Myofascial Pain Syndrome


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DDC PT '14

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Myofascial Pain Syndrome

  1. 1. CervicalCervical MyofascialMyofascial PainPain SyndromeSyndrome Artemio L. Gordonas, Jr. DDC PT- Intern '14
  2. 2. BACKGROUND 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 infraspinatus.
  3. 3. BACKGROUND 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 muscle fibers.
  4. 4. BACKGROUND 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.
  5. 5. DESCRIPTION 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.
  6. 6. DESCRIPTION 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).
  7. 7. ETIOLOGY ✔ overuse or trauma to the muscles ✔ motor vehicle accident ✔ performance of repetitive upper extremity activities
  8. 8. ETIOLOGY 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
  9. 9. EPIDEMIOLOGY 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.
  10. 10. EPIDEMIOLOGY 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.
  11. 11. ANATOMY 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.
  12. 12. ANATOMY Skeletal (voluntary) muscle is further divided into two broad types: slow twitch and fast twitch
  13. 13. Type I fibers (red) Type II a fibers (red) Type II b fibers (white) Contraction time Slow Moderately Fast Very fast Size of motor neuron Small Medium Very large Resistance to fatigue High Fairly high Low Activity Used for Aerobic Long-term anaerobic Short-term anaerobic Maximum duration of use Hours <30 minutes <1 minute Power produced Low Medium Very high Note Consume lactic acid Produce lactic acid and Creatine phosphate Consume Creatine phosphate
  14. 14. PHYSIOLOGY 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.
  15. 15. PHYSIOLOGY 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.
  16. 16. PHYSIOLOGY Skeletal muscle contractions 1. ACTION POTENTIAL 2. activating voltage-gated sodium channels 3. Ca2+ influx 4. activates nicotinic acetylcholine receptors 7. T-tubules (depolarizing) 6. activates L-type Voltage-dependent calcium channels 5. Sarcoplasmic Reticulum release calcium 8. binds to troponin C Myosin bind to actin 10. ATP binds to myosin (release actin) Steps 9 and 10 repeat CONTRACTION CEASES 9. Myosin bind to actin