MYOFASCIAL PAIN SYNDROME (MPS) AND FIBROMYALGIA
MYOFASCIAL PAIN SYNDROME (MPS) AND FIBROMYALGIA
by Ramon P. Datanagan, PTRP, Physical Therapist
Myofascial Pain Syndrome and Fibromyalgia – is a Chronic musculoskeletal pain of various etiologies affects many adults. Among these are Myofascial Pain Syndrome (MPS) and Fibromyalgia.
Myofascial Pain Syndrome
MPS, also known as chronic myofascial pain (CMP) presents with pain in muscles or fascia (a type of connective tissue that surrounds muscles). This pain occurs in distinct, isolated areas of the body. Because any muscle or fascia in the body may be affected, this may cause a variety of localized symptoms. MPS is characterized by myofascial contraction and trigger points (“knots”) in muscles that may be visible or felt beneath the skin. The pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest. These “knots” or fibrous muscle bands are most commonly located in the upper trapezius, rhomboids and paraspinals.
Characteristic features of a myofascial trigger points include focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure. Generally speaking, the muscular pain is steady, aching, and deep. Depending on the case and location the intensity can range from mild discomfort to excruciating and “lightning-like”.
The causes of MPS are not fully documented or understood. Some systemic diseases, such as connective tissue disease, can cause MPS. Poor posture and emotional disturbance might also instigate or contribute to MPS.
There are multiple interventions for MPS including NSAID’s and trigger point injections; however, stretching, and activity are most effective in the management and prevention of MPS. Physical therapy techniques, such as myofascial release. involving gentle fascia manipulation, may improve or remediate the condition. Gentle, sustained stretching exercises within a comfortable range of motion have been shown to decrease pain thresholds, hasten recovery of full range of motion, and improve motor coordination. Regular, non-intense activity is also encouraged. Once the trigger points are gone, muscle strengthening exercise can begin, supporting long-term health of the local muscle system.
Posture evaluation and ergonomics may provide significant relief in the early stages of treatment. Movement therapies may also be helpful.
FIBROMYALGIA
Prevalence of fibromyalgia is approximately 2% to 4%, most commonly affecting women. Unlike MPS, fibromyalgia presents with widespread muscular pain, headache, fatigue, sleep disturbances, and memory/cognitive problems. Working women with fibromyalgia who are hospitalized for chronic musculoskeletal issues were almost 10 times less likely to return to work and 4 times less likely to retain work 1 year post hospitalization.
Patients with fibromyalgia should engage in low-intensity aerobic exercise combined with gentle stretching. Maintaining function in day-to-day activities is the main goal. In this condition, the most limiting factor is pain. Aerobic exercise decreases pain levels, thereby improving function and quality of life. 25 minutes per day, three times a week of aerobic training, with average intensity of 50%, decreases the number of tender points and painful body surface area.
It has been shown that there is a linear relationship between the number of steps taken per day, and relief from symptoms of fibromyalgia. A minimum of 5,000 additional steps per day is highly recommended. Increased physical activity was associated with decreased perception of pain in women with fibromyalgia.
Patient education and cognitive therapy is also an important aspect in the management of fibromyalgia. Patients should be counseled on how to prioritize their time to achieve a balance among work, daily Responsibilities, and leisure.
Role of Physical Therapy
Physical therapy for patients with Myofascial Pain Syndrome focuses on correction of muscle shortening by targeted stretching, strengthening of affected muscles, and correction of aggravating postural and biomechanical factors. Modalities/ machines can be useful in decreasing pain, allowing the patient to participate in an active exercise program. A physical therapist can devise a plan to help relieve your pain based on your signs and symptoms. Various techniques and procedures, including the following, have been demonstrated to be effective in some patients.
Heat – Applying heat, via a hot moist pack wrapped in several layers of towel are applied directly on the exposed area That needs treatment. This relaxes tight muscles and tissues, decreasing pain caused by muscle tension or spasms and vasodilatation of the blood vessels which increases circulation to the area.
Therapeutic Ultrasound – is a form of acoustic vibration propagated in the form of longitudinal compression waves at frequencies too high to be heard by the human ear. This machine provides deep heating to soft tissue structures in the body. Increasing tissue temperature with ultrasound also help to reduce the pain and increase the -stretchiness” of the muscles. Another technique in using therapeutic ultrasound is called Phonophoresis wherein an ultrasound beam can drive a substance (like medicine in an ointment form) dissolve or suspended in a coupling form through the skin.
Electrical muscle stimulation (EMS) using low-frequency transcutaneous electrical nerve stimulation (TENS) – a small machine wherein you connect two electrodes (wires that conduct electrical current) from the machine to the skin. When the current is delivered, this causes less pain because the electricity from the electrodes stimulates the nerves in the affected area and sends signals to the brain that block or “scramble” normal pain signals. Another theory is that the nerves may help the body to produce natural pain killers called endorphins, which may block the perception of pain.
Stretching – gentle passive stretching (stretching assisted by a Physical Therapist) lengthens the tissues, improving the range of motion and overall ability to move. Stretching the muscles and connective tissues can also help relieve muscle stiffness.
Myofascial release /therapy using trigger-point release techniques may be effective in short-term pain relief. Once the trigger points are gone, muscle strengthening exercise can begin, supporting long-term health of the local muscle system. Myofascial release involves gentle fascia manipulation may improve or remediate the condition.
Posture training – Posture evaluation and ergonomics may provide significant relief in the early stages of treatment. Improving your posture can help relieve myofascial pain, particularly in your neck. Exercises that strengthen the muscles surrounding your trigger point will help you avoid overworking any muscle.
Optimal treatment of myofascial pain syndrome can be a multifaceted approach. This can include education of the patient, stress re duction, stretching and exercise programs as well as physical therapy/rehabilitation, sleep Improvement, and medications all best organized by physician who tailors the therapies Over time by customizing there fur the individual patient.
The Palawan MMG Multipurpose Cooperative Hospital Physical Therapy and Rehabilitation Unit is well equipped with all the machines/modalities needed in treating our patients with MPS or Fibromyalgia.