According to the Mayo Clinic myofacial pain syndrome is described as “a chronic form of muscle pain. The pain of myofascial pain syndrome centers around sensitive points in your muscles called trigger points. The trigger points can be painful when touched. And the pain can spread throughout the affected muscle. Nearly everyone experiences muscle pain from time to time that generally resolves in a few days. But people with myofascial pain syndrome have muscle pain that persists or worsens. Myofascial pain caused by trigger points has been linked to many types of pain, including headaches, jaw pain, neck pain, low back pain, pelvic pain, and arm and leg pain. Treatment for myofascial pain syndrome can bring relief in many cases. Treatment options include physical therapy, trigger point injections or medications”.
To understand myofacial pain syndrome we must first understand what myofacia is. Myofacia (facial system) is essentially the glue that holds the body together. The facial system connects the skin to muscles, muscles to tendons, and tendons to bones. The facial system is made up of a variety of substances including, but not limited to collagen, adipose cells, elastin, fibrin, capillaries, and is dense with nerve endings and proprioceptors. Pick any spot on your body from head to toe (including your organs) and you will find a component of the facial system. This is important to understand because it helps us to see the holistic nature of the body.
One can look at the facial system as an interconnected web weaving throughout the body. Much like a spiderweb, pulling on one part of the system has an effect on the entire system. This is why the site of pain is not always the etiology of the pain and why site specific therapy is not always the best treatment. The following video (courtesy of Gill Hedley) is the best/simplest definition of how facia works. Please take a few minutes to watch the video before reading on.[youtube http://www.youtube.com/watch?v=_FtSP-tkSug]
As a corrective exercise specialist I deal with restricted range of motion on a daily basis. Most often this restriction is due to an old injury. Once an injury has occurred the body limits the movement of the joint(s) that are injured as a protective mechanism. This is a very good thing as it prevents further injury. The problem comes once the initial injury has healed, but the lack of range of motion is not addressed. This is why someone can initially have a foot injury, spend 6-8 weeks in a boot to allow the foot to heal, have the boot removed, begin to resume old habits (exercise, sports, work) and find that the foot pain is gone, but now the opposite side shoulder hurts? Why does this happen? Facia! Anytime we take a step the opposite shoulder protracts to help stretch the facia and propel you forward. If the range of motion is limited do to a build up of facia at the injury site the contra-lateral (opposite side) shoulder now has to over protract to make up for the lack of movement at the foot/ankle joint. A kink at one end of the web leads to dysfunction at the other end of the web. Over time this process leads to all sorts of degeneration throughout the kinetic chain.
So, how do we treat myofacial dysfunction with movement therapy? First we mobilize the restricted area. This can be done with foam rollers, hands on manual therapy, and isometric exercises. Once the range of motion is restored the joint(s) in question must be integrated back into the system in all movement patterns (squat, bend, lunge, push, pull, twist, walk, jog, sprint, and all combinations of these movements). Far to often (especially with athletes) we get in a hurry to get back to our activities and miss foundational aspects of the rehabilitative process.
When dealing with chronic pain and tension secondary to an old injury we must not get caught up in treating the painful site exclusively, we must take into account the entire facial web. The body is a holistic system and treating it in any other way is bound to create more dysfunction and pain. Take care of yourself by following the four pillars of wellness: Purpose, Recovery, Nutrition, and Movement. Until next time.
BS Exercise Science, CHEK 2, MTA 1