Myofascial syndrome is a painful condition that often occurs in medical practice. Most patients who have this syndrome are middle-aged women. In view of the fact that the localization of discomfort sensations and their source may be different, it is not always possible to establish the correct diagnosis at once.
Myofascial syndrome - what is it?
Myofascial pain syndrome is associated with the disruption of the muscular apparatus and the membranes covering the muscles (fascia), under the influence of various factors. This condition is not considered a separate disease, and according to the international classification of diseases belongs to the group of pathologies of periarticular soft tissues. Often, when complaints occur in myofascial syndrome, the diagnosis is " myalgia ".
Often, the pathological phenomenon under consideration is observed in skeletal muscles (spinal, cervical, thoracic, etc.), but it can also affect the muscles of the limbs, face, abdomen. Its peculiarity is the presence of trigger points, which are small painful nodules in the thickness of muscle tissue, which differ in increased tone, even when the rest of the muscles are relaxed. These seals are recognized by palpation examination.
Trigger points can be either in the active state and strongly ache when pressed, or in a passive state, causing mild pain only with the strain of the entire muscle. Active triggers prevent excessive stretching of the affected muscle tissue and temporarily weaken its contractility for a period of influence of negative factors that irritate nerve fibers.
Myofascial syndrome - causes
Regardless of the localization of myofascial syndrome, cervical, lumbar, facial or other, pathology is neurological in nature, because all the muscles in our body are controlled by the central nervous system. Pulse signals are transmitted from the brain to the muscles and in the opposite direction, which helps regular correct reduction and relaxation of muscle fibers.
If there are some disorders in the work of the nervous system associated with various pathological factors, the impulses become chaotic or can not be performed normally. Therefore, some muscles cease to obey the brain, long lingering in one position, regardless of the will of man and the needs of his body. Due to a long relaxed state, the necessary motor functions are not performed, and with prolonged exertion (spasm) pain syndrome occurs.
The reasons may be the following pathologies that cause a person to take a forced wrong position of the body or under which they squeeze and damage the nerve fibers:
- osteochondrosis of the spine and its complications;
- dystrophic or inflammatory changes in the joints;
- defects of the spine, bone structures ( scoliosis , flat feet , shortening of limbs, asymmetry of pelvic bones, etc.);
- edematous syndrome in certain diseases;
- diseases of internal organs located in the thoracic, abdominal, small pelvis;
- rheumatic diseases;
- drug intoxication of the body;
- mechanical effects on the nerves (eg, due to injuries, physical exertion), etc.
In addition, we can identify a number of risk factors in which the likelihood of developing myofascial syndrome increases:
- wearing uncomfortable shoes, squeezing clothes and accessories;
- lack of mobility;
- overweight ;
- susceptibility to stress;
- heavy physical work, intensive training;
- hypothermia;
- violations of posture , etc.
Myofascial syndrome of the lumbosacral spine
If there is a myofascial syndrome of the lumbar region and the sacrum, the cause is often excessive dynamic loads (for example, lifting weights, jerks) and prolonged static stress (long work at the computer, driving behind the wheel). In addition, the causative factors can be disc hernias, osteomyelitis, diseases of the digestive system, cancer tumors with metastases in this area.
Myofascial syndrome of the cervical spine
Myofascial cervical syndrome is characterized by the formation of trigger points in the neck muscles along the spine and along the edge of the trapezius muscle located in the posterior region of the neck and in the upper back. In this case, spasms can occur in the occipital part and orbital zone of the head, and with the progression of pathology, vegetative disorders are added.
Myofascial thoracic syndrome
With the appearance of painful foci in the muscle tissues of the anterior thorax, in the small pectoral muscle, myofascial spine syndrome in the thoracic region can be diagnosed. It can be caused both by diseases of the spine, localized in this zone, and diseases of the organs of the thoracic cavity, including including subclavian pains, which give to the shoulders and hands.
Myofascial facial syndrome
When myofascial facial pain syndrome is detected, trigger points can be found in the area of chewing muscles, in the muscular tissues of the temporomandibular joint region, the pterygoid processes of the sphenoid bone. Muscular dysfunctions in this case are often caused by long-existing harmful behavioral habits: chin palm support, jaw clenching in stressful situations, extension of the lower jaw to the side or forward.
Myofascial pelvic syndrome
In women, there is often a myofascial pelvic floor syndrome with possible damage to the following muscles: pear-shaped, internal obturator, muscle lifting the anus, superficial perineal muscles. Causes can be different injuries of the pelvic region, curvature of the spine, different lengths of the lower extremities, hypothermia, wearing tight clothes.
Myofascial syndrome - symptoms
The main manifestation of the syndrome in question is pain in the affected muscle group, which has a pulling, aching character that does not pass at rest, which increases with loads and activation of the triggers. When you touch the trigger points, the pain becomes acute, painful. Characterized by the presence of a zone of reflected pain, in which there are pulling, dull pain sensations. In addition, myofascial pain syndrome symptoms can have the following:
- violations of skin sensitivity;
- blushing or redness of the skin over the affected muscles;
- a feeling of "crawling";
- restriction of movements in the affected area;
- convulsions.
Myofascial syndrome - diagnosis
Myofascial syndrome is diagnosed by a neurologist, taking into account the patient's complaints and in the presence of the following criteria:
- presence of painful seals in the thickness of muscles;
- presence of giving pain, provoked by pressing the triggers;
- established connection between muscle pain and physical overstrain, nervous overload, hypothermia.
When making a diagnosis, first of all, it is necessary to exclude inflammatory phenomena and compression root and spinal pathology (when there is a suspicion of vertebrogenic myofascial syndrome). It is worth noting that neither the hardware nor laboratory techniques in this syndrome reveal any pathological disturbances in muscle tissue, even with exacerbation.
Myofascial syndrome - treatment
Patients who have been diagnosed with myofascial pain syndrome receive a comprehensive treatment, including medication and non-medicament methods. Non-medicamentous are:
- Acupuncture is an unconventional technique in which an effect is created on triggers, often coinciding with acupuncture points, in order to improve blood supply and achieve relaxation of muscle fibers;
- physiotherapeutic procedures: ultrasound therapy, electrostimulation, thermomagnetotherapy, electrophoresis, cryoanalgesia, etc .;
- massage and manual therapy;
- exercise therapy - to strengthen muscle tissue, improve blood circulation in them, correct incorrect posture.
To cure myofascial syndrome, it is important to take into account the causes of its development during the therapy. in parallel with the elimination of discomfort phenomena to engage in and the underlying disease. In addition, patients are given advice on the correct seating at the table, the rational organization of the workplace, the norms of physical activity.
Myofascial syndrome - drugs
If the myofascial syndrome is diagnosed, treatment at home necessarily includes taking medication to relieve pain (local and systemic effects). These are preparations from the following groups:
- muscle relaxants (No-shpa, Sirdalud, Baclofen, Midokalm);
- non-steroidal anti-inflammatory drugs (Nimesil, Diclofeknak, Ibuprofen).
In addition, with intensive pains on an outpatient basis, blockages with Novocaine or Lidocaine can be prescribed. If there are psychoemotional provoking factors, sedatives are prescribed (Valerian, Barbovan, Novopassit). To improve the trophism of tissues, vitamin B and magnesium are often prescribed.
Myofascial syndrome - massage
An important role in the treatment of this pathological condition is given to the course of massage, which allows to activate metabolic processes in tissues, to eliminate muscle tension, to expand the volume of movements. Manual therapy of myofascial pain syndromes can be carried out only by experienced professionals. During the procedures, the pain points are directly affected.
A good effect gives such a manual effect as post-isometric relaxation of muscles, a smooth step-wise stretching of the muscle fibers in a certain given direction. The patient takes different positions during the procedure - sitting, lying on his side, on his back, etc. In this case, there is a short-term counteraction of muscle tissue with a further increase in the amplitude of stretching and relaxation.