Moderate myofascial syndrome. What is myofascial syndrome and how is it treated. What methods of diagnosing and treating the disease exist?

It has been noted that nearly 44 million Americans have myofascial pain. Clinical studies have shown that 30% of patients complaining of pain had active myofascial trigger points. Data from a clinic specializing in headache and neck pain indicate a myofascial etiology of pain in 55% of cases. Thus, it has been determined that active myofascial trigger points often play a role in the symptoms of patients with tension headaches, low back pain, neck pain, temporomandibular pain, shoulder and forearm pain, and pelvic pain.

To interpret the results of studies on the prevalence of myofascial pain, it is important to distinguish between active myofascial trigger points and latent myofascial trigger points. Latent myofascial trigger points are characterized by areas of tension in the muscles that are not accompanied by pain. Active myofascial trigger points are accompanied by pain, which is clearly reproduced when these points are pressed. No studies have been conducted on the incidence of myofascial pain syndromes in rheumatological diseases. But some authors believe that they are often not diagnosed and not treated, but are present as a pain component in systemic rheumatological diseases (SLE, rheumatoid arthritis, osteoarthritis). Currently, myofascial pain syndrome (MPS) refers to any regional manifestations with referred pain emanating from soft tissues (muscles, ligaments, tendons). The name myofascial means that the main source of pain is a specific skeletal muscle. To diagnose such a syndrome, a physical examination and palpation determination of muscle compactions (nodes), called trigger points in the location of skeletal muscle ligaments, are necessary.

A myofascial trigger point is a hypersensitive, dense nodule that produces characteristic referred pain when pressed. With deep palpation directly in the trigger area, the patient’s pain symptoms are completely reproduced.

Theoretically, a person with a palpable trigger point will usually have vague pain at rest. But determination using palpation allows you to determine exactly which muscle there is dysfunction. Trigger points are thought to be more common in the postural muscles.

Researchers divide MPS into two types: Primary MPS, in which the main complaint is specific - muscle trigger pain and the absence of other musculoskeletal pathology; and secondary MBS, which is more common and is characterized by muscle pain and the presence of another underlying musculoskeletal disease (rheumatoid arthritis, spinal canal stenosis, disc herniation, spondylolisthesis, vertebral fractures).

Regardless of the interpretation of MPS, trigger points differ from tender areas in fibromyalgia in that the patient experiences only local tenderness, without referred pain.

MBS is often a diagnosis of exclusion, meaning that other diseases have been ruled out.

Risk factors. There are no specific risk factors for the development of MBS. The diagnosis of myofascial pain syndrome can be made by a doctor to any patient with soft tissue pain. MBS occurs at any age, but more often in middle age, equally in both men and women. People with poor posture (rounded and skewed shoulders, and excessive head tilt) have a higher risk of discomfort in the axial postural muscles and the appearance of trigger points.

Etiology

A precise explanation of the trigger point phenomenon has not yet been obtained. There are certain results of electromyography of trigger points that revealed low-voltage activity of these points, reminiscent of action potentials. It is hypothesized that a myofascial trigger point is a cluster of numerous microscopic lesions with intense activity throughout the nodule. These lesions are thought to arise from a focal metabolic disorder due to trauma or frequent exposure. Factors commonly considered to predispose to the formation of a trigger point include deterioration of the general condition of the body, poor posture, repetitive mechanical stress, sleep disturbance, vitamin deficiency.

Forecast

In simple cases, myofascial pain syndromes can be cured by correcting the factors that caused the appearance of triggers and treating myofascial syndrome. If treatment is ineffective, myofascial syndrome can lead to persistent pain. In some cases, central sensitization leads to widespread pain. fibromyalgia.

Symptoms of MBS

Myofascial pain syndrome pain can occur from just one trigger point, but there are usually multiple trigger points responsible for any pain in a given area. This is a very common phenomenon that begins with a single trigger point followed by the development of satellite trigger points that develop over time due to mechanical imbalances arising from decreased range of motion and muscle pseudo-weakness. The persistent presence of a trigger zone can lead to neuroplastic changes at the level of the dorsal horn, which result in an increase in the sensation of pain (central sensitization occurs), with a tendency to spread beyond the initially involved zone. In some cases, segmental central sensitization leads to mirror-image pain phenomena (that is, pain on the opposite side of the body, in the same segmental location), and in other cases, the progressive spread of segmental central sensitization gives rise to the widespread pain that is characteristic of fibromyalgia .

Pain in the lumbar region

There are many causes for lower back pain. Some are quite serious, such as metastatic cancer, osteomyelitis, massive disc herniations (such as cauda equina syndrome), vertebral fractures, pancreatic cancer, and aortic aneurysms. However, the usual cause of acute lower back pain is the so-called lumbago. In 95% of cases, this problem is cured within three months. In cases where recovery does not occur, the development of chronic pain in the lumbar region is usually accompanied by the discovery of active myofascial trigger points. Typically, this process involves a muscle group, quadratus lumborum; pain emanating from trigger points in these muscles manifests itself as lower back pain, with rare irradiation along the sciatic nerve or to the groin. Trigger points located in the iliopsoas muscle are also a common cause of chronic low back pain. The typical distribution of pain from the iliopsoas muscle is the vertical ligament in the lower back and upper thigh. Trigger points emanating from the gluteus medius from the iliac crest are a common cause of pain in the lumbar region of the sacrum, with possible radiation to the outer thigh.

Neck and shoulder pain

Latent trigger points are a common finding in many muscles of the back of the neck and back. Active trigger points are usually located in the upper part of the trapezius muscle, the levator scapulae muscle. Referred pain from the trapezius muscle usually goes to the back of the neck and to the angle of the jaw. Trigger points of the levator scapulae muscle cause pain in the angle of the neck and shoulder; this pain is often described as sharp, especially when the muscle is actively used. Since many of the muscles in this area are involved in postural function, their development is common in office workers who have poor posture. Because the upper trapezius and levator scapulae act synergistically with several other muscles (scapula elevation and fixation), the occurrence of one trigger point initiates the appearance of satellite points through adjacent muscles involved in the same movement mechanism.

Hip pain

Pain resulting from hip dysfunction is usually located in the lower front of the thigh and groin. This localization is not typical for myofascial pain syndrome from the iliopsoas muscle. In most cases, patients complain of pain in the outer thigh. In some patients it is due to trochanteric bursitis, but in most cases it is associated with myofascial trigger points in adjacent muscles. Of course, the usual trigger points that give rise to pain in the outer thigh come from the gluteus medius and minimus muscles in the trochanter major.

Pelvic pain

The smooth muscles of the pelvis are a common area for the location of myofascial trigger points. Currently, gynecologists and urologists have increasingly begun to suspect myofascial trigger points in the genesis of pain syndromes, which were usually associated with prostatitis, coccygodynia, and vulvodynia. The most indicative in this regard is the levator ani muscle. Trigger points in this muscle may be accompanied by pain in the lower buttocks.

Headaches

Active myofascial trigger points in the muscles of the neck, shoulder and face are a common source of headaches. In many cases, the headache has features called tension headaches, but there is increasing evidence that myofascial trigger points may initiate migraine headaches or be an integral part of the headache mechanism in tension headaches and migraines. For example, trigger points in the mastoid region the appendix can cause pain in the face and supraorbital region. Trigger points in the upper trapezius muscle may cause pain in the forehead or temple. Trigger points in the neck muscles can cause pain in the occipital and orbital region.

Jaw pain

There is a complex relationship between temporomandibular joint disorders and myofascial trigger points. The most common trigger points responsible for jaw pain are located in the area of the massetters, pterygoid bone, upper trapezius and upper sternocleido mastoid.

Upper limb pain

The muscles attached to the shoulder blade are a common location for trigger points that can cause pain in the upper extremities. These muscles include the subscapularis, infraspinatus, teres and serratus. This very common localization of trigger points in these muscles can cause referred pain in the arm and hand. Often, excessive flexion of the neck muscles leads to the formation of trigger points and pain in the elbow and little finger. Myofascial pain syndromes of the upper extremities are often diagnosed as glenohumeral periarteritis, cervical radiculopathy, or anterior thoracic syndrome.

Pain in lower extremities

Trigger points in the calf and thigh muscles may be responsible for lateral hip pain and lateral knee pain, respectively. Anterior knee pain can result from trigger points in various areas of the quadriceps. Back knee pain can result from trigger points in the hamstring and popliteus muscles. Trigger points in the anterior tibialis and peroneus longus muscles can cause pain in the anterior leg and lateral ankle, respectively. Myofascial pain syndrome originating from these muscles is usually caused by ankle injuries or excessive rotation of the leg. Sciatica pain can be similar to pain provoked by trigger currents from the back of the gluteus minimus muscle.

Chest pain and abdominal pain

Diseases affecting the chest and abdominal organs are common problems encountered in internal medicine departments. For example, pain in the anterior chest is a common reason for hospitalization with suspected myocardial infarction, but then it turns out that there is no heart attack. In some cases, chest pain is caused by trigger points in the muscles in the front of the chest. Trigger points in the pectoralis major muscle can cause pain in the anterior chest and radiate to the elbow of the arm and thus simulate an attack of myocardial ischemia. Trigger points in the sternalis muscle usually cause the sensation of pain behind the sternum. Trigger points in the upper and lower rectus abdominis muscles can be similar to gallbladder dysfunction or bladder infections, respectively. It is important to note that myofascial trigger points can accompany diseases of the chest and abdominal organs, and the diagnosis of myofascial syndrome in its pure form should be based only on an adequate examination.

Diagnosis

The clinical diagnosis of myofascial pain depends in principle on the physician, who can suggest this cause as a possible cause to explain the nature of the pain. Myofascial pain syndromes can be similar to a large number of other diseases, so adequate evaluation is necessary. . Myofascial pain is characterized as a non-intense, deep sensation of pain, which intensifies with the work of the muscles involved and stress, which increases muscle stiffness. A characteristic clinical feature of myofascial pain is the detection of a trigger point. This is a clear focus of local pain within the muscle. Sometimes pain on palpation can spread and reproduce the patient's symptoms. But as a rule, the irradiation of pain does not follow the same paths as the cutaneous innervation of the root. Palpation usually reveals a rope-like condensation of muscle fibers, often called a “taut ligament.” Sometimes, quickly flicking this ligament or piercing a trigger point with a needle will lead to a spasmodic contraction of the affected muscle. This convulsive reaction can only be detected in superficial muscles. Myofascial pain often follows muscle injury or repetitive strain. Often in modern clinics, numerous expensive examinations were carried out before a diagnosis of myofascial pain was made. Some patients with a clear cause of musculoskeletal pain (eg, rheumatoid arthritis) may develop myofascial pain syndrome that goes undiagnosed due to the underlying disease. Myofascial pain has certain clinical features that help in making this diagnosis. The pain is typically described as a deep aching sensation, often with a feeling of stiffness in the area involved; this is sometimes seen as joint stiffness. Myofascial pain increases with use of the affected muscle, stress, exposure to cold, or postural imbalance. Radiation from the trigger point may be described as paresthesia, thus being similar to symptoms of radiculopathy (lumbar or cervical). Muscle weakness that occurs due to its low load can lead to symptoms such as fatigue, poor coordination of movements, and sleep disturbances. Patients with myofascial pain involving the muscles of the neck and face may experience symptoms of dizziness, tinnitus, and static disturbances.

Characteristics of a myofascial trigger point:

Focus of pain on palpation of the affected muscle
Reproduction of a complaint of pain when palpating a trigger point (with a force of about 3 kg)
Palpation reveals induration (hardening) of the adjacent muscle
Limited range of motion in the affected muscle
Often pseudo-weakness of the muscle involved (without atrophy)
Often referred pain with prolonged (~5 seconds) pressure on the trigger point.

Treatment

Improved posture and ergonomics

Changing the ergonomics of the workplace and posture allows you to remove one of the possible factors in the appearance of trigger points. And the ability of muscle tissue to avoid increased and inadequate load allows, in some cases, to avoid the actual treatment.

Exercise therapy

The muscles involved in myofascial pain syndrome are in a constant state of contraction, which leads to an energy imbalance, especially in the level of ATP in the muscle, which ultimately leads to a reduction in the number of myomeres due to excess ATP consumption. Effective stretching is achieved by using chloroethylene followed by passive traction on the affected muscle. Another method is post-isometric relaxation. Muscle strengthening is necessary because secondary muscle weakening occurs due to pain. But the load on compacted muscles should be gentle and not cause the appearance of satellite triggers in adjacent muscles.

Trigger point blockade

Trigger point blockade is the most effective direct action and inactivation of these points. Careful technique for performing the blockade is the main key to the success and effect of the blockade. The exact localization of the trigger zone is confirmed if it is possible to obtain a local convulsive reaction; however, this may not be obvious if the needle is piercing deeper muscles. Successful removal of a trigger point usually results in relaxation of the tight area. Dry needling is also possible, but injection of a local anesthetic (lidocaine or novocaine) is more effective. The administration of a local anesthetic allows for an immediate effect on the patient. The introduction of corticosteroids did not justify itself and did not allow obtaining a more lasting effect than an anesthetic. The possibility of using botulinum toxin is still being studied.

Drug treatment

Currently, there is no evidence that any medications are sufficiently effective for myofascial syndrome. NSAIDs and other analgesics can only reduce moderate pain. Antidepressants are indicated for patients with sleep disorders due to the central mechanism of their action. In addition, there is a certain effect when using muscle relaxants, which somewhat reduce muscle spasm.

Psychological methods

In severe cases of myofascial pain syndrome that do not respond to treatment, patients often become restless and depressed. These mood disorders should be treated accordingly. Persistent muscle stiffness increases the pain of myofascial trigger points and can often be effectively treated with biofeedback, behavioral therapy and relaxation-meditation techniques.

Myofascial pain syndrome is a special type of muscle pain associated with the formation of so-called trigger points in muscle tissue, the irritation of which causes unpleasant symptoms. This syndrome is one of the most common causes of chronic pain. However, it is often not recognized and is hidden under the guise of other diseases and pathological conditions.

There is an opinion among doctors that the main cause of muscle pain is. Undoubtedly, it can cause pain of varying intensity. But how then can we explain the fact that some people with severe degenerative-dystrophic changes in the intervertebral discs have no complaints, while other people with minimal manifestations of this process are bothered? Moreover, osteochondrosis is not cured, and muscle pain appears and disappears (in some patients even without treatment). What could this be connected with? Has the condition of the intervertebral discs improved? Or has the osteophyte resolved? Or has it disappeared? In order to understand this problem, below we will dwell in more detail on the causes, features of the course and treatment of myofascial syndrome.

Why pain occurs and what is a trigger point

Muscle pain occurs when trigger points are irritated - areas of spasmodic muscle tissue.

Myofascial trigger point is an area of painful compaction of muscle fiber bundles or sections of muscle fascia, palpation of which reproduces pain (both local and reflected in a distant area) and causes muscle contraction.

Its formation is associated with a whole cascade of pathological reactions. In this case, local muscle hypertonicity and fascial compaction are important. With prolonged and inadequate contraction of the muscle or its individual fibers, the fascia can shorten. This may cause a number of changes:

tense and compacted fascia compresses nerves and vessels, including venous and lymphatic, which leads to disruption of muscle tissue metabolism;
with prolonged muscle tension, lactic acid accumulates in them, which can also cause local soreness;
fascial tension in a pathological area can cause fascial tension in distant areas of the body (pain irradiation);
an increase in the concentration of calcium, which is not able to be adequately removed from the muscles under hypoxic conditions, contributes to their contraction and increased discomfort;
shortening of the fascia over the tendon can cause irritation of the nerve fibers coming from it, and as a result, relaxation of the muscle; shortening it above the muscle belly, on the contrary, can cause contraction of individual bundles of muscle fibers.

Distortion of impulses from tendons and muscle spindles leads to a reciprocal disruption of contraction in the antagonist muscle. As a result, the agonist muscles, due to the work of which this or that movement occurs, become weak and are late to work. And the synergistic muscles (providing assistance to the agonists) become overloaded, become hyperexcitable and begin to ache. Thus, the problem is localized in one place, and the pain occurs in another.

Predisposing factors

Such changes can occur against the background of a degenerative-dystrophic process in the intervertebral discs or without it. This is facilitated by:

staying in an uncomfortable position for a long time (for example, while sleeping, doing monotonous work);
overload of untrained muscles;
bruise or muscle strain due to an unsuccessful sudden movement;
muscle damage due to injury;
their overstretching or compression during prolonged immobilization;
rheumatological diseases (,);
neurological pathology (radicular syndrome);
increased load on the muscular system due to poor posture or asymmetry of limb length;
reflex muscle tension due to dysfunction of internal organs;
hypothermia;
various psychological effects (stress, anxiety, depression, unconscious desire to gain some benefit from one’s illness).

Of particular interest is the role of negative emotions in the formation of muscle tension and pain. As you know, changes in emotional background and stress affect muscle tone. In animals, these reactions are biologically justified. In case of fear or anger, they prepare the body to protect and save life. Adrenaline is released into the blood, causing the heart to contract faster, simultaneously increasing blood pressure and redistributing blood flow to maximize the supply of oxygen and nutrients to the muscles. This allows you to develop maximum muscle effort.

A person experiences a similar reaction during times of stress. However, when faced with unpleasant information, he tenses up internally, preparing for action, but often the latter does not happen. At the same time, physiological changes remain in the form of disturbances in the functioning of internal organs, compactions and muscle pain.

How does the syndrome manifest?

When trigger points located in the head, neck or upper limbs are irritated, a headache occurs.

Clinical manifestations of myofascial pain syndrome depend on the location of trigger points. If they are located in the sternocleidomastoid, temporal, and posterior neck muscles, the patient is bothered by a headache. When they are localized in the masticatory muscles, a person experiences facial pain. In this case, we can identify general criteria that allow us to suspect this type of pain syndrome in a patient:

local pain;
palpable tightness in the muscles;
the presence of an area of increased sensitivity in this area;
reproducibility of unpleasant sensations when the trigger point is irritated;
the presence of a certain irradiation of pain depending on the location of the trigger point;
limitation of range of motion;
increased pain after massage and warming;
reduction of pain with superficial cooling or injection of anesthetic into the muscle.

In addition, muscle pain is often accompanied by various sensory disturbances. Such patients complain:

for numbness;
increased fatigue;
muscle tension.

A combination of this pathology with emotional-vegetative disorders is often observed.

In clinical practice, it is customary to distinguish three phases of myofascial syndrome:

acute (constant excruciating pain, which is maintained by active triggers);
subacute (pain only occurs when moving);
chronic (muscle dysfunction with a feeling of discomfort).

How is it detected?

Diagnosis of myofascial syndrome is based on:

on complaints;
anamnesis data;
objective data obtained by the doctor during the examination;
results of additional research methods.

First of all, you need to make sure that the pain is not associated with a serious pathology, such as a tumor. In doubtful cases, the specialist will prescribe the necessary examination, including computed tomography or magnetic resonance imaging, laboratory tests.

It should be noted that this pathology can be hidden under the guise of other pain syndromes or combined with them. Therefore, it is not always easy to identify it. However, diagnostic criteria (described above) help to suspect the presence of muscle pain and assess the likelihood of myofascial pain syndrome in a patient. Electroneuromyography or ultrasound can be used to visualize trigger points.

Principles of treatment

Treatment of patients suffering from myofascial pain syndrome is aimed at eliminating pain and the cause that caused it. For this purpose, a combination of drug and non-drug therapeutic methods is used. The latter include:

physiotherapeutic effects (medicinal electrophoresis, magnetic and laser therapy, ultrasound therapy, electrical myostimulation, etc.);
reflexology;
passive stretching and massage of affected muscles;
manual therapy.

The following medications are effectively used:

muscle relaxants;
novocaine or lidocaine blockades;
compresses with dimexide;
tricyclic.

Which doctor should I contact?

To reduce pain, NSAIDs, muscle relaxants, and local anesthetics are used.

Treatment of myofascial pain syndrome is a complex process. Often the patient undergoes many consultations with doctors of different specializations. The closest of them to this pathology are rheumatologists. However, a competent vertebrologist, neurologist, massage therapist, osteopath, or orthopedist can also help the patient.

Myofascial syndrome (sometimes called “myofascial pain syndrome”) is something of a chameleon pathology. It is known in medicine under many names: Adams-Stokes, Adams-Morgagni-Stokes and Spence syndromes. Do you think the list is too short? No problem, we can continue:

extra-articular (muscular) rheumatism;
repetitive trauma syndrome (stress, sprain);
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”. Adding to the confusion is the fact that with such an extensive “pedigree” one cannot count on unambiguous definitions. As a result, quite “funny” situations happen when the doctor treats one problem, the pharmacy gives out medicines for the second, and the patient, answering a completely natural question “how is your health,” gives the classic “can’t wait” only because he himself doesn’t really understand, what is sick?

Myofascial pain syndrome in the understanding of some narrow-minded people is, as follows from the beginning of the article, an inexhaustible source for jokes. And patients themselves perceive pain in the back, lower back and shoulders with a certain humor. “What do I have? Everything is the same, muscles. Normal myofascial syndrome, no big deal.” But when a sharp, literally gut-wrenching pain hits a person, the jokes usually end.

The patient finds himself at the doctor’s and begins to “demand” effective and speedy treatment, without thinking at all that he 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 accustomed to the fact that health problems are an obvious reason to see a doctor, and not at all a reason to start independent 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 the person with harmless rubbing and massage.

The essence of the problem

If we approach the issue formally, then it can be argued that myofascial syndrome (MFS) is a tension of certain skeletal muscles, which causes sudden and sharp pain. People traditionally call this condition neuralgia, but this definition is fundamentally incorrect, although the symptoms of both pathologies are very similar. Myofascial pain syndrome (MPPS) is explained, as we have already found out, by muscle tension, and neuralgia by damage to the nerves.

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

increased muscle tone;
significant deterioration in contractility;
various vegetative pathologies;
the appearance of foci of reflected (radiated) 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 location for pain);
head (face, jaw, sometimes temporal region);
sternoclavicular joint area;
small of the back;
peritoneum;
lower limbs;
pelvic floor area (less common, but sometimes happens).

What conclusions can be drawn from this? Firstly, it is pointless to “stifle” unpleasant symptoms with analgesics for MFPS, since they are unlikely to do anything about the cause of the pain. Secondly, you can’t count on a quick recovery in this case either. 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, will have to be dealt with by a surgeon.

Types of trigger points

1. Active CT

When palpated, such a point manifests itself as an unpleasant compaction, and this applies to both of its states: rest and tension. An active TT is located in the place where the nerve enters the muscle, but the impulses generated by it can spread over a fairly large distance, which is why determining a clear localization of an attack is not always possible. Such a trigger not only causes sharp, explosive pain when pressed (the so-called “jumping 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.

Referred 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 CT

Unlike active triggers (points), latent ones are much more common. In a state of muscle relaxation, they may not remind you of their existence in any way, therefore their presence can only be determined at the moment of tension of the corresponding muscle. Palpation of latent TTs rarely provokes the occurrence of “jumping syndrome,” but patients feel the referred pain quite clearly (the symptoms are not as pronounced as when an active trigger manifests itself, but it is impossible to ignore them). Unfortunately, a latent trigger under certain circumstances (hypothermia, increased load on the problem muscle, uncomfortable body position) can transform into an active one.

Based on this, it can be argued that when treating MFPS, the doctor pursues two main goals: to relieve a painful attack (significantly reduce the severity of the influence of the active trigger) and to prevent the transformation of latent TP.

Reasons for the development of MBS and MFBS

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

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

2. Various diseases of organs and body systems:

myocardial ischemia with simultaneous involvement of the atrioventricular node in the pathological process;
coronary vascular diseases;
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 processes of aging of the body.

Risk factors

Symptoms

They depend entirely on the muscle in which the trigger point arose. 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 clear localization;
difficulty opening the mouth (no more than 1.5-2 cm versus 4.5-5.5 in normal condition);
clicking in the temporomandibular joint;
spread of pain to the teeth, pharynx, palate and ear;
decreased activity of the masticatory muscles and their rapid fatigue;
painful palpation;
problems with chewing and swallowing.

2. Possible symptoms

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

3. Location of trigger points

chewing muscles;
upper part of the trapezius muscle;
pterygoid bones;
area of the temporomandibular joint.

Neck

1. Localization of trigger points and pain

shoulder girdle and neck;
scalene muscles;
middle section of the sternocleidomastoid muscle;
area of the scapula and clavicle;
trapezius muscle.

2. Possible symptoms

dizziness and fainting;
various visual impairments;
tinnitus;
increased salivation;
rhinitis;
spread 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 area

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 area and lower part of the peritoneum.

Shoulder

1. Location of trigger points

active TTs: upper trapezius muscle;
latent TT: back and posterior region of the neck.

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

Lower limbs

thigh and calf muscles: pain in the knee or thigh area;
hamstring: aching sensation in the back of the thigh;
tibialis major or minimus: 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 sexual intercourse;
discomfort in the intestines.

Upper limbs

localization of trigger points: lower parts of the scapula;
Referred pain may spread to the arm and hand.

Diagnostics

MFPS is one of those few pathologies that are identified 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 you to visualize the area of spasm.

The most important diagnostic criteria for MFPS

muscle pain occurs after physical activity, being in an uncomfortable position or hypothermia;
periodically manifested referred pain (the result of compression or puncture of 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 there are appropriate indications)

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

Differential diagnosis

nonspecific cerebrovascular accident;
pulmonary embolism;
aortic stenosis;
vasovagal syncope;
blood clot in the heart;
hysteria;
stroke;
epileptic seizure;
pulmonary hypertension;
orthostatic collapse;
Meniere's disease;
hypoglycemia.

Treatment

When MFPS is advanced (and this is what doctors most often encounter), complex therapy is considered the most effective, rather than treatment based on a single method:

Goals and objectives of therapy

1. Elimination of the cause of pain

in case of poor posture: formation of a healthy movement pattern;
orthopedic correction;
treatment (strengthening) of the muscle corset;
for “short pelvis” syndrome: sit only on a “correctly” selected pillow;
if the cause of MFPS is in the ankle muscles: special orthopedic insoles.

2. Drug therapy (pain relief)

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

3. Complementary (alternative) treatment methods

acupressure;
pharmacopuncture and acupuncture;
manual therapy;
massage sessions (cupping is best);
osteopathy;
acupuncture;
hirudotherapy;
Dr. Tkachenko’s method (if symptoms do not go away for a long time).

4. Treatment for facial MFPS

Prevention

promptly treat any diseases of the musculoskeletal system;
provide conditions for normal, full sleep (ideally, a special orthopedic mattress);
avoid prolonged hypothermia, excessive muscle tension and stress;
remember the benefits of exercise: stretching, squats, stretching, bending;
give up effective, but far from 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.

Back pain, which has haunted us from time immemorial, is not always associated with the destruction of bones, which is certainly the imagination of suspicious people. Another mistake is linking any pain symptom to radiculitis. At the same time, the most common reason that makes people suffer, myofascial syndrome, still remains in the shadows.

Myofascial pain syndrome: symptoms and treatment

Let us remember that sciatica is always associated with the reaction of an irritated or inflamed nerve. But it very often happens that pain torments a person constantly from year to year, he undergoes all kinds of examinations, which can even reveal some small hernias. Sometimes they begin to be treated, mistakenly taking them for the source of pain, but such treatment does not lead to anything. It can’t be any other way—you can’t treat something that doesn’t exist. In this case, there is no compression of the nerve root due to the small size of the hernia, there is no inflammation, but the patient is prescribed an endless intake of painkillers that are harmful to health, and is prescribed standard therapeutic exercises for a hernia, which for some reason also turn out to be ineffective.

How to avoid making a medical mistake and on what basis you can suspect MPS - myofascial pain syndrome?

Causes of myofascial syndrome

Myofascial syndrome refers to a somatic and psychosomatic type of pain, that is, chronic spasm in the muscles and fascia can be caused by:

Mechanical, thermal or chemical irritation of the sensory endings of muscle, fascial and tendon fibers
Protective tension in the muscles surrounding the diseased organ
Spasms in paravertebral muscles in degenerative diseases of the spine
Stress, panic mood, depressed psycho-emotional state

Myofascial pain syndrome is an inevitable ally of nerve-radicular pain. This means that either a hernia with acute neurological manifestations also gives rise to MBS, and the doctor’s prescription of treatment with muscle relaxants in parallel with NSAIDs is completely justified here.

At the same time, there is no feedback - MBS often does not have an inflammatory-degenerative nature and is considered in a separate group of muscle pathologies in the classification

The causes of myofascial syndrome are always associated with muscle tension.

MBS of sensory nature

Irritation of soft tissue receptors is caused:

Physiologically incorrect postures maintained for a long time and leading to muscle fatigue:
- long periods of time at the computer or in the car
- same type of repetitive movements leading to overload of individual muscle groups, etc.
Overexertion due to deforming curvatures or congenital anomalies:
- scoliosis or kyphosis
- Scheuermann-Mau disease
- flat feet
- different leg lengths
- hip joint deformation, etc.
Discomfort during sleep:
- sleeping in an awkward position
- a bed unsuitable for night rest (a very hard or, conversely, “leaky” mattress)
Wearing a corset for too long, leading to muscle weakening
Constant contact with chemicals, being in an environment with harmful substances and fumes
Sudden temperature changes and hypothermia

MBS of a protective nature

Myofascial pain syndrome of a protective nature can be caused by the following diseases of internal organs:

In the thoracic region:

Angina pectoris
Myocardial infarction
IHD (coronary heart disease)
Pleurisy
Stomach ulcer

Muscles affected by MBS:

Major and minor pectoralis
staircase
Trapezoidal
Subclavian
Scapular

The presence of MBS in the thoracic region requires priority diagnosis of the chest organs.

In the lumbar region:

Ulcerative and gastritis diseases of the lower stomach, duodenum, small intestine
Pyelonephritis and other renal pathologies

These diseases cause spasms in the paravertebral muscles.

In the lumbosacral region:

Colitis
Urological and gynecological diseases

Pain from the pelvic organs is screened into the muscles of the pelvis, abdomen and sacrum

MBS in the cervicothoracic region is almost always combined with vegetative-vascular dystonia and is reflected:

Burning pain in the back of the head, frontal and temporal parts of the head
and even short-term loss of consciousness

This is explained by spasm of the vertebral artery passing through the cervical spine.

During acupuncture, the location of the points is fixed and determined according to the atlas
With myofascial acupuncture, such points are felt by the therapist when examining the patient’s muscles

If muscle spasms are of visceral origin and associated with neurotrophic disorders, then the surface of the skin above the trigger zone may be reddened.

Electroneuromyography for MBS is ineffective due to the lack of neurological reflexes.

Where to start treatment

Treatment of the syndrome, if it is not associated with serious diseases, begins with non-drug methods, adjusting:

Posture, scoliosis
A working or sleeping place, which is organized taking into account the anatomical characteristics of a person
The patient's lifestyle and nutrition
State of mind

In this way, the very factors that caused MBS are removed.

What is myofascial syndrome and what causes it? Many people think that the causes of back pain are uncomfortable body position during sleep, sudden movements or a cold. However, this is not entirely true. The above factors only lead to an exacerbation of existing pathology of the musculoskeletal system. Until this time, the disease occurred in a latent form. There are many more provoking factors than previously stated.

What is myofascial pain syndrome? This condition is interesting because it can be confused with most spinal pathologies. The pain with this disease is similar to that with a hernia, osteochondrosis or myositis.

What is MFBS?

Each human muscle is covered with a special sheath - fascia. These tissues are inseparable from each other; they function together and become inflamed at the same time. And it is necessary to treat diseases comprehensively. The fascia can shorten over time. This is especially common for people who lead a sedentary lifestyle. As a result, the membrane begins to compress the muscle, causing the latter to involuntarily contract. The muscle compresses blood vessels and nerve endings, but the main danger is tissue dysfunction. This pathological process is called fascial shortening.

In this case, the body engages in adaptive reactions. The functions of weakening muscles begin to be performed by healthier ones. However, they soon begin to weaken and be compressed. Gradually, the pathological process covers all the muscles of the back. In the early stages, this is manifested by changes in posture. Symptoms of later stages of fascial shortening include herniated and protruded intervertebral discs. When the body's compensatory capabilities are exhausted, pain appears. This is myofascial syndrome.

Clinical picture of the disease

Most pathologies of the musculoskeletal system have similar symptoms. Therefore, it is almost impossible to make an accurate diagnosis based on the intensity and localization of unpleasant sensations. Diagnostics should include various laboratory and instrumental research methods.

Myofascial pain syndrome begins to form in the thickness of the muscle, starting with minor spasms.
Gradually, the area covered by pathology increases.
The number of affected areas also increases.
The muscle fibers thicken and severe pain appears. They are called trigger points. The presence of such areas is a specific symptom of the disease. It is this that makes it possible to distinguish pain with MFPS from those with osteochondrosis or hernia.

A detailed examination helps make a final diagnosis.

Referred pain is felt in a place far from the source of inflammation. It can appear either alone or in combination with unpleasant sensations at trigger points. It is impossible to get rid of reflected pain until its true source is found. It helps to recognize the disease by the fact that each trigger point has its own area of influence - a pain pattern.

An experienced person can easily find sources and quickly eliminate them.

When talking about myofascial syndrome, we should not forget about the third symptom of autonomic dysfunction. These may include problems with breathing, sleep and thermoregulation. With the above disease, these signs are mild.

In the morning, there is a feeling of stiffness in the back, headaches, nausea, tinnitus, and causeless anxiety. The daily routine is disrupted, a person cannot sleep at night, and during the day he experiences lethargy and drowsiness.

In later stages, dysfunction of vital organs is possible.

In most cases, such symptoms are not associated with myofascial syndrome. Therefore, people turn to a chiropractor mainly with advanced forms of the disease.

What causes MFBS to develop?

If back pain occurs as a result of sudden movements, hypothermia or lifting heavy objects, its causes are obvious. The listed factors can indeed lead to the development of myofascial syndrome. Together they form a group of causes called acute muscle overload. There is also a chronic type. This may include dysfunction of the musculoskeletal system due to scoliosis, osteochondrosis or a sedentary lifestyle.

Other reasons include:

metabolic disorders;
obesity;
deficiency of calcium and vitamins;
iron deficiency anemia.

Some infectious diseases, smoking, alcoholism and drug addiction can also negatively affect the condition of the musculoskeletal system. The intake of any toxic substances leads to overstrain and inflammation of the muscles and fascia.

Hypothermia is an equally common cause of back pain. The muscles are responsible for producing heat in the body. Therefore, making various movements, a person quickly warms up, and when frozen, begins to tremble. Hypothermia promotes rapid involuntary contraction of fibers, which leads to their overload.

Few people would guess to connect back pain and psycho-emotional disorders. However, this factor turns out to be so obvious that it cannot be neglected.

The most common cause of myofascial syndrome is muscle imbalance. It develops against the background of chronic overload. It should not be surprising that such a condition can occur with physical inactivity. It is this that contributes to improper distribution of loads, which leads to pain.

Some believe that the imbalance is a contradiction between the antagonist muscles - flexor and extensor. However, this is not true. An imbalance is a discrepancy between the tonic and phasic muscles.

The former hold the spine in the desired position, the latter participate in movements. When walking, they must work synchronously. When a person is in a sitting position, only one muscle group functions. If you add problems with posture, the problem takes on a large scale. Static loads lead to overstrain of the tonic muscles, which causes them to thicken and become hard. Motor ones, on the contrary, weaken and lose their inherent functions. Sooner or later, muscle imbalance leads to the development of point spasms. Who treats myofascial syndrome and how does it happen?

Methods of treating the disease

The therapeutic technique is selected taking into account the cause and stage of the disease, the individual characteristics of the body and existing contraindications. There are basic, additional and restorative methods. Auxiliary ones are necessary to enhance the action of the main ones; health-improving ones restore lost body functions. The best results are observed with an integrated approach to solving the problem. However, treatment for myofascial syndrome of the sacral spine can take several weeks or even months.

The simplest and most effective is drug therapy. Therefore, if at the moment a person is not able to visit regularly, he should stop taking medications. Similar treatment can be carried out at home.

You should not endure the pain, citing the fact that tablets and ointments have a large number of side effects. The constant presence of unpleasant sensations causes much more harm to the body. It suppresses and depletes the nervous system. Over time, a person becomes depressed. This may seem surprising to people who are not familiar with the somatoform types of this mental illness. Even the slightest pain negatively affects the functioning of the nervous system, which leads to the fixation of a depressive state. A vicious circle arises: muscle overload - pain - muscle overload.

Unpleasant symptoms may have an increasing or paroxysmal character, over time they cover more and more areas. Therefore, it is necessary to get rid of pain by any means, the most accessible of which are massage and medication. Most often, doctors prescribe anti-inflammatory and painkillers. However, drug therapy should not be carried out for too long. Therefore, in advanced forms of myofascial syndrome of the cervical spine, it turns out to be ineffective. Treatment with folk remedies does not give a positive result.

It is considered more effective, but finding an experienced specialist is quite difficult. Therefore, often the price of an acupuncture session does not correspond to its quality. Do not rashly experiment with your health using alternative therapeutic methods. Physiotherapeutic procedures and physical therapy are additional methods of treatment.

Properly selected exercises can significantly alleviate the patient’s condition with lumbar myofascial syndrome. However, if you start implementing them prematurely, the likelihood of a new exacerbation increases many times over.

The most effective way to relieve pain. The hands of a specialist are the most sensitive instrument. No pills or ointments can restore the correct position of the vertebrae, but manual therapy can. Therapeutic procedures eliminate muscle tension and restore joint mobility. The most commonly used technique is myofascial release, which involves releasing tight muscles.