Myofascial Pain Syndrome

What is Myofascial Pain Syndrome(MPS)?

Myofascial pain syndrome is a chronic local/ regional musculo-skeletal pain disorder that may involve either a single muscle or a muscle group. No systemic features usually. The pain may be of a burning, stabbing, aching or nagging quality. Presence of trigger points in muscle belly. More common in male & Curable.

MPS

vs.

FMS

Local/ regional musculoskeletal pain disorder that may involve either a single muscle or a muscle group. Trigger points at ms belly. Usually no systemic symptoms. More common in males & curable. No genetic predisposition.

Systemic illness with widespread muscle pain. Tender points at Ms. Tendon junction. Other systemic symptoms exists. More common in females & seldom curable. Genetic predisposition.

Myofascial pain vs. Fibromyalgia

Findings
Pain Pattern

Myofascial pain
Local/regional

Fibromyalgia
Generalised

Least Distribution
Muscle spasm

Single muscle
+++

11 tender points
++

Trigger points
Tender points Taut band Referred pain Assoc. findings

Local/regional
Not a feature ++ +++ Mobility restriction, abnormal posture

Not a feature
Common, Widespread --Fatigue, sleep disturbance, IBS, psychological disturbance

Patho-physiology of MPS
It may develop from a muscle lesion or excessive strain on a particular ms/group, ligament or tendon. The lesion or the strain prompts the development of a "trigger point" that, in turn, causes pain. Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. Trigger point, when pressed upon, will cause the pain to be felt elsewhere. This is what is considered "referred pain".

Patho-physiology of MPS
Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae) Repetitive motions; Excessive exercise; Muscle strain due to over activity Systemic conditions (eg, MI, appendicitis, etc.) Lack of activity, Nutritional deficiencies, Hormonal changes (eg,PMS) Nervous tension or stress Chilling of areas of the body (eg, sitting under AC)

Patho-physiology of MPS
There is sensitization of low-threshold mechanosensitive afferents associated with dysfunctional motor endplates in the area of the Trigger Points projecting to sensitized dorsal horn neurons in the spinal cord. Pain referred from Trigger Points and Low Threshold Receptor may be mediated through the spinal cord after stimulation of a sensitive locus.

MPS of back
Illiopsoas & quadratus lumborum muscles. Pain referral pattern may be superficial (lateral) or deep (medial) Iliacus- Upper illiac fossa- LT of femur Psoas M.- T12-L5 body- LT of femur Both functions for Flexion Of the hip + slight lat. Rotation QL- Ilium, 12th rib, TP of L1-L4 QL functions- Lateral flexor & stabilizer of lumber spine.

If psoas is effected- pain referred from the ipsilateral spine in the thoracic Region to the SI area or upper buttocks. Pt. describes their pain by running their hands vertically up and down the spine if unilateral Illiopsoas is effected, for bilateral Illiopsoas & QL pain is described running across low back. QL- pain with weight bearing, discomfort turning over on bed, rising upright,tie the shoe, picking newspaper from floor. Lying gives relief. Cough , sneez exacerbate. Patients describe referred pain from deep TPs to front of the thigh. H/O trauma, weight lifting may be positive. Psoas- painful with active leg rise & decreased with passive. Ext of leg at the hip in the ateral decubitus painful. Pressure at the insertion painful. Psoas muscle tenderness by abdominal palpation. QL TPs- (1) 5-6 cm lat to L1 spine & just below 12th rib pain to illiac crest & sometimes same side lower abdominal quadrant. (2) At L4 level1-2 cm above post illiac crest- pain to GT (3,4) L3 TP & 2 cm above