Myfascial Pain


Neuromuscular & Trigger Point Therapy

This information is not intended to provide medical advice or to replace the advice of a licensed physician. Portions of this information, however, may be used to provide material to your physician for review.

How common is myofascial pain syndrome?

Myofascial pain occurs in about 85% of people sometime during their life. Even this high percentage may not be accurate. Myofascial pain is often underdiagnosed, misdiagnosed or overlooked because it’s hidden in another type of diagnosis such as headache, neck and shoulder pain, pelvic pain, limb pain or nerve pain syndrome.

Men and women are equally affected, though middle-aged inactive women are at the highest risk.

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Where does myofascial pain syndrome most commonly occur?

Myofascial pain and trigger points can develop in any muscle in the body. However, the most commonly affected muscles are those in the upper back, shoulder and neck. These muscles include the:

  • Sternocleidomastoid: This large muscle helps rotate your head to the opposite side and flexes your neck. It is located on both sides of your neck, running from your skull behind your ear area to your collarbone and breast bone.

  • Trapezius: This large, broad, flat triangular back muscle tilts and turns your head and neck, shrugs and steadies your shoulders, and twists your arms. The muscle extends from the base of your skull to the middle of your back.

  • Levator scapulae: This pair of strap-like muscles help raise and rotate each of your shoulder blades. They run from the first four cervical vertebra to the top edge of your shoulder.

  • Infraspinatus: This triangular muscle, located on the back side of each of your shoulder blades, helps rotate and stabilize your shoulder joints. It’s one of four muscles of the rotator cuff.

  • Rhomboids: This pair of upper back muscles pull your shoulder blades together when they contract and attach the upper limbs to your shoulder blade. These muscles run diagonally from the neck and chest vertebrae of the spine down to the back of the shoulder blades.

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What are the symptoms of myofascial pain syndrome?

Symptoms are different for each person with myofascial pain syndrome. Sometimes the pain happens suddenly and all at once, and that is called a “flare-up” of symptoms. At other times it’s a constant, dull pain that sort of lingers in the background.

Symptoms of myofascial pain syndrome include:

  • Pain that’s described as deep aching, throbbing, tight, stiff or vice-like.

  • Trigger points (a small bump, nodule or knot in the muscle that causes pain when touched and sometimes when it’s not touched).

  • Muscles that are tender or sore.

  • Weakness in the affected muscle(s).

  • Reduced range of motion in the affected areas (e.g., you may be unable to completely rotate your shoulder).

People with myofascial pain syndrome often have other health problems that coincide. Commonly reported problems include:

  • Headaches.

  • Poor sleep.

  • Stress, anxiety, depression.

  • Feeling tired (fatigue).

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What causes myofascial pain syndrome?

The jury is still out about all of the causes, contributing factors and exactly how the pain mechanism works.

Causes of myofascial pain syndrome include:

  • Muscle injury.

  • Muscle strain/repetitive muscle use (e.g. hammering).

  • Muscle weakness/lack of muscle activity (e.g. a leg in a cast will not get enough movement).

  • Poor posture.

  • Working in or living in a cold environment.

  • Emotional stress (can cause muscle tension).

  • Pinched nerve.

Other factors thought to contribute to the development of myofascial pain syndrome include:

  • Metabolic or hormonal problems such as thyroid disease or diabetic neuropathy.

  • Vitamin deficiencies, including vitamin D and folate.

  • Presence of chronic infections.

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Questions your therapist may ask to assess myofascial pain syndrome:

Your healthcare provider may order a few tests to rule out other conditions and ask you questions about your pain and symptom, including:

  • Where do you feel the pain?

  • How would you describe your pain?

  • How often do you experience pain?

  • What makes your pain better?

  • What makes your pain worse?

  • Have you had any recent injuries?

  • Do your symptoms get better at certain times during the day?

  • What does your work day look like (to look for activities in which there is muscle strain/repetitive motion)?

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How is myofascial pain syndrome treated?

If you have myofascial pain syndrome, treatment will be more successful if you see your healthcare provider early after symptoms develop — before trigger points are established. Many treatments are available and your medical professional will likely use a combination of the following to manage your pain and restore affected muscles:

  • Neuromuscular therapy and Manual therapy (stretch and relax muscles).

  • Physical therapy (to strengthen, stretch and relax muscles).

  • Dry needling (pushing thin needles into the trigger point to decrease tightness, increase blood flow and relieve pain).

  • Wet needling / trigger point injections (using a needle to inject lidocaine [or other anesthetic] into the trigger point to relieve pain).

  • “Spray and stretch” (spraying a trigger point with a coolant, then slowly, manually stretching the muscles).

  • Low-level light therapy / cold laser (using lasers to stimulate the release of pain-relieving chemicals).

  • Ultrasound (using sound waves to penetrate muscles).

  • Transcutaneous electrical nerve stimulation (TENS therapy; pads are attached to your skin through which low-voltage electrical signals are sent).

  • Acupuncture and relaxation therapies, including biofeedback and cognitive behavioral therapy (also good for improving sleep and reducing anxiety).

Prescription medication options may include:

  • Pain-killing medications (analgesics).

  • Nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Muscle relaxants.

  • Steroids.

  • Antidepressants.

  • Sedatives to improve the quality of your sleep.

Treatments you can do at home include:

  • Heat (as in a heating pad). Some people benefit from cold/ice packs.

  • Exercise. Specifically weight-bearing exercises (to strengthen muscles), stretching exercises (to stretch muscles) and aerobic exercises (to get more oxygen into the muscles).

  • Over-the-counter pain killers (such as acetaminophen) or NSAIDs (such as ibuprofen or naproxen). Don’t take these drugs if you are taking analgesics or NSAIDs prescribed by your healthcare provider.

  • Relaxation techniques, including yoga (to stretch and relax muscles and decrease stress), breathing exercises and meditation.

  • Dietary changes (avoid foods known to cause inflammation).

  • Soaking in warm water.

  • Massages.

The duration of myofascial pain syndrome varies from person to person. With treatment, it may go away after a day or a few weeks, but it can take longer for some. How fast your myofascial pain syndrome resolves depends on a number of factors, including:

  • Your general health.

  • Diet.

  • Amount and quality of sleep.

  • How vigilantly you obey your healthcare provider’s recommendations.

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Can myofascial pain syndrome be prevented?

There are certain factors that can put you more at risk for developing myofascial pain syndrome. Managing these risk factors may not prevent you from developing the syndrome, but could help reduce the severity of the condition.

Many of the prevention suggestions to follow are also pain management strategies:

  • Maintain proper sleep hygiene.

  • Reduce your stress.

  • Get exercise.

  • Avoid preventable muscle injury. (e.g., is the shoulder bag/purse you carry too heavy and digging into the muscles in your shoulder?).

  • Practice relaxation methods.

  • Eat a healthy diet, such as the Mediterranean diet.

Some foods cause inflammation, and inflammation increases myofascial pain. Some foods to avoid include:

  • Fried foods (French fries, for example).

  • Dairy (milk, cheese, yogurt).

  • Refined carbohydrates and foods with refined flour (pastries, white bread, pastas, breakfast cereals, pizza).

  • Margarine (butter), vegetable oil.

  • Sugary foods and beverages such as soft drinks.

  • Red meat (burgers, steaks).

  • Artificial sweeteners and general additives (“no sugar added” products, zero-calorie “diet” soft drinks, processed foods that include fruit, ice cream, candy).

  • Processed meat (hot dogs, sausage).

Check your cupboards and your fridge. Empty it of any foods that will increase your myofascial pain syndrome symptoms.

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