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Myofascial Pain – Causes, Symptoms and Treatment

Myofascial pain is a chronic muscle pain condition caused by sensitive trigger points within muscle tissue. It commonly affects the neck, shoulders, and back.

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Myofascial pain is a chronic muscle pain condition caused by sensitive trigger points within muscle tissue. It commonly affects the neck, shoulders, and back.

What is Myofascial Pain?

Myofascial pain refers to persistent or recurring pain originating from muscle tissue and its surrounding connective tissue layer, known as the fascia. Myofascial pain syndrome (MPS) is one of the most common causes of musculoskeletal pain and can affect people of all ages. A key characteristic of this condition is the presence of locally tender areas within a muscle, called trigger points, which can produce referred pain in distant body regions when pressure is applied.

Causes

Myofascial pain can be triggered or aggravated by a variety of factors:

Muscle overuse: Repetitive one-sided movements, such as those from desk work or physical labour
Acute injuries: Strains, contusions, or trauma leading to muscle tension
Poor posture: Prolonged unfavourable body positions, especially in the neck and shoulder region
Stress and psychological burden: Emotional stress can lead to unconscious muscle tension
Nutritional deficiencies: Lack of vitamins (e.g. vitamin D, B12) or minerals (e.g. magnesium) can impair muscle function
Sleep deprivation: Insufficient sleep reduces muscle recovery and regeneration

Symptoms

The symptoms of myofascial pain syndrome are diverse and can significantly impact daily life:

Tenderness at specific muscle points (trigger points)
Referred pain to neighbouring or distant body areas (referred pain)
Muscle weakness and restricted range of motion
Tension headaches, especially when the neck and shoulder muscles are involved
Tingling or numbness in the arms or legs
Sleep disturbances caused by persistent pain
General fatigue and difficulty concentrating

Diagnosis

The diagnosis of myofascial pain syndrome is primarily clinical, as standard laboratory tests and imaging studies are typically unremarkable.

Physical Examination

The clinician systematically palpates the affected muscles to identify active trigger points -- hardened, pressure-sensitive nodules within the muscle that reproduce the characteristic referred pain when compressed. The range of motion of the affected body region is also assessed.

Differential Diagnosis

It is important to distinguish myofascial pain syndrome from similar conditions such as fibromyalgia, in which pain is diffuse and widespread, or from radicular pain syndromes caused by nerve root irritation. Blood tests or imaging (MRI, ultrasound) may be used to rule out other underlying causes.

Treatment

Treatment of myofascial pain syndrome is multimodal, aiming to deactivate trigger points, restore muscle function, and provide lasting pain relief.

Physiotherapy and Manual Therapy

Physical therapy forms the cornerstone of treatment and may include:

Trigger point massage: Targeted pressure applied to trigger points to deactivate them
Stretching and mobilisation: Improving muscle flexibility and fascial elasticity
Heat therapy: Relaxing tense muscles through the application of heat
Dry needling: Insertion of fine needles directly into trigger points without injection of any substance

Pharmacological Treatment

For significant pain, the following medications may be considered:

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac for pain relief
Muscle relaxants to reduce muscle tension
Local anaesthetic injections directly into trigger points (trigger point infiltration)
Antidepressants (e.g. tricyclic antidepressants) for chronic pain with associated sleep disturbances

Additional Therapeutic Approaches

Psychotherapy and stress management: Addressing emotional stress as a contributing factor
Acupuncture: May contribute to pain reduction
Occupational therapy: Adapting the workplace and daily habits
Exercise: Regular moderate physical activity to prevent recurrence

Prognosis and Prevention

With consistent treatment and modification of contributing factors, the prognosis for myofascial pain syndrome is generally favourable. Preventive measures include ergonomic workplace design, regular movement breaks, stress management, and a balanced diet. Left untreated, the condition can become chronic and substantially reduce quality of life.

References

Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Williams and Wilkins, 1999.
Gerwin RD. Diagnosis of myofascial pain syndrome. Physical Medicine and Rehabilitation Clinics of North America. 2014;25(2):341-355.
World Health Organization (WHO). Musculoskeletal conditions. Available at: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (accessed 2024).

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