Healing Chronic Myofascial Pain - Results That Last

Recently, during a discussion about Pain Awareness Month with a patient, I encountered an interesting perspective. She mentioned that she had spent a long time trying to avoid being aware of her pain. This viewpoint is common among many who deal with pain or trauma. The goal of pain awareness is not to focus more on pain to amplify it, but rather to explore natural and alternative methods, aside from medication or surgery, for treating and preventing pain based on our current knowledge.

The Centers for Disease Control and Prevention's (CDC) Mortality and Morbidity Report states that over 51 million Americans, or 20%, experience chronic pain, and nearly 7% suffer from high-impact chronic pain. The annual cost of chronic pain in the United States is estimated to be between $560 and $635 billion. Despite the substantial funds involved, chronic pain continues to increase each year. Many individuals are seeking affordable remedies, and we are pleased to contribute to the solution. While chronic pain is prevalent, it is not something you have to endure!

Pain can be categorized into different types; acute pain occurs with an injury or an episode that lasts a few days before gradually diminishing. For instance, sudden low back pain or neck pain that restricts head movement is considered acute pain. Chronic pain is quite different; it typically persists for at least six months and can be debilitating for many people. At our clinic, we have been addressing both acute and chronic pain for years. The physical therapy profession has transformed in its approach to pain treatment. Years ago, a typical physical therapy session included hot packs, ultrasound, massage, electrical stimulation, or spinal traction. Patients with pain were managed with these methods over several appointments rather than being cured. Therapists functioned more like technicians than the problem-solving experts we are today. The difference in education and methods between then and now is stark. On average, it takes 17 years for clinical practice to align with research. A significant challenge for those with chronic pain is the feeling of not being heard by many healthcare providers. If you've been shuffled from provider to provider without relief or improvement, you may need to explore options outside the conventional medical system, which might mean treatments are not covered by your health insurance.

Renowned pain researcher Lorimer Moseley describes pain as the "opinion of the brain." Essentially, the brain experiences pain and reacts by tightening muscles and fascia, which are the connective tissues surrounding every muscle fiber, nerve, and organ. When an area of the body is injured or traumatized, regardless of the severity, the brain protects the affected area, causing other parts of the body to compensate. This compensation can lead to myofascial trigger points or muscle knots, similar to the rope diagram above. Myofascial pain is a regional pain syndrome marked by the presence of a sensitive spot (myofascial trigger point) within a tight band of skeletal fibers. These trigger points can be deactivated with proper treatment, including manual therapy and dry needling. Physician Janet Travell pioneered the study of referred pain patterns, further explored by physician David Simons and Dr. CZ Hong. Janet Travell was also the first to use dry needling therapy, which involves inserting a sterile needle of various lengths into muscle tissue to trigger a reflexive twitch, resetting the nervous system. The "fast-movement procedure" developed by Dr. Hong, or the "multiple insertion technique," is considered most effective for reducing trigger points by eliciting a local twitch response. This approach has been further recommended by Simons and is widely accepted for trigger point injection or dry needling therapy.

Myofascial trigger points are a leading cause of musculoskeletal pain, particularly in the pelvic girdle, as observed in our clinical practice. Symptoms include pelvic pain, hip pain, back pain, bladder pain, severe menstrual cramps, jaw pain, headaches, and foot pain. Trigger points cause muscles to remain tense, weakening them and placing stress on nearby joints. When a trigger point is pressed, it can refer pain to a different location, meaning the source of pain might be in a different area or muscle than where the pain is felt. For instance, bladder pain can stem from trigger points in the pelvic floor muscles. Trigger points limit joint movement and reduce circulation, depriving muscles of nutrients and oxygen, leading to a buildup of metabolic waste. These wastes stimulate nerve endings, potentially causing spasms and inflammation. Pain arises from both mechanical pressure and chemical stimulation, and this cycle continues until intervention is provided. Notably, stretching a trigger point can worsen the muscle knot, similar to tightening a rope by pulling its ends (see above diagram). This explains why activities like yoga or stretching may sometimes exacerbate myofascial pain.

Integrative Dry Needling therapy is just one of the methods we use at our clinic to alleviate muscle tension and pain. We also employ various manual techniques, including kinesiotape, high-speed percussion therapy, cupping (both static and dynamic), soft tissue mobilization, visceral mobilization, and trigger point release. Self-treatment of trigger points offers a long-term solution for "muscle memory," as muscle tone often repeats the same patterns unless addressed. As David Simmons, M.D., states, "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 trust in the body's natural healing ability within a safe and healthy environment. We empower and educate individuals to help themselves. If the same muscle patterns persist and the correct muscles do not function properly, muscle tightness can recur, eventually leading to myofascial trigger points that cause ongoing pain and dysfunction. Therefore, we offer fascia rolling classes and maintenance sessions that include bodywork and/or dry needling, and we remind our clients of the self-management techniques they learned during treatment. For more information about Integrative Dry Needling therapy at our clinic, click here. We provide results along with self-management tools that individuals can use throughout their lives. I love encountering someone who continues to use what they learned at our clinic years ago to maintain 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 talk to one of our pain specialists or schedule an evaluation to 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