Healing Chronic Myofascial Pain

Recently I was made aware of a viewpoint when discussing Pain Awareness Month with a patient. She claimed that being aware of her pain was something she had worked hard on avoiding for a long time. Her perspective is something that many individuals feel (or don't feel) as they cope with pain or trauma. The purpose of pain awareness is not to bring more attention to pain to increase it, but to be aware of natural and alternative methods, other than medication or surgery, to treat and prevent pain according to our current body of evidence. According to the CDC and Prevention's Mortality and Morbidity Report, more than 51 million or 20% of Americans live with chronic pain and almost 7% have high-impact chronic pain. The estimated costs for chronic pain in the United States is $560 to $635 BILLION annually. You would think chronic pain would be erradicated with how much money is generated, however the numbers continue to grow each year. Many sufferers are looking for cost-effective cures and we are glad to be part of the solution. Although common, you don't have to live with chronic pain!

There are different types of pain; acute pain is what you experience when you have injury or an attack of pain that lasts a few days and then gradually subsides. Sudden low back pain or sciatica is one example or when you wake up in the morning and cannot turn your head. Chronic pain is a different story. It usually has been present for at least six months and can be disabling for many individuals. Pain, whether acute or chronic, is something we have treated for years at our clinic and I have devoted my career to understanding it since I have experienced both acute and chronic pain. As a physical therapist for 30 years, our profession has evolved in how we treat pain. When I started my career in 1993, the gold standard was to use hot packs, ultrasound, massage, electrical stimulation or spinal traction. I even used microcurrent (MNS) for a bit and although I never used Diathermy, I learned about it in PT school. A person with pain was never cured, but rather managed with modalities and several appointments for weeks on end. Therapists were operating as technicians, not as the problem solving experts we are today. The contrast between education and our methods then and now could not be any more different. However, on average it takes 17 years for clinical practice to catch up with research. What is more frustrating for those experiencing chronic pain is not feeling heard by many providers in the healthcare system. If you have been passed from provider to provider without resolution or improvement in pain symptoms, you might have to seek help outside of the traditional medical route, which might mean that the treatment may not be covered by your medical insurance.

Pain is the "opinion of the brain", according to renowned pain researcher, Lorimer Mosely. In other words, pain is experienced by the brain and the brain responds by protecting and tightening muscles and fascia (connective tissues that envelopes every muscle fiber, nerve and organ). If an area of the body sustains an injury or trauma, whether big or small, the brain protects the area and other parts of the body compensate, resulting in myofascial trigger points or muscle knots. Myofascial pain is a regional pain syndrome characterized with the existence of a sensitive spot (myofascial trigger point) in the taut band of skeletal fibers. Myofascial trigger points can be inactivated with appropriate treatment that includes manual therapy and dry needling, according to Hong. Physician Janet Travell is the pioneer of referred pain patterns, which was further studied by physician David Simmons. Janet Travell was also the first practitioner to use dry needling therapy, which involves inserting a sterile needle of differing lengths into muscle tissue to elicit a reflexive twitch to reset the nervous system. "Fast-movement procedure" or "multiple insertion technique" appears to be the most effective at reducing trigger points as the result of eliciting a local twitch response. This has been further recommended by Simmons and widely accepted for trigger point injection or dry needling therapy.

Myofascial trigger points are the most common cause of musculoskeletal pain, especially within the pelvic girdle, as seen in our clinical practice with symptoms ranging from pelvic pain, hip pain, back pain, bladder pain, debilitating menstrual cramps, jaw pain, headaches and foot pain. Trigger points cause a muscle to remain tight, weakening the muscle and putting stress on nearby joints. If a trigger point is palpated, it refers pain to a remote location, meaning the actual source of pain could be a different area or muscle other than the location in which the pain is actually felt. One example is the experience of bladder pain resulting from trigger points in the pelvic floor muscles. Trigger points restrict motion of joints and decrease circulation, depriving muscles of nutrients and oxygen, resulting in a collection of metabolic waste that remains stagnant. These metabolic wastes excite nerve endings which can lead to spasm and inflammation. Pain is caused by both mechanical pressure and chemical stimulation and this cycle repeats itself unless intervention occurs. It is important to note that stretching a trigger point can tighten the muscle knot more, much like pulling two ends of a rope taut (see above diagram).

Integrative Dry Needling therapy is only one of the techniques used at our clinic to reset the nervous system to reduce muscle tone and pain. Other manual techniques include kinesiotape, high-speen percussion therapy, cupping (static and dynamic), soft tissue mobilization, visceral mobilization and trigger point release. Self treatment of trigger points is a long-term solution as for "muscle memory" as muscle tone tends to repeat the same behavior if not addressed. To quote David Simmons, M.D., "there is no substitute for learning to control your own musculoskeletal pain. Treating myofascial trigger points yourself addresses the source of that kind of common pain and is not just a way of temporarily relieving it." At Healthy Core, we believe in the body's ability to heal itself, within a safe and healthy environment. We empower and educate individuals so they can help themselves. If the same muscle patterns are repeated (we are creatures of habit) and the correct muscles do not work properly, muscle tightness can return and eventually lead to myofascial trigger points that cause persistent pain and dysfunction. For this reason, we offer maintenance sessions that include body work and/or dry needling, and remind our clients about the self-management techniques they were taught.

In addition to self-treatment of trigger points, it is recommended to get to the cause of the symptoms, such as gut inflammation or neurological dysfunction. We recommend seeking help from a skilled practitioner in getting to the root cause. We work with other providers including physicians, chiropractors, functional medicine providers, massage therapists, trainers, coaches and counselors. At Healthy Core, we get to the bottom of the pain puzzle by evaluating and treating core muscular dysfunction, adhesions in the abdominal and pelvic region that restrict muscle and organ mobility and pelvic girdle malalignment, in addition to dry needling therapy and other manual therapies. For more information about Integrative Dry Needling therapy at our clinic, click here. We offer a solution for the problem, along with self-management tools that individuals can use throughout their lifetime. I love when I run into a someone who is still using what they learned years ago at our clinic to live a pain-free lifestyle!

Living with chronic pain is not necessary nor normal. Contact our clinic at (330)528-0034 if you would like to schedule an evaluation and get to the root cause of your pain. We want to help you beyond an "episode of care" to prevent and treat chronic pain so you can live optimally and be the best version of yourself!

references:

Hong, Chang-Zern. Editorial Needling Therapy for Myofascial Pain Control. Evidence-Based Complentary and Alternative Medicine. Volume 2013. Article ID 946597.

written by Janine Laughlin, PT - January 2016; edited September 2023