Myofascial describes a symptom or treatment that relates to the connective tissue of the muscles -- the fasciae -- and the muscles themselves. Practitioners treat myofascial pain using myofascial release, physical manipulation aimed at relaxing the muscles and fasciae. Many events can cause myofascial pain, including physical strain, surgery, and inflammatory conditions that tighten the muscles. Often, people feel the pain from these knot-like constrictions at a different point in the body than the specific problem area. The release of these origins or "trigger points" can alleviate pain.
Fasciae (plural of fascia) enclose muscles and organs with a fibrous sheet. They are similar to ligaments and tendons but surround rather than join muscle tissue. Fasciae can become sensitive and tighten around the muscle, causing pain. These are the trigger points a massage therapist or other practitioner will "release" to help ease pain.
The strands of skeletal muscle we see in diagrams are actually muscle tissue wrapped in fasciae, made from a collagen-based material, that provides connective tissue for the muscle much as joints use tendons and ligaments. While the fascia helps the muscle do its job, the interaction between it and the muscle tissue can produce pain and difficulty using the muscle.
Trigger points are knots in the muscles, especially where the muscle and fascia interact. They often cause muscle pain and placing pressure on them or using other special techniques can alleviate that pain. It is up to the practitioner to identify the origin, however, as the pain is often referred or carried by nerves to other parts of the body. Direct interaction with the trigger points, such as massage, injections, or acupuncture, requires dedicated knowledge of what kind of pain is most often caused by which trigger points.
Some people with chronic muscle-related pain receive a diagnosis of myofascial pain syndrome. An important characteristic of this condition is sensitive trigger points that persist or get worse over time. Muscle pain treatments such as stretching and taking medications may help, but for this syndrome, addressing the trigger points is the key. Causes of myofascial pain syndrome include repetitive motions which contract the muscles, but stress-related muscle tension is also a common cause. For this reason, experts often prescribe relaxation techniques to prevent and lessen myofascial pain.
The lifestyles of most people subject the back, neck, and shoulders to both physical and emotional stress. Over time, trigger points can develop and cause various forms of back pain. Referred pain caused by these trigger points can make it difficult to discuss the source of the pain with a professional -- it seems to be all over. As trigger points are discovered, the practitioner can create a therapeutic plan that defines the source of this type of back pain and appropriate treatment.
Painful trigger points, the root of myofascial pain, usually arise from clenching motions such as the anxious holding of tension in the body or repetitive motions in work or hobbies that condition these bundles of fasciae and muscles to tighten and hold in place. Injuries can also cause these knots to form, whether from the accidents themselves or the necessary treatment, such as surgery.
Differential diagnosis of myofascial pain and fibromyalgia has come a long way since doctors first defined these conditions; diagnoses received decades ago may benefit from a review to adjust and improve treatment. The two conditions have many common symptoms such as loss of sleep, depression, anxiety, and bowel problems. One key difference between myofascial pain and fibromyalgia is the location of the pain. Myofascial pain is localized, while fibromyalgia pain generally occurs throughout the body.
Myofascial pain is not like a typical muscle injury which, with some basic treatment such as heat or massage, will often resolve over time. Rather, the condition tends to get worse over time as the knots in the muscle and fascia bundles continue to contract and produce pain. Activities and stress the cause the syndrome, if they are ongoing, will continue to exacerbate existing trigger points and possibly create more.
Myofascial release therapy is provided by a trained professional such as a massage therapist. This person has learned to locate the knots or trigger points which feel much harder than the surrounding soft tissue and muscle. These release points may be some distance from the referred pain the patient feels. Focused manual pressure helps release the tension in the knot and alleviate myofascial pain.
Acupuncture and direct injections of medication to relax the muscles or alleviate pain can help those with myofascial pain syndrome. Systemic administration of muscle relaxants and pain medications may relieve symptoms as well. A key component of treating myofascial pain syndrome and related conditions is a proper diagnosis so that a treatment plan and targeted therapy can begin.
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