Fibromyalgia and Myofascial Trigger Point TherapyPrint
***The following is an excerpt from the chapter on Pain Management in the book, Taking Charge of Fibromyalgia, By Julie Kelly, M.S., R.N. and Rosalie Devonshire, M.S.W., LCSW.
Fibromyalgia and Myofascial Trigger Point Therapy
Myofascial Pain Syndrome (MPS)
Myofascial pain syndrome is often confused with fibromyalgia. Some physicians, including Mark Pelligrino, M.D., believe that myofascial pain syndrome and fibromyalgia are similar conditions and can be related. Others feel that the two conditions are very different. You may have both conditions at the same time. If you have both, each condition can amplify and exacerbate the other. Myofascial pain syndrome is characterized by painful muscles and the presence of trigger points and taut bands of muscle fibers which are ropey and painful when palpated. Fibromyalgia is diagnosed by the presence of tender points, which do not refer pain and are not hard or knotted.
Some people who experience myofascial pain may be misdiagnosed as having fibromyalgia. A physical trauma may set up conditions for a localized myofascial pain syndrome to develop such as in the neck, shoulders, or back. If trigger points and tight ropey muscle bands are not present, then localized pain may be called regional fibromyalgia. If myofascial pain is not treated properly, or if one is predisposed to developing fibromyalgia, some doctors theorize that myofascial pain may spread to become widespread fibromyalgia pain. It is important to have a thorough assessment by a qualified professional to determine if you have myofascial pain syndrome, fibromyalgia, or both and which treatment options will be most beneficial for you.
Myofascial pain syndrome is found equally in men and women, while 90% of patients who are diagnosed with FMS are women. MPS is usually more localized than fibromyalgia. People who have myofascial pain syndrome may feel fatigued and have problems with sleep. Fibromyalgia patients generally experience more widespread pain and an achy, flu like feeling all over. They also have sleep difficulties and more cognitive problems. You may have both MPS and FMS at the same time.
MPS can be treated by myofascial trigger point therapy, trigger point injections, anti-inflammatory medications, muscle relaxants, pain medications, and other treatments. If you have fibromyalgia and do not have trigger points, then some of these treatments may not benefit you.
Trigger Points vs Tender Points
- Trigger points refer pain; tender points do not.
- Trigger points cause numerous symptoms.
- Trigger points can be caused by a variety of problems.
- Trigger points can be treated.
- Tender points are unique to fibromyalgia.
Many FMS patients are confused about the difference between tender points and trigger points. Trigger points are small, contracted knots in the muscles that can be felt with your fingers and mayfeel like a small lump or stone under your skin. They emit their own electrical signals, which can be measured by specialized electronic equipment. They are different from tender points.
Tender points are the specific points on the body that, when touched, feel tender to the person being touched. Tender points are the areas physicians touch or feel to determine the diagnosis of FMS and are not areas in which the muscles are knotted or have a lumpy feel.
Trigger points have been well studied by two physicians, Dr. Janet Travell and Dr. David Simons. Their classic textbook Myofascial Pain and Dysfunction: The Trigger Point Manual describes trigger points in detail. Many massage therapists, physical therapists, and myofascial trigger point therapists have training in defusing trigger points.
Trigger points can cause patients a lot of pain and discomfort. A confusing aspect about them is that they can cause pain in an area far away from the actual site of the trigger point. This is called referred pain. Tender points do not refer pain. For instance, trigger points in your scalene muscles located on the side of your neck can cause pain in your chest, upper arm, lower arm, thumb, and forefinger, as well as in an area near your shoulder blade. Many FMS patients suffer with Temporal-Mandibular-joint pain which could be set off by trigger points located in the masseter muscles in the jaw. Trigger points in this area can cause pain in the front of the face near the sinuses, in the teeth, and in the ear, along with ringing in the ears. Trigger points are common, can be found in any muscle of the body, and can last indefinitely if they are not deactivated by proper treatment. Muscles affected by trigger points feel hard; they may limit your range of motion and cause stiffness in your joints.
Trigger points may arise after surgery or after a joint is forced to remain immobile by the use of splints or braces. They can begin after a physical trauma such as whiplash, sprain, fracture, or dislocation. Repetitive movements can cause them, as can poor body mechanics or asymmetry of a body part. Trigger points can cause numerous symptoms besides pain, which may include weakness, dizziness, blurred vision, goose bumps, headaches, pain during intercourse, nausea, diarrhea, numbness, and cold extremities-depending on the location of the trigger point. Dr. Travell believed that fibromyalgia could begin with the appearance of trigger points in various places of the body.
Treatment of Trigger Points and Myofascial Pain
The good news about trigger points is that they can be treated by a technique called myofascial trigger point therapy. Specially trained massage therapists, and myofascial trigger point therapists can treat them, or you can treat them yourself once you have some education in this area. Biofeedback or relaxation therapy can help patients learn to relax tense, tight muscles. Trigger point injections may be helpful as well.
Relieving the referred pain of trigger points requires pressing and compression on the knot for 30- 60 seconds, slowly releasing the pressure, and then massaging it. Massage is better done with tools, rather than your fingers, as your fingers will tire quickly. Deep, stroking massage is best done in one direction only. Massaging the muscle can be done for as long as you like and you can perform this technique up to 12 times per day for better relief. Although this process may be painful, when done in the right "spot," it should eventually lead to less pain. If the trigger point returns in the future, you can treat it again with the same technique. Tender points cannot be treated in this manner.
Acupressure is a compression technique. Many fibromyalgia patients constantly rub their shoulders or may ask their family members to rub their sore knots. Tools are available to help facilitate breaking up the knots or tight bands, allowing your fingers to rest!