Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN

Nearly everyone experiences muscle pain from time to time, whether it is following a long walk with friends or after completing yard work for the first time in the spring. Muscles get overworked and the soreness that follows is a fairly common occurrence. This pain usually clears up within a couple of days and the bearer is back to action in no time at all. There are also chronic causes of pain that do not simply resolve within a few days and are often provoked with even light activities.

Myofascial pain syndrome (MPS) refers to pain and inflammation in the body’s soft tissues. MPS is a common, painful disorder that is responsible for many physician visits, and usually affects the muscles and the connective tissue that covers the muscles. Often is a chronic problem and it may involve either a single muscle or a group of muscles. MPS can affect any skeletal muscles in the body. There are 640 named skeletal muscles in the body and skeletal muscle accounts for approximately 50% of body weight. As you can see MPS can potentially be responsible for many cases of chronic musculoskeletal pain.

Myofascial pain can cause local or referred pain, tightness, tenderness, popping and clicking, stiffness and limitation of movement, autonomic phenomena such as a local twitch response in the affected muscle or muscles, and muscle weakness without atrophy. In some cases, the area where a person experiences the pain may not be where the myofascial pain generator is located. Specific “trigger” or tender points may be involved, sometimes in completely different areas, and these trigger points can refer pain to other areas of the body. Trigger points, which cause referred pain in characteristic areas for specific muscles, can restrict range of motion, and create a visible or palpable twitch response to local stimulation such as pressing or rubbing over the trigger point. These are classic signs of MPS. In addition to the local or regional pain associated with MPS, chronic sufferers also have higher incidence of depression, fatigue and behavioral disturbances.

Trigger points can be identified by pain that results when pressure is applied to an area of a person’s body. In the diagnosis of myofascial pain syndrome, four types of trigger points can be distinguished:

• An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is associated with a local or regional pain.
• A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point.
• A secondary trigger point is a highly irritable spot in a muscle that can become active due to a trigger point and muscular overload in another muscle.
• A satellite myofascial point is a highly irritable spot in a muscle that becomes inactive because the muscle is in the region of another trigger pain.

An active trigger point is an area that refers pain to a remote area in a defined pattern when local stimulation is applied. Satellite trigger points appear in response to a primary, active trigger point and usually disappear after the primary trigger point has been inactivated. Latent trigger points cause stiffness and limitation of motion but frequently there is no pain and latent trigger points are often found in asymptomatic individuals.

Myofascial pain may develop from a muscle injury or from excessive strain/strain on a particular muscle or muscle group, ligaments or tendons. This typically occurs after a muscle has been contracted repetitively during jobs or hobbies, and can also be caused by stress-related muscle tension. Causes may include but are not exclusively limited to:

• Poor Posture
• General Fatigue and Overworking Muscles
• Repetitive Motions (Jobs, Hobbies, Sports) and Muscular Injuries
• Medical Conditions (Including Heart Attack, Stomach Irritation)
• Lack of Activity (Such Immobilization After Injury)
• Chronic Fatigue and Regional Pain Conditions (Fibromyalgia)
• Stress and Anxiety
• Intervertebral Disc Injury (Herniation or Bulging)

Short-term muscle soreness, such as delayed onset muscle soreness (DOMS) is very common after starting a new exercise program or even following activities such as cleaning out the garage or raking leaves all afternoon. This type of soreness usually resolves after a few days. If your muscle pain persists despite rest, massage and similar self-care measures, then make an appointment with your doctor.

Treatment for myofascial pain syndrome may include medications such as pain relievers and muscle relaxers, and some have found that antidepressants and sedatives are also effective in certain populations. Trigger point injections involve injecting a numbing agent or a steroid into a trigger point and this can help relieve the pain. Physical therapy, relaxation and anti-anxiety techniques are also effective measures. Discuss your options and treatment preferences with your doctor. You may need to try more than one approach to find pain relief.

A physical therapist is a musculoskeletal expert and can devise a plan to help relieve or manage your pain based on your signs and symptoms. Physical therapy to relieve myofascial pain syndrome may involve:

• Stretching – Gentle stretching exercises may help to ease the pain in your affected muscle by triggering a relaxation response in the tight muscle.
• Strengthening Activities – Gentle strengthening may help to correct postural deviations that may be causing localized myofascial tightness and pain.
• Soft Tissue Mobilization and Massage to the affected muscle may help relieve your pain. This may include myofascial manipulation and varying amounts of pressure to assist with decreasing muscle tone.
• Heat/Ice – Applying heat or ice can help relieve muscle tension and reduce pain.
• Ultrasound – This type of therapy uses sound waves to increase blood circulation and warmth, which may promote healing in muscles affected by myofascial pain syndrome.
• Spinal Manipulation – Spinal manipulation may inhibit tone and create a relaxation/inhibition effect on affected muscles.
• Dry Needling – Dry needling is a process by which fine gauge solid filament needles are inserted into the symptomatic areas and trigger points to create tiny lesions in the underlying soft tissue and release trigger points respectively. These lesions stimulate the body’s natural response of healing by stimulation of the central nervous system to create an anti-inflammatory reaction.

You may find that no one approach is completely effective for eliminating myofascial pain syndrome but that several approaches may complement each other and allow you to manage this often debilitating condition and return to daily activities.

At Professional Rehabilitation Services we pride ourselves in distinction, and one of our Board Certified Orthopedic Physical Therapists will pursue an individualized treatment approach to your needs. We treat a wide variety of musculoskeletal conditions using the latest in evidence based therapies provided by highly credentialed physical therapists. In addition to being licensed physical therapists, our providers have additional specialty certifications and training in orthopedics, manual therapy, sports, strength and conditioning, vestibular treatment, and now dry needling. Less than 5% of physical therapists in South Carolina are board certified in orthopedics. All physical therapists at Professional Rehabilitation Services are board certified.

So if you or someone you know is having musculoskeletal pain and would like to know more about dry needling or other physical therapy options for myofascial pain, seek the consultation of a physical therapist at one of our three locations or see your physician for a referral to one of our facilities. For further information on this or other related topics you can contact Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside) (843) 831-0163 at Professional Rehabilitation Services, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, Brian P. Kinmartin PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, or, or visit our website at www.prsrehabservices.com where you can learn more about the company and even download a referral form for your physician to fill out. You can also call and schedule a free 15-minute consultation!