle group), has characteristic manifestations and patterns of flow.

Myofascial pain syndrome is based on tissue microdamages. They can be obtained with a sudden simultaneous muscle contraction or against the background of chronic overload. Trauma leads to the release of calcium ions from the cells, which initiate muscle spasm.

Development mechanism

Prolonged muscle tension is painful in itself. It also impairs microcirculation. In conditions of lack of oxygen and excessive muscle work, the release of energy occurs along the path of a fast anaerobic carbohydrate cycle. The oxidation process is incomplete. The resulting lactic acid accumulates in the muscles, decomposing into lactate and hydrogen ions. Hydrogen disrupts the conduction of an electrical signal, causing a burning sensation in the muscles.

In the absence of a rest period and increasing exhaustion, aseptic inflammation occurs in the tissues. Inflammatory mediators, prostaglandin, serotonin are produced. Together with underoxidized metabolic products, these substances stimulate receptors, which leads to a reflex protective muscle tension in response to pain.

A vicious circle is formed, maintaining a painful prolonged muscle contraction. The muscle becomes thickened, painful, the range of possible movements decreases. Against this background, trigger points are formed. These are small areas of increased excitability in the affected area and at a distance. Their irritation leads to local painful convulsive contraction, accompanied by vegetative changes.

With the prolonged existence of a spasm, reversible structural changes occur in the trigger areas of the muscles.

Myofascial trigger points can be active or latent. Prolonged exposure to certain factors can lead to the formation of latent triggers without the presence of a clearly defined pain syndrome. In this case, additional influence, including psycho-emotional, can become a trigger. There is an activation of latent points, myofascial syndrome develops.

Etiology

The causes of myofascial pain syndrome can be:

• diseases of the spine, leading to reflex tension of the paravertebral muscle groups in the affected area and to compensatory mobility of neighboring sections;

• unusual, inadequate, intense and prolonged loads;

• long-term preservation of one posture, leading to uneven muscle tension on different sides of the body (improper seating at the desktop, computer, driving a car);

• immobilization of body parts, movement with crutches and other means, uneven support;

• hypothermia;

• constantly repetitive movements, especially twisting the torso (features of the profession);

• stress, anxiety-depressive syndrome;

• protective muscle tension in case of pain syndrome not associated with the spine (with pathology of the joints or internal organs).

Especially often there is myofascial pain syndrome of the lumbar spine. A variety of active movements, weight lifting, combined with a high load to maintain the vertical position of the body - all this creates the prerequisites for the development of spasm in the presence of provoking or causative factors.

Clinical picture

The main symptoms of myofascial pain syndrome are:

• pain - local or in the area of ​​​​large muscle groups;

• restriction of movements;

• tight compaction of the muscle;

• the presence of a trigger point;

• a zone of referred pain characteristic of each muscle.

Pain is the most felt at trigger points. They are felt on palpation as small compacted areas. Wherein their irritation leads to a sharp contraction of the muscle and severe pain. This may be accompanied by shivering and vegetative reactions - redness or marbling of the skin, sweating.

The zone of reflected pain is obligatory, while the sensations in it are dull, prolonged, painful, varying in intensity. Each muscle has its own area of ​​reflection and distribution with localization within one sclerotome.

Myofascial pain syndrome has stages of development.

• In the acute period, the pain is pronounced, excruciating, almost constant, aggravated by the slightest impact.

• In the second stage, the pain bothers with movement and activation of triggers, but subsides at rest. Then the syndrome reverses. In this case, there is no pain, but some movements cause discomfort, and the triggers are in a latent state.

Both acute and chronic pain often lead to emotional reactions and disruption of vital functions. Sleep and appetite may worsen, mood may decrease, and efficiency may decrease. In addition, chronic affective disorders can themselves manifest as viscero-vegetative and pain syndromes, including myofascial ones.

Diagnosis of MFBC is aimed primarily at the exclusion of inflammation and radicular syndrome. It is based primarily on the data of a thorough examination and has clear criteria.

Principles of treatment

Therapy of myofascial pain syndrome should be complex. At the same time, it is important not only how long this condition is treated, but also how complete the effect is on all links of pathogenesis. The impact on myofascial pain syndrome of the lower back, cervical or thoracic region has general principles and approaches.

Treatment includes pharmacological and non-pharmacological methods.

• Mandatory measures are rest, posture and position correction. Apply corsets, orthopedic pads.

• The use of drugs is local (skin), local (injections into triggers) and systemic (taking pills, injections).

• In chronic pain syndrome, GABA-ergic drugs, antidepressants of various groups, sedatives and vegetotropic drugs are prescribed to relieve asthenic, anxious, depressive and autonomic reactions.

• Injections into trigger points are effective - “dry” and with the introduction of painkillers.

From non-drug methods use:

• trigger point acupressure;

• post-isometric muscle relaxation - forced stepwise stretching of the muscle with adaptation to a new length;

• stretching the muscle with the spraying of painkillers on the surface of the skin;

• acupuncture;

The subsidence of pain does not always mean a cure. The transition of trigger points to a latent, dormant state makes it possible to resume MFBS with the resumption of adverse provocative effects. Therefore, it is important to take preventive measures.

Important points of prevention are the use of orthopedic devices, posture correction, rationalization of movements in the performance of work duties, proper seating at the table, in front of a monitor or while driving a car, strengthening the muscle corset.

Myofascial pain syndrome is a condition of prolonged pathological muscle tone with the formation of trigger points. Treatment should be aimed at pain relief with the destruction of the pathological circle "pain-spasm-pain" and must be supplemented by preventing the reactivation of latent triggers.