Myofascial Pain

Myofascial pain can be a primary or secondary phenomenom. It is considered to be caused by trauma to a muscle. It is believed that an initial muscle injury results in rupture of the sarcoplasmic reticulum, with release of ionized intracellular calcium. This results in sustained and vigorous contraction. This vigorous contraction can lead to compromise of the muscle's own blood supply. As relaxation is the ATP dependent process in the muscular contraction cycle, the muscle is unable to relax. Local ischemia and hypoxia is also seen, and release of nociceptive substances occurs, which sensitizes free nerve endings. A vicious cycle is then established, as increased nociceptive input to the CNS results in reflex activation of motor efferents' leading to more muscular tension. Ultimately, fibrin deposition can occur. The physical finding of a discrete, circumscribed painful area in a muscle body, sometimes felt as a taut band, establishes the diagnosis, and is referred to as a trigger point. Trigger point injections are performed to alleviate the muscle spasm, both with local anesthetic and/or steroid. In fact, dry needling these points has even been shown to be effective in reversing the state of muscle spasm.