Spine Muscles in Pain? Myofascial Pain Syndrome May Be to Blame

You might not know what myofascial pain syndrome is, but you’ve likely experienced it. “Myo” means “muscle” and “fascia” refers to the bands of tissue that cover and connect the various muscles or organs. If you’ve ever felt tightness, twitching trigger points, or a painful “knot” in your neck or back, myofascial pain syndrome may be the cause.

Myofascial pain syndrome is very common—researchers estimate it affects approximately 44 million people in the United States alone.1 This article will answer the most common questions related to myofascial pain syndrome in the spine, including how you can prevent this type of pain from recurring.

myofascial pain syndrome and trigger pointsIllustration typifies myofascial trigger points in a man's neck, mid-back and low back musculature. Photo Source: 123RF.com.

Trigger Points: Stepping Stones to Myofascial Pain Syndrome

Myofascial pain is unique in that it’s associated with trigger points—areas of tenderness and stiffness within the muscle tissue that reduce your range of motion. Myofascial pain syndrome can occur when you have several areas of active trigger points.2

People often refer to trigger points as “knots,” as they feel tight and bundled to the touch compared to the suppler surrounding muscle. As the muscle becomes tight, it can cut off its own blood supply, which can trigger muscle tenderness, pain, and further spasm or tightness in the muscle.

Trigger points can form in muscles all over your body—including those in your neck, mid-back, and low back.

One of the common characteristics of trigger points is that they cause referred pain, or pain that travels or spreads to a nearby location (eg, a trigger point near a shoulder may send pain across your upper back). They may also twitch when prodded.

Almost everyone has trigger points, but not every trigger point causes symptoms. Latent trigger points may reduce your range of motion but will only cause pain when directly palpated or compressed, whereas active trigger points can be painful at any time—even when you’re resting. Lifestyle factors, such as stress and poor posture, can cause a latent trigger point to turn active.

Historical Note of Interest: Janet Travell, MD, (1901-1997) is credited with providing our understanding of myofascial pain caused by trigger points, which really came to light when treating a future President of the United States—John F. Kennedy. When Kennedy was a senator, Dr. Travell diagnosed and treated his muscular low back and leg pain by injecting doses of procaine (a numbing medicine) into myofascial trigger points. The treatment was effective allowing Kennedy to continue his political career. Furthermore, Dr. Travell was the first female to hold the post as White House physician serving President Kennedy.

What Causes Trigger Points and Myofascial Pain Syndrome in the Spine?

Spinal injury or trauma may result in myofascial pain syndrome, but lifestyle factors often play a big role. Holding a poor posture for too long (eg, sleeping in an uncomfortable position) causes physical muscular stress on your spinal muscles. Also, mental and emotional stress can manifest in muscle tension that can encourage the development of trigger points.

The trapezius muscle, which extends from the back of the neck down across the shoulders and upper back, is among the most common sites of spinal trigger points and myofascial pain syndrome because it bears a significant amount of pressure (eg, bearing the weight of a heavy handbag) and is susceptible to whiplash injury.3

What’s the Difference Between Myofascial Pain Syndrome and Fibromyalgia?

Because myofascial pain syndrome is so closely linked to trigger points, a comparison with fibromyalgia tender points often arises. Myofascial pain syndrome and fibromyalgia are 2 distinct conditions, and the table below outlines the primary differences between them.

Because myofascial syndrome and fibromyalgia are unique conditions, you may develop both conditions. Your doctor(s) can help craft a treatment approach that addresses the pain of both trigger points and tender points.

differences between myofascial pain syndrome and fibromyalgiaTable: Differences between myofascial pain syndrome and fibromyalgia.

Why It’s Hard for Doctors to Diagnose Myofascial Pain Syndrome

Myofascial pain syndrome is common in patients, yet perplexing to the medical community. Some of the reasons it’s challenging to diagnose myofascial pain syndrome include:

  1. Researchers aren’t exactly sure how trigger points and myofascial pain syndrome cause pain. Not knowing the cause makes diagnosing difficult.
  2. Myofascial pain syndrome is easily confused for other spinal disorders and conditions. For example, you may have low back pain caused by myofascial pain syndrome in your lumbar spine. Other causes of low back pain, such as arthritis of the lumbar facet joints, may cause similar pain. The cause of low back pain needs to be carefully assessed.
  3. There is no diagnosing standard for myofascial pain syndrome. That is, doctors don’t have a tried-and-true test to secure a diagnosis.

Though there’s not a standard diagnosing protocol for spine-related myofascial pain syndrome, manual palpation—that is the use of hands to feel for tenderness, twitching, and/or tightness at the site of the trigger point(s)—is the most common way doctors diagnose myofascial pain syndrome.

Your doctor may rely solely on manual palpation to identify trigger points, but ultrasound is an emerging diagnostic tool for myofascial pain syndrome. Ultrasound can produce clear images of your soft tissues and may show active trigger points, but more research is needed to secure its place as a go-to diagnostic method for myofascial pain syndrome.

In some cases, your personal or primary care doctor may be able to diagnose spine-related myofascial pain syndrome, but he or she may refer you to a pain specialist or a spine specialist such as a physiatrist, physical therapist, or massage therapist for further evaluation and treatment.

Treating Spine-related Myofascial Pain Syndrome: A Multidisciplinary Approach

There’s still a lot doctors and medical researchers have yet to learn about myofascial pain syndrome, so treatment recommendations vary. However, most doctors support a multidisciplinary treatment approach—that is, using a variety of therapies and employing lifestyle changes to manage trigger point pain and prevent it from coming back.

Below are other common treatments for myofascial pain syndrome.

Putting Pain Under Pressure: Myofascial Release Therapy
Myofascial release is a broad category of manual (using a therapist’s hand or elbow) or instrument-guided (eg, a foam roller) therapy designed to release constricted muscles and fascia by putting pressure on them.

Different forms of myofascial release therapy exist, such as Graston Technique, Melt Method, and Active Release Technique. Several practitioners and clinicians are trained in myofascial release therapy, including massage therapists, physical therapists, chiropractors, and physiatrists. While the techniques and practitioners vary, the overall goal is still the same: Put pressure on the trigger point to release it.

Myofascial release therapy may sound a lot like massage, but they are distinct modalities. Massage moves muscles up and down, while myofascial release therapy involves firm pressure directly into the stiff fascia and muscle.

Having repeated targeted pressure on the tight fascia is not a soothing experience—many patients report discomfort and soreness during and shortly after the therapy. However, once the trigger point loosens up, blood flow and nerve function will begin returning to the area. And not long after that, you may experience reduced neck or back pain.

Barriers to Myofascial Release Therapy
Myofascial release therapy is a nebulous therapy—it’s not well-defined. For example, there’s not a specific way to perform it, as different types of practitioners practice different variations of it.

Also, there’s no accepted credentialing standard for myofascial release therapy, so locating a qualified practitioner may be a challenge.

Finally, myofascial release therapy doesn’t have a strong body of evidence to support its effectiveness or illuminate how it actually works to relieve pain. Without solid research support, most insurance plans don’t cover it (but it may be included in physical therapy coverage).

Additional Treatment Options for Spinal Myofascial Pain Syndrome

Myofascial release therapy is just one option to relieve trigger point pain in your back or neck. Below are other common treatments to manage spine-related myofascial pain syndrome.

At-home treatments
If you know the location of your trigger points (a doctor or therapist can help locate it for you, if you don’t), you can treat them at home with some simple tools. Rolling the trigger point over a foam roller, golf ball, or tennis ball can help loosen up any tight areas at home.

Over-the-counter pain medication
If your doctor approves, taking an over-the-counter pain reliever like acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) may ease your spine pain and allow you to enjoy daily activities.

Physical therapy
In addition to myofascial release therapy, physical therapists may use massage, heat, electrical stimulation, and ultrasound to release trigger points. They may also teach you stretches and exercises to keep your muscles warm and flexible, which will ward off future trigger points.

Massage therapy
Licensed massage therapists may practice myofascial release therapy, but other forms of massage (like deep tissue massage) may also help ease trigger points in your spine. Massage can also help you relax, which is important to preventing myofascial pain syndrome. Learning how to keep stress and anxiety in check will keep the tension—and trigger points—out of the muscles in your back and neck.

Dry needling and acupuncture
While both therapies use needles, dry needling and acupuncture are 2 different treatments that may reduce myofascial pain syndrome. Dry needling doesn’t have as strong of a research backing as acupuncture, but it may help increase blood flow to the trigger point area.

Acupuncture involves the inserting needles into specific points on the body. Doing so signals your nervous system to release chemicals into the body that alter your ability to feel pain—and that means you may feel less myofascial pain.

Trigger point injections
If you’ve tried a variety of home treatments, physical therapies, and lifestyle adjustments (like reducing stress) without any success, talk to your doctor about whether trigger point injections are right for you. Trigger point injections may help relieve your trigger point pain, and your doctor may recommend them in conjunction with a physical therapy program.

Keeping the Myofascial Pain Away: Prevention Strategies

Many people who have trigger points or myofascial pain syndrome in their spine have recurring “knots” and tightness throughout their back and neck. To prevent myofascial pain syndrome from becoming an ongoing condition, practice healthy lifestyle habits that promote good spinal muscle health. Regularly stretching and exercising (to keep muscles warm and mobile) and keeping stress under control (to prevent tension from building up in your muscles and fascia) makes it harder for trigger points to activate and cause pain.

Updated on: 02/04/19
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