Myofascial Pain Rehabilitation

The Physical Medicine and Rehabilitation Physician ... Adding Quality to Life

Advanced Medical Rehabilitation Group
Gary DiBlasio, M.D., P.A.
701 Northlake Boulevard North Palm Beach, FL 33408 Suite 208

1807 South Kanner Hwy, Stuart, FL 34994

Voice: (561) 863-2828 ● Fax: (561) 863-2914

 

Dedicated to the state-of-the-art non-invasive medical treatment of spine and pain disorders.


Myofascial pain (MP) is a common painful disorder responsible for many pain clinic visits. MP can affect any skeletal muscles in the body. Skeletal muscle accounts for approximately 50% of body weight, and approximately 400 muscles make up the body. MP is responsible for many cases of chronic musculoskeletal pain.

MP can cause local or referred pain, tightness, tenderness, popping and clicking, stiffness and limitation of movement, autonomic phenomena, local twitch response (LTR) in the affected muscle, and muscle weakness without atrophy. Trigger points (TrPs), which cause referred pain in characteristic areas for specific muscles, restricted range of motion (ROM), and a visible or palpable LTR to local stimulation, are classic signs of MP. Over 70% of trigger points correspond to acupuncture points used to treat pain.

  • In the US: MP is extremely common, and almost everyone develops a TrP at some time. In the US, 14.4% of the general population suffers from chronic musculoskeletal pain. Approximately 21-93% of patients with regional pain complaints have MP. Studies have demonstrated that 25-54% of asymptomatic individuals have latent TrPs.

Patients usually complain of regionalized aching and poorly localized pain in the muscles and joints. They also may complain of sensory disturbance, like numbness in a similar area of distribution. Onset may be acute after a specific event or trauma (eg, moving quickly in an awkward position) or chronic from poor posture or overuse. The type of pain felt is characteristic of the muscle involved. Patients may note disturbed sleep and may have been through the "great pillow search" to try to find a comfortable sleeping position. They may or may not be aware of muscle weakness in the affected muscles and may have a tendency to drop things.

A Physiatrist can provide accurate diagnosis of MP. Unfortunately, most medical school and residency training programs do not cover this common condition adequately. Locating TrPs is the most important part of the physical examination. TrPs tend to occur in characteristic locations in individual muscles. Travell and Simons' Myofascial Pain and Dysfunction. The Trigger Point Manual is considered the criterion standard reference on locating and treating TrPs.

Causes: Several factors contribute to MP. Abnormal stresses on the muscles from sudden stress on shortened muscles, leg-length discrepancies, or skeletal asymmetry are thought to be common causes of MP. Poor posture also may serve to cause MP. Assumption of a static position for a prolonged period of time also has been implicated in MP. Anemia and low levels of calcium, potassium, iron, and vitamins C, B-1, B-6, and B-12 are believed to play a role. Chronic infections and sleep deprivation have been cited as causative factors, as have radiculopathy, visceral diseases, and depression. Hypothyroidism, hyperuricemia, and hypoglycemia also have been implicated in MP.

 

 
     
 
     

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