Muscle
Muscle spasm and myofascial pain
Myofascial pain arises from muscle and the fascia that surrounds it. Its characteristic feature is the trigger point: a discrete, tender spot within a taut band of muscle which, when pressed, reproduces the person’s pain and often refers it to a predictable location some distance away. That referral is why the site of the pain and the site of the problem are frequently not the same place, and why treatment directed only at where it hurts often fails.
Symptoms
Myofascial pain is usually described as deep and aching rather than sharp, and it behaves differently from nerve pain.
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A deep, aching pain
Persistent and often described as a knot or a band of tightness, rather than the burning or electric quality of nerve pain.
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Referred pain
Pressing the trigger point reproduces pain in a recognisable pattern elsewhere — a point in the upper trapezius referring into the head and behind the eye, for instance.
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Restricted movement
The affected muscle is often shortened and stiff, limiting range at the nearest joint without the joint itself being abnormal.
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Poor sleep and fatigue
Commonly reported alongside persistent muscle pain, and each tends to make the other worse.
Causes and contributing factors
Trigger points typically develop where muscle is loaded in a sustained or repetitive way, or where it is compensating for something else.
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Sustained posture and repetitive load
Long periods at a desk, overhead work and repetitive tasks are frequent contributors, particularly in the neck, shoulder girdle and low back.
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Injury and guarding
Muscle around an injured joint or segment often tightens protectively, and that guarding can outlast the original injury.
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Underlying conditions
Persistent myofascial pain can accompany spinal problems, and is worth distinguishing from fibromyalgia, which is more widespread and diagnosed differently.
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Sleep, stress and inactivity
Each is associated with both the development and the persistence of muscle pain, which is why treatment usually addresses more than the muscle itself.
Diagnosis
There is no blood test or scan for myofascial pain. It is a clinical diagnosis made by examination and by excluding other causes.
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Examination of the muscle
Palpation identifies taut bands and tender points, and the key finding is that pressure reproduces the person’s familiar pain and its referral pattern.
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Excluding other sources
Nerve root problems, joint pathology and — for neck and shoulder pain — referral from elsewhere are considered, since all can coexist with muscle pain.
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Investigating what is driving it
Where trigger points keep returning in the same place, the question becomes what is loading that muscle, rather than how to treat the point again.
Common questions
Is this the same as fibromyalgia?
No. Myofascial pain is regional and centred on identifiable trigger points; fibromyalgia is widespread pain with characteristic associated symptoms and different diagnostic criteria. The two can occur in the same person.
Why does pressing my shoulder cause a headache?
Trigger points refer pain in patterns that are consistent between people and do not follow nerve distributions. Referral from the neck and shoulder muscles into the head is one of the most common of these patterns.
Will it come back?
Recurrence is common where the contributing load has not changed. Treatment of the trigger point tends to work best alongside changes to the posture, activity or mechanics that produced it.
Does massage help?
Manual treatment helps many people, particularly alongside stretching and strengthening. It is generally more effective as part of a programme than as an isolated treatment.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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