Artemio L. Gordonas, Jr.
DDC PT- Intern '14
Pain attributed to muscle and its surrounding fascia is
termed myofascial pain, with cervical myofascial pain
thought to occur following either overuse or trauma
to the muscles that support the shoulders and neck.
In the cervical spine, the muscles most often
implicated in myofascial pain are the trapezius,
levator scapulae, rhomboids, supraspinatus, and
Myofascial pain in any location is characterized on
examination by the presence of trigger points located
in skeletal muscle. A trigger point is defined as a
hyperirritable area located in a palpable, taut band of
The primary concern for patients with cervical
myofascial pain is chronicity. Recurrence of
myofascial pain is a common scenario. Prompt
treatment prevents other muscles in the functional
unit from compensating and, consequently, producing
a more widespread and chronic problem. Migraine
headaches and muscle contraction headaches are
known to occur frequently in the patient with
Myofascial pain syndrome is defined as a chronic,
regional pain syndrome. The hallmark classification of
MPS comprises the myofascial trigger points (MtrPs)
in a muscle which have a specific referred pattern of
pain. The trigger point is defined as a hyper-irritable
area in a tight band of muscle. The pain from these
points is described as dull, aching, and deep.
Additional impairments from the trigger points include
decreased ROM when the muscle is being stretched,
decreased strength in the muscle, and increased pain
with muscle stretching. The trigger points may be
active (producing a classic pain pattern) or latent
(asymptomatic unless palpated).
✔ overuse or trauma to the muscles
✔ motor vehicle accident
✔ performance of repetitive upper extremity activities
Possible Causes of Trigger Points
✔ Chronic overload of the muscle
✔ Acute overload of the muscle
✔ Poorly conditioned muscles
✔ Postural stresses (such as sitting for prolonged
periods of time)
✔ Poor body mechanics
Occurrence in the United States
➔ Myofascial pain is thought to occur commonly
in the general population. As many as 21% of
patients seen in general orthopedic clinics have
myofascial pain. Of patients seen at specialty
pain management centers, 85-93% have a
myofascial pain component to their condition.
Sex- and age-related demographics
➔ Cervical myofascial pain occurs in both sexes,
but with a predominance among women.
Myofascial pain seems to occur more frequently
with increasing age until midlife. The incidence
declines gradually after middle age.
Types of Tissue
● Skeletal muscle or "voluntary muscle"
● Smooth muscle or "involuntary muscle"
Cardiac muscle is also an "involuntary muscle"
- Cardiac and skeletal muscles are "striated" in that
they contain sarcomeres that are packed into highly
regular arrangements of bundles.
Skeletal (voluntary) muscle is further divided into two
broad types: slow twitch and fast twitch
Type I fibers
Type II a fibers
Type II b fibers
Size of motor
Small Medium Very large
High Fairly high Low
Activity Used for
Hours <30 minutes <1 minute
Power produced Low Medium Very high
Produce lactic acid
There are three general types of muscle tissues:
➢ Skeletal muscle responsible for movement
➢ Cardiac muscle responsible for pumping blood
➢ Smooth muscle responsible for sustained contractions
in the vascular system, gastrointestinal tract, and other
areas in the body.
Skeletal and cardiac muscles are called striated muscle because of
their striped appearance under a microscope, which is due to the
highly organized alternating pattern of A band and I band.
Skeletal muscle contractions
3. Ca2+ influx
Steps 9 and
9. Myosin bind