Myofascial Pain Syndrome

What is it?

Myofascial pain syndrome is a regional pain condition arising from the muscles and the connective tissue that surrounds them (fascia). The pain comes from structures known as trigger points: hyperirritable spots on a tight band of muscle that are tender when pressed and often refer pain to a distant area. For example, a trigger point in the trapezius muscle at the top of the shoulder can refer pain to the side of the head and the temple, causing a headache.

There are two types of trigger point. Active trigger points cause pain on their own. Latent trigger points do not cause pain by themselves but hurt when pressed, and they can still lead to muscle stiffness and restricted movement. Myofascial pain is most common in the muscles of the neck and shoulders, around the shoulder blades, and in the lower back and hips; when it involves the jaw muscles, it can cause jaw and facial pain.

Myofascial pain is a common cause of muscle pain and often forms part of the picture in neck pain, low back pain or shoulder and arm pain.

What causes it?

How trigger points develop is not fully understood, but overloading a muscle, or using it in an awkward way, is thought to be the key factor. The main causes and risk factors are:

• Repetitive movements and overuse: work, hobbies or sports that repeatedly strain the same muscle group.
• Poor posture and long periods in one position: desk work, looking down at a screen or phone, or an unsuitable pillow.
• Sudden strain or injury: heavy lifting, a fall or a road traffic accident.
• Stress and anxiety: these can lead to muscles being held tense without you noticing.
• Sleep problems and inactivity: both make it harder for muscles to recover.
• Associated conditions: thyroid problems, some vitamin and mineral deficiencies, or joint and spine problems can help to keep the pain going.

If these perpetuating factors are not addressed, trigger points can return despite treatment.

How is it diagnosed?

Diagnosis is based on the history and examination. The doctor feels the painful muscle; finding a tight band and a tender spot, and reproducing the patient's familiar pain by pressing on it, supports the diagnosis. Sometimes a brief twitch of the muscle (a local twitch response) can be seen when the trigger point is touched.

No blood test or scan can show myofascial pain. Scans and blood tests are requested when other conditions that cause similar symptoms need to be ruled out, such as nerve compression from a disc herniation in the neck or lower back, joint disease or thyroid problems. If the pain has spread to many parts of the body and comes with tiredness and sleep problems, fibromyalgia is also considered; the two conditions can occur together.

Treatment options

Treatment aims to deactivate trigger points, restore the muscle's normal flexibility and strength, and correct the factors that keep the pain going. It combines approaches that complement each other, and the patient's active involvement makes a real difference to the outcome.

Conservative care

• Addressing perpetuating factors: an ergonomic workspace, better postural habits, regular breaks and stress management.
• Physiotherapy and exercise: stretching, strengthening and posture training form the basis of treatment. Manual pressure on trigger points, massage techniques, heat and TENS (transcutaneous electrical nerve stimulation) can be used in support.
• Medication: short courses of anti-inflammatory painkillers and, where needed, muscle relaxants may be used. For long-standing pain, certain antidepressants that can help with pain and sleep may be considered at low doses.
• Sleep and relaxation: better sleep habits and relaxation techniques help to reduce muscle tension.

Interventional pain treatments

If clear trigger points persist despite physiotherapy and exercise, or pain makes it difficult to keep up an exercise programme, a trigger point injection may be considered. A small amount of local anaesthetic is injected into the trigger point with a fine needle to help the tight band relax and the pain ease. For deep muscles, or areas close to the lining of the lung, the procedure can be performed under ultrasound guidance.

Continuing with stretching and physiotherapy after the injection is important to make the most of its effect. In suitable patients, trigger point injections can provide a meaningful reduction in pain and make rehabilitation easier, although how long the effect lasts varies from person to person. An injection does not replace exercise and postural changes, and its possible risks are discussed in detail beforehand.

Preventing recurrence

Myofascial pain tends to come back if the habits that triggered it continue. Regular stretching and strengthening, frequent breaks at work, a screen and chair set up to suit your body, and skills for managing stress all reduce the chance of the pain returning.

When should you see a doctor?

See a doctor if your muscle pain is not easing after a few weeks, keeps coming back, disturbs your sleep or comes with headaches. An algology (pain medicine) specialist will look for trigger points, check whether there is another cause for the pain, and draw up a plan that includes physiotherapy and, where needed, injections; you can request an appointment through our contact page.