Have you ever wondered why after a long day of work you’d feel an annoying aching, and dull pain;
No matter what you do, you can’t get rid of the pain, you go to sleep annoyed from your long day at work, and you contemplate if it's all worth it...
Today I'll be discussing the most common pain syndrome in the neck (cervical) region that the majority of my clients complain from every single day, paired with their chief complaint, and how you can prevent it from occurring
What is Myofascial Pain Syndrome?
Myofascial Pain Syndrome, one of the most common diagnoses for office workers, and hustlers of the 21st century, due to bad posture, muscle imbalance, or simply living a sedentary lifestyle, other differential diagnoses we will discuss along with MPS is cervical disk hernia which could lead to neuropathy or any surrounding structure pressing on the nerves in the cervical region, Temporomandibular joint pain is possibly a deferred pain that makes you think that you have neck pain, we will discuss them all in detail in a second, and Fibromyalgia which is similar to MPS excluding any inflammations.
"Myo" means muscle, "Fascia" is connective tissue that surround whatever structures in a specific area, and binds them together and acts as a lubricant between them, runs parallel or wavy to them and made up of closely packed bundles of collagen fibers, which makes them flexible structures that can withstand unidirectional tensile force.
Where does the pain come from?
The liquid fascia (blood and lymph) can be a source of pain as changes in the following can affect surrounding tissues, leading to myofascial pain:
Flow velocity
Direction
Type of flow
Myofascial pain can be caused by any structure that is tangled in the fascia:
Nerves
Muscles
Connective tissue
There are hypotheses for Myofascial pain
First one is "Trigger points": which have two types
Active: which is pain without movement
Passive or latent pain: which is painful upon palpation, and vague, non-localized
Second one is "Change in connective tissue" due to inflammation
Fibroblasts transform to myo-fibroblasts which causes the following:
One, shortening of tissue;
Two, increase in tone which causes nociceptive stimulus;
Third, altering polarization of muscle fibers which leads to muscle contraction;
Fourth, which leads to the contraction to be repeated over and over again, which causes pain, and further shortening of the muscle fibers
Differential Diagnosis for Myofascial Pain
Temporomandibular Joint (TMJ) pain can be associated with myofascial pain, but other structures can also refer pain to the TMJ. Try manual techniques for TMJ pain relief, the body may sometime mistake a pain in a specific region for pain in another, I am mentioning TMJ because jaw pain just like toothache, makes you clench your teeth, or be tense, anxiety and stress are important subjective factors for diagnosing MPS.
Cervical disk herniation, occurs due to constant compression to the cervical neck it can be associated with myofascial pain syndrome, or independent by itself, disk herniation depending on their level, can either cause discomfort, or in worse cases, cause paresthesia in the arms extending to your fingertips.
Fibromyalgia Syndrome is a disease characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints, without detectable inflammation.
Fun fact, a study done on Chronic non-specific pain syndrome has indicated that 93.75%of participants had TRIGGER POINTS especially on the horizontal fibers of the trapezius, there were also active myofascial trigger points in levator scapulae 82.14%, multifidi 77.68%, and splenius cervicis 62.5%
Management for myofascial pain syndrome
Muscle exercises
Trigger point therapy
Behavioural therapy
As a study by Fricton and Steenks note, short-term goals should focus on restoring muscle length, addressing postural dysfunction, and achieving full joint range of motion with exercises and trigger point therapy. [Click here for the full study]
The long-term goals should focus on reducing symptoms and limiting their negative effects, and achieving normal function without the need for additional health care.
"Failure to address the entire problem through a team approach, if needed, may lead to failure to resolve the pain and perpetuation of a chronic pain syndrome."
Lastly, let's discuss a study on the relationship between the following & their management
Myofascial Pain Syndrome, Forward Head Posture and Episodic Tension-Type Headache
The following section provides a summary of Fernández‐de‐las‐Peñas et al.'s research article: Myofascial Trigger Points, Neck Mobility, and Forward Head Posture in Episodic Tension-Type Headache [Click here for the full study]
Objective of the study
Was to evaluate the relationship between trigger points, forward head posture, neck mobility, and other variables related to headache intensity and temporal profile
Methodology used
Fifteen individuals with episodic tension type headache and fifteen matched control groups were assessed with them.
Trigger points in the upper trapezius, sternocleidomastoids, and temporalis muscles were identified on both sides using the Simons and Gerwin diagnostic criteria method.
Forward Head Posture was evaluated by measuring the craniovertebral angle using side view pictures.
Cervical range of motion was measured using a goniometer. Participants were asked to keep a 4-week headache diary, noting headache intensity, frequency and duration.
The Authors found the following results
- Patients in the Episodic Tention Type Headache group had more trigger points in the right upper trapezius muscles, the left sternocleidomastoid, and both temporalis muscles than the control group that didn't have Headaches
- Headache intensity, frequency and duration did not differ depending on trigger point activity in the Episodic Tention Type Headache group
- They also demonstrated greater Forward Head Posture than the control group that didn't have headaches
- They had reduced neck mobility compared to the control group in terms of total range of motion, however, the authors concluded that neck mobility did not impact headache parameters
Let's discuss how to manage "Trigger Points"
It was noted that regional, persistent pain in the neck (cervical) region will exacerbate the limited range of motion in affected postural muscle, especially in the neck, shoulder and pelvic muscles.
Trigger points present as tension headaches, tinnitus, temporomandibular joint pain, reduced range of motion in the legs, and low back pain in certain situations.
An intervention that can be used is spraying anesthesia and stretching the muscle passively
Ultrasound can be used to heat up the muscles and stretch them passively too
Manual therapy, and cross frictional massage can act as a pain reducing therapy, and forcing the muscle to stretch at the trigger points
A hot moist pack that can contour on the neck can help relax the muscles, especially when applied for 20 minutes at a time, this is usually the best intervention within my scope of practice in conjunction with Manual therapy and cross friction massage for pain relief and inactivating trigger points.
Icing is also used for pain reduction, or activation of lengthened muscles that are too weak to contract
Injection has been found to be one of the most effective interventions to inactivate trigger points and rapidly reduce pain, but that is not within our scope of practice so a referral to Orthopedic is necessary
I hope this was helpful for your situation, and if you have any inquiries or questions feel free to contact me through any of the available channels, have a wonderful day!
