Myofascial Pain Syndromes and Acupunture Point Injection Therapy

Myofascial Pain Syndromes and Acupuncture Point Injection Therapy

By Kevin Scrimgeour R.Ac. 

NOTE: The following I have used the term trigger point this is not the same as standard anatomical trigger points. These are acupunture ashi or tender points related to stagnation of energy flow and this creates pain. The term trigger point used here are used for simplicity and I will further explain the difference between what an acupunturist means by a trigger point and what a medical person means. Below is more of a medical explanation for simplicity sake and brevity. 

How do I know if I have Myofascial Pain?

In order to understand if one has myofascial pain (MP) one should know that 70% of all pain problems seen in any doctors office are MP syndromes. The remaining 30% is from other causes but always has a secondary MP component. Hard to get away from these stats. Myofascial simply means originating in the muscle and its related tissues. Muscle comprises 40% of the total body mass and makes up most of our physical body. We all have tight bands of muscle that can cause injury and pain it is a part of aging. Where these tight bands are sensitive it is designated as a trigger point. These can exist at different levels of sensitivity, not so tender are called latent and very sore would be called active. These problematic triggered muscles can cause all types of pain and often are overlooked by most physicians. For example foot pain could be referred from a muscle that is chronically tight and sore in the calf or even hip. MP can be the main cause of aggravation to a tendon or joint and even strangulation of a nerve or blood vessel resulting pain, numbness or slow recovery. Trigger point injection therapy is a short term solution to treat pain permanently not manage it for a long period.

Why get Point Injections why not just use massage or other less invasive treatments for Muscle or Myofascial Pain.

Good question and yes you should get massage, stretch, use hot packs, exercise the muscle, see a podarthist, physio or a podiatrist they can all help with myofascial pain as well. However and this is a big however, Janet Travell (MD) who was the originator of the term trigger point (and was also the first female to be head physician to the president of the US, John F. Kennedy) and she researched with a team, many medical treatments to clear Myofascial Pain Syndromes. She realized many patients after surgery, physio, massage and a variety of other interventions still had myofascial pain. The only technique that worked when all else failed was injections into the trigger points themselves. So if you have tried many other treatments and still keep getting the same type of pain then trigger point injections are often the only thing that will be able to resolve and treat your pain. Also if you want to increase your recovery time with other inventions trigger point therapy will help with that too. Since most injuries or pain will create an active or latent muscle problem as well.

Are trigger point injections painful and do they always help?

Neurotherapy injections are painless and available if one is worried about deeper injections. Trigger point injection therapy when done by a licensed and well trained sensitive and attentive therapist are often interesting in sensation as you feel the muscle being released. The muscle will twitch and some people really enjoy the feeling. It can be uncomfortable which is why every measure is taken for safety and comfort. The results are worth it, frequently instant and significant. It is often the only treatment available that can move an injury from pain management to pain treatment.

Yes they always will help. However, in chronic or difficult cases it takes time for the muscle to regain its normal function and one treatment is not realistic. Clearing a trigger point is the first step and all that is needed If the muscle is properly mobilized, stretched, gets adequate nutrition, is not stressed, and rested properly at night. If you have or are able to create this therapeutic environment for your injury then more treatments will not be necessary.

EXAMPLES OF ACTIVE AND LATENT TRIGGER POINTS?

Active myofascial trigger point

• Refers a pattern of pain at rest or at motion.
• Usually refers pain on direct compression.
• Mediates a local twitch response.
• Tender to palpation.
• Prevents full lengthening of muscle.Weakens the muscle.

Latent myofascial trigger point.

• Clinically quiescent with respect to spontaneous pain.
• May refer pain.
• Tender to palpation.
• Prevents full lengthening of muscle.
• Weakens the muscle.
• They accumulate from all of the vast number of physical things that happen to us.
• If all our trigger points remain latent we gradually become stiffer and weaker.
• If some become active we experience myofascial pain.

How does Myofacial Pain relate to the cause of sports injuries?

Myofascial theory sees almost all injuries as due to tight bands in the muscles. Muscle tearing can be present as a result of a fall or other event. The tear is seen as self limiting it will heal itself but the true cause is the tight band and treatment should be directed there. Otherwise the muscle will not work nor will the joint it is connected with. The tear a result of poor flexibility or strength of the muscle due to a tight band. Sports injuries are a good example because the person is healthy otherwise and so not other factors are present other than a stress on the joint or muscle in the event of an injury.

Treatment for any sports injury is heat, never Ice, stretch, massage, mobilization and trigger point injections. Massage, orthotics, acupunture, herbs, nutrition all will support the healing process and slow the formation of future tight bands. Injection for almost 20 years is seen to be the most effective way to clear problematic tight muscle bands.


How are common Myofascial Pain Syndromes treated?

Simple problems: Can begin treatment immediately and see what happens. Sports injuries for example require about 30 minutes or a half session. Injection(B12 and procaine) with heat and stretches with home stretches. Most will recover in 1 to 3 sessions.

Difficult problems: If a complex history of treatment but healthy otherwise can begin treatment immediately may take anywhere from 1 to 5 or more sessions depending on other health factors and what medical treatments have been tried previously.

Complex problems: Severe accidents or illness as well as pain. Need to examine all the other factors that perpetuate trigger points, diet, sleep, stress ect. A good therapeutic environment, communication with family doctor and other professionals and detailed history must be established before proceeding.