Myofascial Pain Syndrome

What is myofascial pain syndrome?

Myofascial pain syndrome is a chronic condition that arises from inflammation in your muscles and fascia (the thin, connective tissue that surrounds your muscles). “Myo” means muscle and “fascial” means fascia.

If your body was an orange, your skin would be the outside orange peel, your muscles would be the fleshy orange fruit itself and the thin white membrane surrounding each orange segment would be the fascia. Fascia surrounds every level of muscle tissue — muscle fibers, single muscles and muscle groups.

For most people, myofascial pain occurs in one specific area. But in some cases, it can affect multiple areas (but is usually on the same side of your body).

How common is myofascial pain syndrome?

Myofascial pain syndrome is common. Experts estimate that up to 85% of the general population will develop the condition at some point.

What does myofascial pain syndrome feel like?

Symptoms are different for each person with myofascial pain syndrome. Sometimes the pain happens suddenly and all at once. At other times it’s a constant, dull pain that sort of lingers in the background.

Myofascial pain syndrome symptoms include:

• Pain that’s aching, throbbing, tight, stiff or vice-like.
• Trigger points (small bumps, nodules or knots in your muscle that causes pain when touched and sometimes when they’re not touched). These commonly develop as the condition worsens.
• Sore, tender muscles.
• Weak muscles.
• Reduced range of motion. (For example, you might not be able to completely rotate your shoulder.)

Sometimes, people with myofascial pain syndrome have other health conditions, too. Common issues include:

• Headaches.
• Poor sleep.
• Stress.
• Anxiety.
• Depression.
• Feeling tired (fatigue).

Types of myofascial trigger points

There are four types of trigger points:

• An active trigger point typically lies within a muscle. Applied pressure results in pain at the site of the trigger point or along that same muscle.
• A latent trigger point is inactive (dormant) but could become active.
• A secondary trigger point is a knot in a muscle other than the one with the active trigger point. An active trigger point and secondary trigger point can become irritated at the same time.
• A satellite trigger point is one that becomes inactive because it overlaps with the region of another trigger point.

What causes myofascial pain syndrome?

Experts are still learning why some people are more prone to myofascial pain.

Some of the most common causes seem to include:

• Muscle injury.
• Repetitive motions (like hammering).
• Poor posture.

Risk factors that might contribute to the development of myofascial pain syndrome include:

• Muscle weakness.
• Lack of muscle activity (like having your leg in a cast).
• Working in or living in a cold environment.
• Emotional stress (can cause muscle tension).
• Pinched nerves.
• Metabolic or hormonal issues like thyroid disease or diabetes-related neuropathy.
• Vitamin deficiencies, including vitamin D and folate.
• Chronic infections.

How do healthcare providers diagnose myofascial pain syndrome?

Myofascial pain syndrome is often underdiagnosed and overlooked. This is because many of its symptoms overlap with other conditions that affect your nerves, bones, ligaments or tendons.

To diagnose myofascial pain syndrome, your healthcare provider will need to physically examine your muscles — to feel for taut bands of muscles and then find the tender spots. Finding and applying pressure to a trigger point will result in pain, felt at the immediate spot or in an area a short distance away (referred pain).

Are there tests that can help diagnose myofascial pain syndrome?

Currently, there are no tests that can diagnose myofascial pain syndrome. There are also no visible signs like redness, swelling or unusual muscle warmth.

Your healthcare provider may recommend tests to rule out other conditions. They may also ask you questions about your symptoms, including:

• Where do you feel the pain?
• How would you describe your pain?
• How often do you experience pain?
• What makes your pain better?
• What makes your pain worse?
• Have you had any recent injuries?
• Do your symptoms get better at certain times during the day?
• What kind of work do you do?
• What kinds of movements does your job involve?

Your healthcare provider may check your gait (how you walk) and your posture to see if there’s a balance of muscle use and look for signs of muscle weakness. They may also ask you about other health problems that can contribute to myofascial pain syndrome — including how much and how well you sleep and if you feel stressed, anxious or depressed.

How do healthcare providers treat myofascial pain syndrome?

There are several myofascial pain syndrome treatments available. These include:

• In-office treatments.
• Medication.
• At-home remedies.

If you have myofascial pain syndrome symptoms, it’s best to see a healthcare provider early on — before your pain gets worse. Treatment is often more successful if you start it before trigger points form.

In-office treatments for myofascial pain syndrome

Your provider will likely recommend a combination of these treatments:

• Physical therapy to strengthen, stretch and relax your muscles.
• Dry needling (pushing thin needles into the trigger point to decrease tightness, increase blood flow and relieve pain).
• Trigger point injections (using a needle to inject lidocaine, or another anesthetic, into the trigger point to relieve pain).
• “Spray and stretch” (spraying a trigger point with a coolant, then slowly, manually stretching your muscles).
• Low-level light therapy/cold laser (using lasers to stimulate the release of pain-relieving chemicals).
• Ultrasound therapy (using sound waves to penetrate muscles).
• Transcutaneous electrical nerve stimulation (TENS), in which your provider attaches pads to your skin and sends low-voltage electrical signals to the trigger points.
• Acupuncture and relaxation therapies, including biofeedback and cognitive behavioral therapy (CBT), are also good for improving sleep and reducing anxiety.

Medication

Your healthcare provider may also prescribe myofascial pain syndrome medications, which may include:

• Pain relievers.
• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Muscle relaxants.
• Steroids.
• Antidepressants.
• Sedatives to improve the quality of your sleep.

At-home remedies

You can also try things at home to relieve your symptoms, including:

• Ice packs to reduce inflammation and heat packs to relax your muscles.
• Myofascial pain syndrome exercises, including weight-bearing exercises (to strengthen muscles), stretching exercises (to stretch muscles) and aerobic exercises (to get more oxygen into the muscles).
• Over-the-counter pain relievers (such as acetaminophen) or NSAIDs (such as ibuprofen or naproxen). Don’t take these drugs if you’re taking prescription analgesics or NSAIDs.
• Relaxation techniques, including yoga (to stretch and relax muscles and decrease stress), breathing exercises and meditation.
• Dietary changes, especially avoiding foods known to cause inflammation.
• Soaking in warm water.
• Massage.

What kind of healthcare providers treat myofascial pain syndrome?

There are a few types of providers who can treat myofascial pain syndrome, including:

• Physiatrists (medical doctors who specialize in physical medicine and rehabilitation).
• Pain management specialists.
• Rheumatologists.
• Orthopedists.
• Physical therapists.

Can I prevent myofascial pain syndrome?

You can’t always prevent myofascial pain syndrome. But there are certain things you can do to reduce your risk:

• Maintain proper sleep hygiene.
• Reduce your stress.
• Get exercise.
• Avoid preventable muscle injury. (For instance, is the bag or backpack you carry too heavy and digging into the muscles in your shoulder?)
• Practice relaxation methods.
• Eat a balanced diet, such as the Mediterranean diet.
• Stay hydrated.

Certain foods cause inflammation, and inflammation increases myofascial pain. Some foods to avoid include:

• Fried foods (French fries, for example).
• Dairy (milk, cheese, yogurt).
• Refined carbohydrates and foods with refined flour (pastries, white bread, pastas, breakfast cereals, pizza).
• Margarine, butter, vegetable oil.
• Sugary foods and beverages such as soft drinks.
• Red meat (burgers, steaks).
• Artificial sweeteners and general additives (“no sugar added” products, zero-calorie “diet” soft drinks, processed foods that include fruit, ice cream and candy).
• Processed meat (hot dogs, sausage).

Check your cupboards and your fridge. Empty them of any foods that’ll increase your myofascial pain syndrome symptoms. It’s OK if you can’t do this all at once. Try removing one type of food at a time and go at a pace that’s comfortable for you.

What can I expect if I have myofascial pain syndrome?

Each person’s pain — including its location and severity — is unique. Pain can flare up from time to time or be ongoing and long lasting. Successful treatment usually requires finding healthcare providers you’re comfortable with and following their management plan.

How long does myofascial pain syndrome last?

The duration of myofascial pain syndrome varies from person to person. With treatment, it may go away after a day or a few weeks, but it can take longer for some.

How can I take care of myself?

Living with myofascial pain syndrome is uncomfortable at best, unbearable at worst. Take care of yourself by following your healthcare provider’s treatment plan and using at-home remedies. Try things like exercise, diet changes, soaks in warm water, massages, etc. You’ll likely have to experiment to figure out what treatments work best to reduce your pain.

When should I see my healthcare provider?

If you have pain in a specific area that doesn’t go away, schedule an appointment with a healthcare provider (preferably before you develop trigger points). Your provider can run tests to rule out other conditions and come up with a plan that works for you.

What questions should I ask my healthcare provider?

Here are some questions you might want to ask your provider during your appointment:

• What medications will help with my myofascial pain syndrome?
• How did I get myofascial pain syndrome?
• Am I at risk for other pain conditions?
• What’s my treatment plan?
• Should I see a pain management specialist?
• What can I do to feel better?
• How soon should I return to see you?

Myofascial pain syndrome vs. fibromyalgia: What’s the difference?

Myofascial pain and fibromyalgia pain feel similar. Both have trigger points that cause pain. But these are different conditions.

While myofascial pain occurs in one specific area (or, if more than one area, those areas are typically on the same side of your body), fibromyalgia pain occurs throughout your entire body. People with fibromyalgia are more likely to have:

• More trigger points.
• General pain.
• More severe fatigue.
• Sleep disorders.
• Headaches.
• Irritable bowel syndrome (IBS).
• Additional sensations like swelling, burning, prickling or tingling.

A note from Cleveland Clinic

Everyone experiences pain during their lifetime. But when that pain is unbearable or long-lasting, it’s time to seek help from a healthcare provider. Fortunately, you can reduce or eliminate most pain — including myofascial pain — with the right treatment.