Myofascial pain PDF Print E-mail

The concept of myofascial pain is a relative new concept and refers to pains in the muscles and tendons. These types of pains are the exceedingly common: approximately 70-80% of all patients who suffers  pain, suffers from myofascial pain. A majority of people end up living  a very poor quality of life due to being in pain. The good news is that there now is a way of treating this kind of pain, and greatly improve the level of pain, even curing and eliminating the pain.
In 1983, Dr. Travell (known amongst other things for treating President Kennedy) published her book with Dr. Simons “ Myofascial Pain and Dysfunction, the Triggerpoint Manual”. This book combines almost all current knowledge on these pains, and has become the reference book for this subject. It was Dr. Travell, together with Dr. Simons, that created the concept ‘triggerpoint’. The pain is concentrated in small ‘points’ in the muscle. These points are painful when pressed and feel like hard lumps inside the muscle. The muscle fibres are in permanent contraction and suffer from isquemia, and an energy crisis. In daily practice these points can be detected by palpation, and cannot be seen with imaging tools such as magnetic resonance or other scanners. Blood tests also don’t work.
Muscles and tendons have for a long time been omitted as a subject in medical education. Very few doctors know much about the new possibilities for treatment. Doctors, in general, work with x-rays and images from other scans. Thus, things that show up in scans, such as arthrosis and prolapsed discs get the blame for the pain. This leads to an erroneous belief that the pain cannot be relived, that it is chronic, and can only be managed and calmed down by medication. In so many cases, this is not the case! The pain originates from the muscles and tendons around the joint and can be cured/eased with the new treatment methods.
Myofascial pain is the cause behind many different diagnoses, such as: Arthrosis, Bursitis, Ischias syndrome, Lumbago, Frozen shoulder, Tendinitis, Fibromyalgia, Tennis elbow, Tension neck, Herniated disc etc.
This is a typical example: A patient gets pain around his hip joint. The x-ray study shows some arthrosis of the joint. As treatment he receives anti inflammatory pain medication and possibly instructions for physiotherapy. Only a very small percentage of patients are cured with this treatment. The pain continues, the tablets alleviate the situation slightly, but do not cure it. The pain increases after strain and becomes chronic. Because it is not possible to fix the wear in the joint, we think that the pain too will remain. However, this is not the correct conclusion since in most cases; the pain is due to the soft tissues not the joint itself. Therefore, after a few sessions of specific treatment with this innovative method, the pain often disappears (although the arthrosis remains!).
The treatment is directed at the so called trigger points which are  inactivated. Efficient treatment combines several methods. The goal is to re-establish the metabolism and the normal function of the affected tissue. One of the most efficient treatments begins by infiltrating the triggerpoints with a weak local anaesthetic solution (sometimes with a corticoid). The infiltration reduces the pain, increases the circulation and relaxes the muscle and even rinses the tissues of toxic metabolites such as lactic acid. After infiltration the use of apparatus such as ultra sound or laser can help to relax the tissue. A very important part of the treatment is the manual massage and stretching of the tissue, which releases the localised spasms, and returns the normal function of the tissue. Usually this needs several treatment sessions. Normally 4 to 6 treatments, of 45-50mins each will be enough.
Almost as important as the treatment of the pain, is accessing and rectifying the ergonomics of the patient. Many needs to learn about the importance of body posture and how to use the body correctly. Rectifying bad postures and poor working habits will help to prevent the condition reoccurring in the future.


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