What is Myofascial Pain Syndrome, trigger point and It's 2 types?

Myofascial pain syndrome?

To understand myofascial pain syndrome The word myofascial is a combination of two words “myo” which means muscle and “fascial” which stands for fascia which is a connective tissue covering around the muscles. so in myofascial pain syndrome, the pain is present in muscle and its fascia. The syndrome is a collection of symptoms so if myofascial pain is not properly treated it leads to chronic pain (long-lasting pain up to years). 

The pain for a long time causes depression and sleep disturbance and muscle spasm also occurs. The main feature of this problem is the formation of trigger points in the muscle which causes unpleasant continuous pain in a specific region of the body. It is also called “regional pain syndrome''.

 Myofascial pain syndrome

Trigger points in myofascial pain syndrome:

A trigger point is actually a hypersensitive or hyperirritable spot in a muscle that causes pain on applying pressure. There is a natural mechanism for muscles to contract while we are doing any work and relax when work is done. In certain conditions where stress over muscles is greater some fibers of the muscles restrict relaxation and become taught. Due to tightness in muscle fibers, small hard nodules develop in the muscles which are called trigger points.

Pain pattern:

Trigger point pain is not in a specific location where the trigger point is present but usually referred to other parts of the body and involves the whole region like sternocleidomastoid (SCM) pain is present in the head and neck, hamstring pain refers to the whole leg like sciatica. Trigger points are present in many muscles of the body such as the bicep, tricep, neck muscle, and back muscles.

Types of trigger points:

There are two main types of trigger points:

1. Active trigger points have specific pain patterns. Unprompted pain occurs and refers to the whole region. Pain also occurs on the movement of the part.
2. Latent trigger points are only sensitive to touch. Normally remains dormant, the pain only occurs when you palpate the area where the trigger point is present.

Causes of myofascial pain Syndrome:

Many causes are responsible for trigger points formation and then lead to myofascial pain syndrome:

Trauma :

 Any type of injury, trauma, and surgery can cause trigger point formation due to immobilization. When a patient is on complete bed rest he is more prone to muscle weakness and active range of motion also decreases. Stress after trauma is also a factor responsible for trigger point formation so pain is produced on the movement of muscles.

Improper  weight lifting techniques:

When a person lifts overweight with improper lifting techniques then stress on the muscle causes band formation which develops trigger points.

Sedentary lifestyle:

The muscle becomes inactive and more vulnerable to strain when you attain a sedentary lifestyle. These weak muscles have more chances to develop trigger points.

Poor posture:

Poor posture like stooping too much while doing your office job or any other work, when bending your head toward your shoulder to hold your phone and many other bad postures put stress on your muscles and ultimately lead to developing trigger points.

Sustained posture: 

Sitting or standing for a long time such as teachers who take lectures while standing for a long period and orthopedic surgeons who stay for a long time in operation theaters are at more risk to develop tension in their muscles which can cause trigger points.

Repetitive activity:

Repetitive activities such as typing jobs, sports activities, and many other professions where you perform the same task, again and again, cause microtrauma to muscles as a result trigger points develop in the muscle.

Aging:

Aging plays a critical role in the development of trigger points because of muscle weakness. With increasing age strength of the muscles decreases and atrophy of the muscles also occurs.

People become less active with advanced age so they become more prone to stress at their muscles.

What is the Diagnosis of trigger points?

Diagnosis of a trigger point is made on the clinical history and physical examination alone. Sometimes physicians misinterpret the symptoms and ask the patient for an x-ray and MRI but the trigger point does not appear on any type of medical imaging.

What is the treatment for Myofascial Pain Syndrome?

Myofascial pain syndrome is treated by the following procedures:

1. Correct risk factors.
2. Trigger points release.
3. PNF techniques.
4. Muscle strengthening 

Correct Risk factors:

All the risk factors of myofascial pain syndrome should be avoided. Stress due to overload, posture abnormalities, overweight, sustained sitting or trauma should be minimized by adopting good posture, reducing weight, avoiding sustained posture (short period of rest between activities), and performing active or active-assisted exercises.

Trigger points release:

There are the following methods to eliminate trigger points:

• Spray and stretch is a physical therapy technique where a vapor coolant spray is applied on the region where trigger points are present. spray applied topically on the skin which works as anesthetic agent and decreases pain sensation. stretch on the muscle is applied after cooling the skin by spray so that muscle becomes lengthen and trigger points inactivate.
• Trigger point release/myofascial release is also a physical therapy technique where trigger points are removed by applying pressure over the trigger point to remove tension in the muscle and overlying fascia. In this technique first, a physical therapist applies a massage at a tight band of muscle and then stretches the muscle by applying pressure to release tension in the superficial group of muscles. the second method is to apply constant light pressure with fingers, thumb,elbow, or thenar eminence of hand and hold this for a few seconds and then release the pressure slowly. Repeat both procedures many times to remove trigger points.
• Dry needling is a Chinese method to inactivate trigger points by inserting a fine needle inside the trigger point so that tension in the muscle reduces which eliminates trigger points. It is an invasive procedure so proper technique is needed. Pain is reduced but there are many side effects like bruising, bleeding, pneumothorax, rupturing of structures passing nearby if the needle goes deep inside.
• Trigger point injection is also similar to dry needling but here a medicine which is a mixture of anesthetics and steroids is inserted into the trigger point by a syringe. It removes pain and inactivates trigger points but the risk factors are the same as for dry needling.

PNF techniques:

Contract, relax with passive or active stretch PNF technique is used to treat myofascial pain syndrome. In this technique, a therapist stretches the painful muscle to the available pain-free range and then asks the patient to contract the muscle isotonically for a few seconds and then relax. After relaxing the muscle for a few seconds the therapist applies stress again to gain new ROM. In this way, tight bands of muscle become lengthened and trigger points become inactive.

Muscle strengthening:

As inactive or weak muscles are more prone to develop trigger points so muscle strengthening exercises should be done to minimize the risk. Static Isometric exercises are best for traumatic bed-bound patients and for those who have a sedentary lifestyle. These are also suitable for people of advanced age as these exercises are safer than isotonic exercises.