What Is Myofascial Pain Syndrome?

Myofascial pain syndrome (MPS) is a common yet often misunderstood condition characterized by trigger points within the muscles or fascia (a type of connective tissue), leading to either acute or chronic muscle pain and/or weakness. While the exact causes remain unknown, factors such as repetitive motions, poor posture, and stress are known to contribute.

Symptoms typically include pain, stiffness, and weakness, which can occur in one or more areas. The pain can become more widespread throughout your body. Diagnosis typically involves a physical examination, often by a skilled healthcare provider familiar with musculoskeletal conditions, such as an orthopedist. There are many treatment strategies, including physical therapy, medications, nerve stimulation, massage, and alternative therapies like acupuncture.

Types of MPS

Understanding the distinction between the two main types of MPS—acute and chronic—is essential for healthcare providers to develop tailored treatment plans that address the underlying causes and manage symptoms effectively. 

Acute

This type of MPS typically occurs suddenly and is often linked to a specific injury or overuse of one or two muscle regions. It manifests as localized muscle pain or stiffness, which may limit movement and resolve with rest or appropriate treatment. Acute MPS typically resolves after a few weeks.

Chronic

Chronic MPS involves persistent or recurrent muscle pain that lasts for months or even years. Unlike acute MPS, the pain in chronic MPS may not be directly related to a recent injury or overuse, and it typically causes more widespread pain.

Chronic MPS also often involves trigger points—tender areas in muscles that can cause referred pain to other parts of the body. Chronic MPS can significantly affect daily activities, leading to decreased mobility and increased discomfort.

Myofascial Pain Syndrome Symptoms

Recognizing the symptoms of myofascial pain syndrome is crucial for early diagnosis and effective management. MPS can manifest in various ways, affecting muscles and causing discomfort that may interfere with daily activities.

There are two hallmark symptoms of MPS:

• Muscle pain in localized (small) areas
• Trigger points causing pain that may radiate to other areas of the body ("referred pain")

Other less frequent symptoms of myofascial pain syndrome include:

• Tension headaches or migraines
• Limited range of motion in affected muscles
• Pain that worsens with movement or pressure
  
• Referred pain
• Stiffness or tightness in muscles
• Fatigue or weakness
• Disturbed sleep patterns due to pain or discomfort
• Tender knots or nodules in your muscles

What Causes Myofascial Pain Syndrome? 

Researchers are still figuring out exactly why MPS happens. Some research hypothesizes that it may be because muscles become strained from being used either too much or not enough.

Certain factors may make MPS more likely, such as:

• Injuries
• Poor posture
• Doing the same movements over and over
• Scoliosis
• Osteoarthritis
• Some health conditions, such as thyroid problems, low vitamin D levels, or low iron levels

Diagnosis

There are no laboratory or imaging tests that can diagnose myofascial pain syndrome. It's typically diagnosed through a medical history review and physical examination. This can be performed by your primary care provider (PCP). Your PCP may also refer you to an orthopedist, rheumatologist, physical therapist, or pain management specialist.

You may be assessed using the following methods:

• A medical history review to understand the symptoms, medical conditions, and any potential triggers for the pain
• A visual exam to look for posture issues
• A physical examination to identify tender areas in muscles known as trigger points
• Use imaging tests such as an ultrasound or magnetic resonance imaging (MRI) scan to rule out other underlying conditions or injuries

Healthcare providers may perform electromyography (EMG) or nerve conduction studies to evaluate nerve function and rule out neuropathic pain conditions such as neuropathy or complex regional pain syndrome.

Treatments for Myofascial Pain Syndrome  

Treating myofascial pain syndrome involves focusing on relieving pain, reducing muscle tension, and improving overall function.

Treatment strategies may vary depending on the severity of symptoms and individual needs. Healthcare providers may also combine treatment methods for a personalized approach. Treatments that focus on trigger points may include:

• Physical therapy: Uses targeted exercises, stretching, and manual therapy techniques to alleviate muscle tension and improve flexibility
• Dry needling: Inserting thin needles into trigger points to stimulate muscle relaxation and relieve pain
• Ultrasound therapy: Using sound waves to penetrate soft tissues, aiding in the breakdown of trigger points, reducing inflammation, and promoting tissue healing
• Transcutaneous electrical nerve stimulation: Using a small device to send low-voltage electric signals through pads attached to the skin, offering pain relief and promoting muscle relaxation in the affected area
• Cold laser, or low-level light therapy: Exposing the trigger point to near-infrared light, aiding in pain relief and muscle relaxation
• Electrical stimulation: Placing electrodes on the affected muscle and using low-voltage electric signals to induce rapid muscle contractions, helping to relieve trigger point pain
• Wet needling (trigger point injections): Combining needle insertion with the simultaneous injection of a numbing agent or steroid to provide immediate relief from trigger point pain
  

Other options for managing myofascial pain syndrome that your provider may recommend may include:

• Heat therapy
• Acupuncture
• Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) for pain management
• Lidocaine patches for localized pain relief
• Muscle relaxants
• Corticosteroids
• Dietary adjustments to reduce inflammation and avoid potential pain triggers
• Cymbalta (duloxetine), a medication that may help manage chronic pain conditions through its effects on neurotransmitters in the brain and spinal cord

Behavior modification techniques such as exercise, posture correction, ergonomic workstation setup, yoga, meditation, and optimizing sleep habits may also help treat MPS.

Prevention

While researchers have identified certain factors that may contribute to the development of myofascial pain syndrome, such as poor posture, repetitive motions, and muscle overuse, there is no definitive method for preventing the condition entirely. Some people with MPS have no potential risk factors.

Practicing proper body mechanics, managing stress effectively, and seeking prompt treatment for musculoskeletal issues or injuries may help reduce your risk of developing MPS. Further research is needed to provide more insight into potential preventive measures.

Related Conditions

Other medical conditions may present with similar symptoms as MPS.

Fibromyalgia

Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, tenderness, and fatigue. It is associated with other symptoms and co-occurring conditions, such as sleep disturbances, mood disorders, and cognitive difficulties.

Fibromyalgia and MPS are the two most common forms of chronic musculoskeletal pain. Because there is such a significant overlap between fibromyalgia and MPS symptoms, MPS is often accidentally diagnosed as fibromyalgia.

It is possible to have both fibromyalgia and myofascial pain syndrome at the same time. In these cases, it is essential to consult a healthcare provider who can properly diagnose both conditions and help provide a treatment plan for each condition.

Tension-Type Headache

Tension-type headaches are the most common type of headache, characterized by mild to moderate, non-pulsating pain. It is said to feel like a tight band around your head or pressure on your forehead or back of your head.

Tension-type headaches often coexist with MPS, as trigger points in the neck and shoulder muscles can contribute to headache pain. Muscle tension and stress, which can trigger tension-type headaches, can also make MPS symptoms worse or even cause them to start.

A Quick Review

Myofascial pain syndrome is a complex condition characterized by trigger points in the muscle or fascia, leading to either acute or chronic pain. This can affect your mobility and quality of life.

Recognizing the symptoms, seeking timely diagnosis, and adopting healthy lifestyle habits are key steps in improving outcomes for individuals with MPS.

While its exact causes remain unclear, a multifaceted approach to treatment involving physical therapy, medications, and alternative therapies can help manage symptoms effectively.