Module 2: Understanding Myofascial Pain and Dysfunction

Objective:

Explore the pathophysiology of myofascial pain and identify key indicators of fascial restriction in clinical assessments.

Content:

1. Definition of Myofascial Pain and Differentiation from Other Types of Musculoskeletal Pain

Myofascial pain is a chronic pain disorder that originates from myofascial tissues, which include muscles and the surrounding fascia. It is characterized by pain and tenderness in localized areas, commonly referred to as “trigger points.” These areas of hyperirritability within muscle and fascia can cause referred pain patterns, which means pain is felt in regions distant from the actual site of the trigger point (Simons et al., 1999). Unlike joint or nerve-related pain, myofascial pain is often described as deep, aching, and difficult to localize. Understanding this distinction is critical in practice because myofascial pain responds differently to treatment than other types of musculoskeletal pain, such as inflammatory or neuropathic pain (Travell & Simons, 1999).

Trigger points are often classified into two categories: active trigger points, which cause pain at rest and limit range of motion, and latent trigger points, which may not cause noticeable symptoms until palpated or activated by specific movements (Simons et al., 1999). Differentiating these characteristics helps practitioners provide targeted and appropriate interventions.

2. Mechanisms Contributing to Myofascial Pain

Several physiological mechanisms contribute to myofascial pain, including the presence of trigger points, ischemia, and inflammation within restricted fascia. Research suggests that trigger points form when muscle fibers remain in a contracted state due to abnormal neuromuscular activity, which restricts blood flow and creates local hypoxia (Shah et al., 2015). This ischemic environment leads to the release of biochemical substances, such as substance P and calcitonin gene-related peptide, which activate nociceptors and contribute to a cycle of pain and muscle tension (Shah et al., 2005).

Additionally, inflammation in restricted fascia may play a role in myofascial pain. Inflammatory mediators are commonly found at the site of active trigger points, causing localized pain and increased sensitivity in the affected area (Dommerholt et al., 2006). This inflammation, combined with restricted blood flow, can lead to a heightened state of sensitivity in the muscle and fascia, creating a feedback loop that perpetuates pain (Borg-Stein & Simons, 2002).

The integrated hypothesis of myofascial pain proposes that both mechanical and biochemical factors interact in a way that perpetuates trigger points. According to this model, repeated or sustained muscle contractions lead to a cycle of ATP depletion, triggering contracture in muscle fibers and pain perception through mechanical and chemical changes (Shah et al., 2015). Understanding these mechanisms is essential for developing effective treatments that break this cycle of pain and dysfunction.

3. Tools and Techniques for Assessing Myofascial Restrictions

Accurate assessment of myofascial restrictions is key to designing effective treatment plans. Various assessment tools and techniques can help clinicians identify areas of fascial tightness, muscle tension, and trigger points:

• Palpation: Palpation is a primary technique used to detect trigger points and areas of tension within the fascia and muscle. Practitioners use their hands to locate taut bands and nodules, which may elicit referred pain patterns when pressed. Sensitivity to touch, along with the presence of tender points, can indicate active trigger points (Simons et al., 1999).
• Movement Analysis: Analyzing movement patterns helps practitioners observe compensations and limitations that may stem from myofascial restrictions. Restricted fascia can limit joint range of motion, alter muscle activation patterns, and create compensatory movements that can lead to further dysfunction if not addressed (Huijing, 2009).
• Visual Assessment: Visual assessment of posture and alignment can reveal asymmetries and imbalances associated with myofascial dysfunction. Patients with chronic myofascial pain often exhibit postural deviations, such as forward head posture or pelvic tilt, which may contribute to the development of myofascial restrictions (Dommerholt & Huijbregts, 2011).

By combining these assessment methods, practitioners can more accurately identify myofascial restrictions and plan targeted interventions to release tension, improve mobility, and alleviate pain.

Key Learning Outcome:

Practitioners will be able to assess and identify myofascial restrictions accurately, facilitating targeted interventions that address underlying dysfunction and enhance patient outcomes.

References

1. Borg-Stein, J., & Simons, D. G. (2002). Myofascial pain. Archives of Physical Medicine and Rehabilitation, 83(3), S40-S47. doi:10.1053/apmr.2002.32155
2. Dommerholt, J., & Huijbregts, P. A. (2011). Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management. Jones & Bartlett Learning.
3. Dommerholt, J., Bron, C., & Franssen, J. (2006). Myofascial trigger points: An evidence-informed review. Journal of Manual & Manipulative Therapy, 14(4), 203-221. doi:10.1179/106698106790819168
4. Huijing, P. A. (2009). Epimuscular myofascial force transmission: A historical review and implications for new research. International Society of Biomechanics in Sports Conference Proceedings, 28, 1-11.
5. Shah, J. P., Thaker, N., Heimur, J., Phillips, T. M., & Gerber, L. H. (2015). Myofascial trigger points then and now: A historical and scientific perspective. Archives of Physical Medicine and Rehabilitation, 96(9), 1734-1752. doi:10.1016/j.apmr.2015.04.028
6. Simons, D. G., Travell, J. G., & Simons, L. S. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins.
7. Travell, J. G., & Simons, D. G. (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: Upper Half of Body. Lippincott Williams & Wilkins.