Nonsurgical and Nonpharmaceutical Solutions for Chronic Myofascial Pain

Muscle Knot in Myofascial Pain Syndromes

Recently, in a conversation with a patient about Pain Awareness Month, I came across an intriguing perspective. She shared that she had spent considerable time trying to ignore her pain. This outlook is prevalent among those experiencing pain or trauma. The aim of pain awareness is not to concentrate on pain to intensify it, but to investigate natural and alternative approaches, beyond medication or surgery, for treating and preventing pain with our current understanding.

According to the Mortality and Morbidity Report by the Centers for Disease Control and Prevention (CDC), over 51 million Americans, or 20%, live with chronic pain, and nearly 7% endure high-impact chronic pain. The annual cost associated with chronic pain in the United States ranges from $560 to $635 billion. Despite the significant financial implications, the incidence of chronic pain rises annually. Many people are in search of cost-effective solutions, and we are glad to be part of the answer. Although chronic pain is widespread, it is not something you must suffer through!

Pain can be divided into various types; acute pain arises from an injury or episode and typically lasts a few days before subsiding. For example, sudden low back pain or neck pain that limits head movement is classified as acute pain. Chronic pain is quite different, as it usually lasts for at least six months and can be debilitating for many individuals. At our clinic, we have been treating both acute and chronic pain for years. The field of physical therapy has evolved significantly in its approach to pain management. In the past, a standard physical therapy session involved hot packs, ultrasound, massage, electrical stimulation, or spinal traction. These methods were used to manage pain over several sessions rather than providing a cure. Therapists acted more like technicians than the problem-solving experts we are today. The difference in education and methods between then and now is significant. On average, it takes 17 years for clinical practice to catch up with research. A major challenge for those with chronic pain is the feeling of not being heard by many healthcare providers. If you've been passed from provider to provider without relief or improvement, you may need to consider 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 senses pain and responds by tightening muscles and fascia, which are the connective tissues surrounding every muscle fiber, nerve, and organ. When a part 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 characterized by 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 primary source of musculoskeletal pain, especially in the pelvic girdle, as seen in our clinical practice. Symptoms can include pelvic, hip, back, bladder pain, severe menstrual cramps, jaw pain, headaches, and foot pain. These trigger points keep muscles tense, weakening them and stressing nearby joints. Pressing a trigger point can refer pain to another area, meaning the pain's source might differ from where it's felt. For example, bladder pain may originate from trigger points in the pelvic floor muscles. Trigger points restrict 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 results from both mechanical pressure and chemical stimulation, continuing until intervention occurs. Notably, stretching a trigger point can worsen the muscle knot, similar to tightening a rope by pulling its ends. This explains why activities like yoga or stretching might sometimes worsen myofascial pain.

At our clinic, Integrative Dry Needling therapy is one of the techniques we use to reduce muscle tension and pain. We also utilize various manual methods such as kinesiotape, high-speed percussion therapy, static and dynamic cupping, soft tissue mobilization, visceral mobilization, and trigger point release. We utilize various fascial tools and educate individuals how to treat themselves. Addressing trigger points yourself provides a long-term solution for "muscle memory," as muscle tone tends to repeat patterns unless treated. As David Simmons, M.D., mentions, "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 natural healing abilities within a safe and healthy environment. We empower and educate individuals to help themselves through self fascial release and corrective exercises. For more information about Integrative Dry Needling therapy at our clinic, click here. We deliver results along with self-management tools that individuals can use throughout their lives. I love seeing someone who continues to apply what they learned at our clinic years ago to maintain a pain-free lifestyle!

Enduring chronic pain is neither essential nor typical. Reach out to our clinic at (330)528-0034 if you wish to speak with one of our physical therapy specialists or arrange an evaluation to uncover the underlying cause of your pain. Our goal is to assist you beyond just a single treatment session, aiming to prevent and manage chronic pain so you can live your best life and achieve your fullest potential!

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 2026