The Hidden Source of Muscle Pain and Soft Tissue Pain

By Stephen Akamine

Neck muscle painWhy is it called a hidden source of Muscle Pain and Soft Tissue Pain?

There is a source of Muscle Pain and Soft Tissue Pain that can be difficult to pinpoint, because the pain is felt in a location that is not the source of the problem, and if not treated properly is oftentimes difficult to resolve. That is why it has been deemed as a “Hidden Source of Pain”. This hidden source of pain is known as Myofascial Pain or Myofascial Pain Syndrome.

What is Myofascial Pain?

If it feels like your muscles are literally in knots, and pressing on those knots creates pain someplace else on your body, then you are more than likely experiencing Myofascial Pain, also known as Myofascial Pain Syndrome. The prefix “Myo” means muscle, and the suffix “Fascia” means connective tissue, therefore the word “Myofascial” translates to muscle and connective tissue. The word “Syndrome” basically means a group of symptoms. In essence, Myofascial Pain Syndrome literally means muscle and connective tissue pain symptoms. Myofascial Pain Syndrome is directly related to and associated with Trigger Points.

What is the definition of a Trigger Point?

Trigger Points are extremely irritable knots in taut bands of muscle and connective tissue that can produce tenderness, a “twitch response” in part of the soft tissue, and a neurological phenomenon of referred pain to different locations of the body when external pressure is placed upon them, hence the term “Trigger Point”.

What are some descriptions of the response generated by putting external pressure on a Trigger Point?

When external pressure is exerted upon a Trigger Point, the descriptions of the result of that pressure vary according to the patient, the source of the problem, and where the symptoms are referred to. Some symptoms have been labeled as being tender, burning, searing, itching, tingling, twitching, and electrical in feeling.

Where can Trigger Points be found?

Trigger Points can be found in many different types of soft tissue such as muscle, tendon, ligament, skin, scar tissue, and joint capsules. Trigger Points can be caused by other trigger points, direct trauma to soft tissue, infection, disease, radiculopathy-nerve root pain, repetitive stress injury, smoking, or psychological distress. Trigger points also inhibit blood flow, which can make the pain worse unless treated. Trigger Points have different characteristics, qualities and predictable pain patterns that can overlap and require extensive and often intensive treatment to eliminate them.

What are the characteristics of Trigger Points?

Active Trigger Points actively refer pain along nerve pathways locally, or to adjacent locations. Latent Trigger Points only refer pain when some type of pressure or force is placed upon the trigger point itself or to the soft tissue structure where the latent trigger point is located. Key Trigger Points have pain referral patterns that activate or create a Latent trigger point along a nerve pathway. Key trigger points also activate “Satellite Trigger Points” in other soft tissue structures. Both must be treated in order to alleviate both sources of pain. Primary trigger points may activate Secondary trigger points in other structures, and again, both must be treated in order to alleviate both sources of pain.

What treatment options are available for Myofascial Pain Syndrome?

Depending upon the health or medical practitioner, treatment options include low-level laser therapy, ultrasound, dry needling, injections, spray and stretch using a vapocoolant spray, electrostimulation, ischemic compression, and medical massage therapy emphasizing the specified treatment of trigger points. Stretch and spray technique is when the muscle and trigger point are sprayed with a coolant, then the muscle is slowly stretched. Injections of Lidocaine can be performed by Physiatrists, but keep in mind that Muscle Soreness is a common side effect for that technique and many others.

What is an effective and proven treatment method for Myofascial Pain?

Highly Skilled Medical Massage Therapists apply a combination of Myofascial Release, Quasi-Static Pressure, Muscle Energy Technique, and Counterstrain to get rid of Myofascial Pain while minimizing the effects of Muscle Soreness. Myofascial Release stretches and loosens the Fascia so that your body can move freely, removing pain and restriction. Quasi-Static pressure works within the patient’s pain tolerance. Muscle Energy Technique and Counterstrain work on sensors in soft tissue known as “Proprioceptors” to relax muscles, tendons, and ligaments.

What does Myofascial Pain Syndrome and Trigger Points represent, and is it enough just to directly treat either condition?

It is important for all of us to understand that Myofascial Pain Syndrome and Trigger Points represent the effect of a problem or problems, and not the cause of a problem. This means that Myofascial Pain or Trigger Points were created by “something”, and that “something” most commonly is some kind of soft tissue injury. In most cases, the injury is caused by repetitive stress, trauma, or weakness. This means that we must look beyond the direct treatment of Myofascial Pain or Trigger Points if we are to truly resolve both the cause and effect of the problems we are experiencing, or we will more than likely have to treat the same conditions over and over again.

What will help to ensure that Myofascial Pain and Trigger Points don’t return after they are treated?

If repetitive stress is the cause of the problem, then the source of that repetitive stress must be alleviated to provide for a rehabilitative environment, or healing will never take place. Weakness is usually a very big cause of the problem, and if strengthening of the wrong muscle groups are taking place in the belief of solving the problem, then that will only serve to make the problem worse, not better. Likewise, lengthening and stretching already overstretched Muscle Groups will make muscles that are already weak even weaker.

What should be done prior to treatment for Myofascial Pain?

A Diagnostic Pain Assessment conducted by a skilled Medical Massage Therapist that consists of tests for Soft Tissue Palpation, Muscular Strength, Muscular Weakness, AROM-Active Range of Motion, PROM-Passive Range of Motion, and RROM-Resisted Range of Motion should be conducted prior to treatment for Myofascial Pain and Trigger Points. The results of the Assessment will determine the most effective treatment plan for muscles and soft tissue that need to be strengthened, and shortened soft tissue structures that need to be lengthened, as well as providing the Therapist with a “Map” of the Trigger Points and soft tissue dysfunction that was encountered.

What should be done at home to enhance the effective treatment of our soft tissue problems?

Myofascial Pain Syndrome cannot be treated solely and effectively by a healthcare practitioner, if repetitive stress, muscle weakness, and shortened musculature is the cause of the problem. A Myofascial Pain patient will benefit from applications of hydrotherapy, stretching and strengthening, and self-trigger point therapy at home to prevent reoccurrence of trigger point restriction, increase blood flow, maintain flexibility, and promote healing.

What then is the best overall treatment approach to Myofascial Pain Syndrome?

An organized, multi-faceted treatment approach, put together by a highly skilled Medical Massage Therapist, based upon the results of a Diagnostic Pain Assessment, Cutting Edge Medical Massage Therapy, and At-Home Rehabilitation is the very best way to ensure that the Myofascial Pain and Trigger Points we are experiencing will be effectively “eliminated” and will never bother us again.


About the Author:
Stephen Akamine is highly regarded as one of the top Licensed Medical Massage Therapists in the State of Hawaii. You can find Myofascial Pain Information and information about soft tissue treatment for pain at his online resource center.

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