Pain straight from the muscle

Myofascial Pain Syndrome is an insidious disease that is difficult to treat and even harder to diagnose. The condition for effective therapy is accepting two important facts: that pain can be transmitted by attacking a completely healthy organ and that poorly working muscles are a source of serious problems for the entire body.

The first symptoms of the disease appeared in January 2008, in the form of acute bladder pain and the feeling that I should urinate all the time. I heard that I have interstitial cystitis, a chronic condition for which no cure has yet been invented. Yet in the months that followed, the pain spread to my thighs, knees, hips, buttocks, stomach, and back. Before I heard the correct diagnosis three years later, I had gone through the offices of urologists, gynecologists, orthopedists, physiotherapists, manual therapists, rheumatologists, neurologists, chiropractors and homeopaths.

So what was wrong with me? Something no one had predicted given my condition: I was suffering from myofascial pain syndrome, a disease caused by muscle fibers that were contracting but not relaxing. As a result, knots of tightened muscles, called trigger points, formed in my body, sending pain to various parts of the body that might have been perfectly healthy on their own. Many doctors have no idea what myofascial pain syndrome is, and very few know how to treat it.

In my case, trigger points located in the pelvic floor, where the muscles form a cup shape, sent painful stimuli to the bladder. The points in the thighs acted on the knee joints causing unpleasant pain when walking. The tightened muscles of the hips, buttocks and abdomen meant that my pelvis and lower spine were not in line, leading to severe back pain. I suffered so much from this that sometimes I could only sit for a short while. – Why has no one been able to properly diagnose me before? I asked Timothy Tylor, who was the first to explain to me why I am suffering so much. “Because doctors don’t know much about muscles,” was the answer. – It’s a rather neglected body part.

Most medical schools and physiotherapy courses do not address the fascia pain syndrome at all – mainly because it has an atypical form of transferred pain. According to Robert Gerwin, professor of neuroscience at Johns Hopkins University, transferred pain has only recently been considered by medicine. – I remember once talking to a neurosurgeon for a long time, who was convincing me that transferred pain is not possible at all because it occurs without a logical connection: there is no nerve, blood vessel or other conduit connecting two places – says Gerwin. Of course, the neurosurgeon did not understand that the transmission of pain stimuli took place through the spinal cord.

Pain signals from tense muscles travel to specific parts of the spinal cord, which also receive stimuli from other parts of the body. Transferred pain occurs when muscle aches and pains are treated by the nervous system as if they were coming from a place in the body other than the one that is afflicted. While physicians are increasingly recognizing the existence of transferred pain, its diagnosis and treatment are often beyond the power of medical professionals. In order to correctly recognize trigger points, you should first undergo appropriate training. The physician should palpate each patient to identify those places where the patient’s muscle fibers are extremely tense.

In a survey of American doctors in 2000, over 88 percent. of the respondents stated that the myofascial pain syndrome is a fully fledged disease entity, but there is no agreement as to the criteria that must be met by such a diagnosis. Norman Harden, medical director of the Pain Research Center at Chicago’s Rehabilitation Institute, believes doctors would need clear and sanctioned criteria for diagnosing this pain syndrome and guidance on recognized treatments. Harden recently distributed a similar survey to doctors to see if awareness of this health problem had increased. The preliminary results of the study show that it is not.

According to Gerwin, myofascial pain syndrome often causes or contributes to other ailments such as chronic back pain, headaches or pelvic pain. Trigger points can arise anywhere on the body as a result of an injury or when the muscles have to deal with pain over an extended period of time. Hardening of muscle fibers can be the result of putting too much strain on certain parts of the body or of poor posture that involves muscle groups that are not adapted to this type of effort.

Taylor knows this well as a doctor but also as a patient. The myofascial pain syndrome began to bother him in 2003, while jogging every day. “I felt a sharp pain in my buttocks like when my brothers shot me with a compressed air gun,” she recalls. He looked for signs of injury, but found nothing, so he hobbled home, assuming he had strained his muscles and that it would be over in a few days. And yet it was not.

First he went to the family doctor. Then he visited the offices of specialists: neurologists, rheumatologists, orthopedic surgeons, physiotherapists and physiotherapists. Three years later, one of the doctors diagnosed Taylor’s pain problems were caused by the pear-shaped muscle that runs through the buttocks from the pelvic sacrum. The patient was instructed to stretch and strengthen the muscles, but such rehabilitation only made matters worse. The pain gradually spread to the patient’s knees, to his head, and to his fingers.

Until one day, Taylor found useful information himself: he was doing his own research on the web collecting data on the piriformis – which, as it later turned out, is a very popular trigger point – when he came across information about myofascial pain syndrome. “I’ve been to a bone doctor, a joint doctor, and a nervous system doctor, but neither of them was interested in my muscles,” he notes. Nobody even tried to pinpoint the trigger points on the patient’s body. Since then, Taylor has dedicated himself to researching, diagnosing and treating a medical condition he suffers from. I met him in 2011, when he was already the owner of his own office established for people with pain ailments.

A popular method of relieving suffering from suffering is dry needling, which is exactly what the name suggests: tiny needles are inserted into the skin, causing vibrations at the very center of the trigger point, which allows the muscle fibers to loosen. This technique is similar to acupuncture, but dry needling focuses on trigger points, not meridians, energy zones that Chinese medicine is interested in. Typically, each trigger point requires several needle treatments to loosen for the benefit of the patient. Between sessions, the patient should knead the indicated areas himself with hard objects such as tennis balls and hold them in a grip for a minute or two. This type of treatment can be useful in the case of muscle strain due to postural defects, as well as metabolic problems related to vitamin or mineral deficiency, hypothyroidism and hormonal disorders that may contribute to trigger points.

While some research has been done in this area, we still know too little about the proper treatment of trigger points. Researchers from the Universities of Exeter and Plymouth, as well as specialists from the British Acupuncture Association, note that only one in seven studies has confirmed the beneficial effects of dry needling on patients. Placebo had the same effect as the needles in four other experiments. (…) In the United States, some physiotherapists are still convinced of the validity of dry needling on trigger points. Scientists are now using ultrasound imaging to find out what the effects of needle sessions are. (…)

Gerwin believes that proper training would enable doctors to more accurately target trigger points in a patient. He himself conducts seminars on this subject. (…) According to Harden, without clear criteria for diagnosis, people like him will continue to seek help for years, going from specialist to specialist. “When public awareness of the disease rises and doctors learn to make the right diagnosis, this frustrating search for patients who do not know what is wrong will finally end,” she says hopefully.

More research on myofascial pain syndrome will certainly be useful, but there is already a greater understanding of the disease in the medical community. “I think it has finally been acknowledged that such a thing as pain transferred even exists,” notes Gerwin. (…) – And this is a significant step on the way to understanding what pain comes from a muscle.

I myself feel much better after a complicated treatment, which included dry needling, stretching, pressure, and even relaxation therapies. I don’t have to resort to needles anymore, but I still require exercises that I do on my own to prevent new trigger points from forming on my body and to loosen those that have formed anyway.

Tekst: Amy Mathews Amos

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