- What is a disease?
- What causes the pathological process?
- What are the methods of diagnosis and treatment of the disease?
Myofascial pain syndrome is a neurological disease characterized by reflex pains that form in the muscles and adjacent fascias. According to the international classification of the ICD 10, the disease refers to the pathology of the periarticular soft tissues. Myofascial syndrome manifests itself in response to changes in ligaments, joints, intervertebral discs, internal organs. It is characterized by increased tonus( hypertonus) of muscle fibers of non-inflammatory nature. Progression of the disease leads to the defeat of new muscle groups, which aggravates the course of the pathology and worsens the prognosis for recovery.
What is a disease?
Myofascial syndrome occurs quite often in neurology. It is characterized by the formation of local compaction of muscle fibers in response to the effects of unfavorable factors. This compaction is a site of hypertonia, which becomes a source of pain - the so-called trigger point. It is located in the thickness of the muscle fibers at the site of the motor nerve, which is responsible for their contractility.
In terms of clinical manifestations, active and passive trigger points are isolated. An active trigger leads to an intense pain syndrome, both in motion and at rest. It is sensitive to palpation of the spasmodic muscle and causes a symptom of "jump" - feeling the place of hypertonia contributes to a significant increase in pain and causes the patient to literally jump in place. In addition, an active trigger point reduces the functional capacity of the muscle, weakens the muscle fiber and makes it difficult to stretch.
Trigger points correspond to acupuncture zones in Chinese medicine
There is a zone of reflected pain that spreads along the motor nerve path. Discomfort can appear in remote areas of the body from the source of the onset of pain syndrome, arise in the internal organs, trunk, limbs. In these areas, there are manifestations of autonomic dysfunction in the form of hypertrichosis( excessive hair), changes in the color of the skin, increased sweating.
Trigger points can be latent in nature. With such a course of the disease, they lead exclusively to local pains in their locus, the reflected pain syndrome is absent. Latent triggers occur much more often than active ones, but under the influence of provoking factors they can be transformed into an active state. The process is aggravated by hypothermia, stress, and heavy physical stress. The impact of favorable conditions, such as heat, emotional rest, massage, causes the transition of the active trigger to a latent state.
Location of triggers on the neck and in the area of diffuse pain
Several phases are distinguished during myofascial syndrome:
- acute - characterized by intense local and distant pain;
- subacute - manifested by pain syndrome only during motor activity;
- chronic - there is a feeling of discomfort in the trigger zones, local pains appear when exposed to provoking external factors.
A significant role in exacerbating the disease has mental factors - experiences, fear, anger, irritability.
What causes the pathological process?
The formation of the myofascial pain syndrome is based on the overstrain of the muscle fibers due to the arrival of pathological nerve impulses from the brain.
In the chronic course of the disease, a vicious circle is created in the muscle fibers and adjacent fascias. Pathology of the musculoskeletal system or internal organs leads to spasm of certain muscle groups. This causes a constant pain syndrome. In turn, in the central sections of the nervous system, pain stimuli are fixed, which limits the functioning of the affected motor segment and aggravates the course of the disease. We list the main causes of myofascial syndrome.
Degenerative-dystrophic changes of the spinal column, such as osteochondrosis, often cause reflex muscular-tonic pain in the back, limbs, or internal organs. When the cervical region is affected, local sensitivity is observed in the paravertebral zone( lateral from the spinous processes of the vertebrae) and distant pains in the neck, scapula, collarbones, upper extremities. Osteochondrosis of the lumbar and thoracic region causes a spasm of the near-vertebral, intercostal and major muscles of the back, which can give a pain syndrome imitating angina, an attack of hepatic colic or acute pancreatitis.
Diseases of joints and visceral organs
The pathology of the joints and internal organs leads to a reflex spasm of the surrounding muscles and is a protective mechanism. Thanks to hypertonicity, a muscular corset is created for the affected organ and immobilization of the diseased joint. For example, myocardial infarction causes tension and muscle sensitivity in the left half of the breast. Chronic inflammation of the pelvic organs( kidneys, ovaries, bladder) contributes to myofascial pain in the pelvic floor, anterior abdominal wall or loin.
Anomalies in the development of the musculoskeletal system
Asymmetry of the lower limbs with a difference of more than 1 cm causes a violation of the physiological position of the body when walking, which leads to an overload of various muscle groups. Myofascial pain occurs with flat feet, scoliosis, kyphotic deformity of the chest, underdevelopment of the shoulder girdle, asymmetry of the pelvic bones. Chronic muscle strain during anomalies in the development of the axial skeleton causes the appearance of trigger zones and contributes to the progression of the disease.
Posture changes lead to myofascial pain
Bed rest and restriction of motor activity due to immobilization of limbs with gypsum or traction apparatus after fractures leads to the development of hypertonic muscle. In the recovery period of treatment there is stiffness of joints with compaction of muscle groups in the area of trauma. After removing the gypsum or the apparatus, there is discomfort in the back with a fracture of the legs in the lumbar region of the spine, with injuries of the hands in the neck and upper body. Myofascial pain can provoke the wearing of pressing clothing and accessories( tie, neck scarf, belt, shoulder straps), medical bandages, heavy bags or backpacks.
Intense physical activity
Weak development of the muscular corset of the back and muscle groups of the limbs is a provoking factor in the occurrence of myofascial pain syndrome. The risk group includes people of mental work, leading a sedentary lifestyle or athletes who neglect a warm-up before starting a workout. A sharp stretching of untrained or non-warmed muscle forms a trigger zone, which leads to painful sensations. Long-term presence in a forced static position, for example, working at a computer, contributes to the appearance of pathology.
Prolonged work behind the computer contributes to the appearance of muscle spasm and pain in the back
Subcooling and bruises
The effect of low temperature on the whole body or individual parts of the body( feet, waist, neck) in combination with muscle overload in this area leads to the activation of trigger points. For example, dysfunction of the mandibular joint progresses when exposed to strong wind or a draft. In this case, a spasm of chewing musculature, a restriction of the mobility of the lower jaw, an inability to fully open the mouth. Myofascial facial pains are accompanied by painful clicks when chewing and spread to the neck, neck, and shoulder. The same symptoms occur when a strong blow to the face in the area of the cheek or temple.
The state of deep emotional shock reflex causes muscle spasm, especially in the vertebrogenous( vertebral) zone of the trunk and in the extremities. This defensive reaction has emerged in the process of evolution and is aimed at mobilizing the body's forces for struggle or flight. With chronic stress, the muscles are in a state of prolonged hypertension and lose the ability to relax, which causes myofascial pain. The pathological process is especially pronounced in depressive states.
What are the methods for diagnosing and treating the disease?
When the patient first consults the physician collects an anamnesis( history) of the disease, identifies concomitant somatic and mental disorders, conducts a physical examination. The feeling of spasmodic muscles allows to detect the compaction sites and localization of trigger points, as well as areas of reflected pain.
for diagnosing a disease to be detected and the trigger point area of distribution of pain
K diagnostic features myofascial pain syndromes relates:
- occurrence of pain after subcooling, stress, prolonged physical exertion or static posture;
- Detection of a tightened strand in the thickness of the affected muscle, the point of the greatest soreness( trigger), and the zone of spread of the pain syndrome;
- absence of signs of muscle atrophy, detection of hypertonia during myography or ultrasound examination;
- symptom of "jump";
- exposure to heat and massage reduces the manifestations of the disease;
- concomitant depression, emotional instability and other behavioral disorders.
For the therapy of the pathological process, the elimination of an etiological( causative) disease is of great importance. With scoliosis it is necessary to adjust the posture. Osteochondrosis requires the use of chondroprotectors and normalization of metabolic processes in the body. For different lengths of limbs, orthopedic shoes are used.
Treating myofascial syndrome include:
- post isometric relaxation of the affected muscle segments - manual technique, designed to relax spastic muscles by stretching their hands masseur after prestressing;
- puncture of trigger zones with the introduction of novocaine or without the use of medications - leads to relaxation of the muscle strand and the removal of pain;
- acupressure - strong pressure on the trigger zone, which causes ischemia in the area of pain and disturbs the flow of pathological nerve impulses from the central parts of the nervous system;
- massage, physiotherapy, acupuncture - promote relaxation of muscle fibers, activate metabolism, normalize blood flow in the area of pathology;
- muscle relaxants for the elimination of hypertonia and the cessation of pain impulses from the affected muscles to the brain - midokalm, baclofen, sirdalud;
- preparations for normalization of the limbic-reticular system - blockers, GABA receptor( adaptol, Noofen), sedatives( Barboval, valerian) Wegetotropona preparations( ballaspon), tricyclic antidepressants( azafen amitriptyline);
- complexes of vitamins of group B for improvement of trophism of nervous tissue - neurobeks, milgamma;
- therapeutic exercise for strengthening muscles, improving blood flow, correcting bad posture, learning the correct motor stereotype and controlling the state of muscles.
To treat the pathological process follows the first manifestations of the disease before the formation of complications and the progression of the disease. The earlier preventive measures have been taken, the higher the chances for improvement and recovery.
Myofascial pain syndrome requires correct diagnosis and comprehensive treatment with an individual approach to each patient. Therapy of the disease includes the impact on both somatic pathology and the human psyche, behavioral and emotional responses. Timely detection and therapy of the disease prevents the chronic course of the disease and effectively removes pain.