AN EXPERT REVIEW AND SYNOPSIS OF MYOFASCIAL PAIN SYNDROMES
Dr. Bruno Bordoni recently wrote an article for STAT Pearls titled Myofascial Pain, in which he stated, "Different tissues work in harmony to make up the myofascial continuum. Thanks to the fascial tissue, all the muscles make up a network in constant connection, and it becomes an error to consider a muscular district as a separate entity. It is impossible to intervene or come in contact with a muscle excluding the associated connective or fascia tissues." He went on to talk about the fact that the liquid portion of both blood and lymph are actually fascia (HERE), that fascia has contractility (HERE), that it has conductibility (HERE), as well as the various ways it is organized and intertwined with numerous other tissues. And of course he spoke of FASCIA AS A SOURCE OF PAIN. Today we will not so much be discussing SCAR TISSUE / FIBROSIS, but the dreaded MYOFASCIAL TRIGGER POINT.
What's just as interesting as calling trigger points a source of pain is that he referred to them a "source of functional limitation". In other words, these creatures (TP's) are not only painful, they have the potential to alter the way you go about your normal day-to-day life. Bordoni went on to talk about the various theories on why people get Trigger Points. Here are some of the takeaways (trying to simplify some of this for my readers).
One of the theories that Bordoni specifically mentioned has to do with altered neurological function of the nervous system as it relates to the SKIN. "The concept of altered electrical activity of the skin and the afferents [sensory nerves] coming from the TPs could explain the altered emotional state in patients with the myofascial syndrome (anxiety and depression)." Interesting, considering ANXIETY and DEPRESSION are both considered to be "inflammatory" diseases (HERE).
Furthermore, we saw confirmation of previous studies that various parts of the brains of people in chronic pain, and especially chronic myofascial pain, actually shrink and atrophy. In fact, I've seen studies showing that this phenomenon can be so severe that over time, brain scans of those who have lived with chronic pain become almost indistinguishable from people with neurodegenerative diseases such as ALZHEIMER'S (HERE).
Although the books by TRAVELL & SIMONS were mentioned (Janet Travell was JFK'S PERSONAL PHYSICIAN), what I found most interesting was the lack of consensus as to what can be used to effectively image and / or destroy these creatures ("Currently, the causes of the presence of TPs are only speculative, as well as the correct evaluative and therapeutic approach."). As far as treatment, Bordoni mentioned every single one of my 'BIG FIVE,' as well as "lidocaine patches, BOTOX, POSTURE-CONTROL EXERCISES, NUTRITION, THERAPY, CHIROPRACTIC ADJUSTMENTS [actually, he mentioned "Osteopathic Manipulation"], ultrasound, STRETCHING, DRY NEEDLING, YOGA, ACUPUNCTURE" and a number of others. What wasn't mentioned was, at least in my mind, even more interesting than what was. Namely, any sort of bodywork, massage therapy, rolfing, TISSUE REMODELING, etc.
The paper's theme was that the drugs are not going to be very helpful and can actually cause a myriad of SIDE EFFECTS. It seems that Bordoni would agree that A SYSTEMIC APPROACH to trigger points has the potential to be much more effective than simply attacking these beasts in a purely local fashion. If you appreciated today's post, be sure to share it with others. FACEBOOK is still an effective way to reach the people you love and care about most!
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).