Myofascial Pain Syndrome


Myofascial Pain Syndrome is characterized by chronic pain presenting with painful knots and constrictions referred to as trigger points that involve muscles and the tissue that surrounds them. It can present anywhere on the body and is quite common in the neck, shoulder, and upper back regions. It can involve a single muscle or multiple muscles.


The definitive cause of myofascial pain syndrome is unknown

Suspected causes include:

  • Poor posture

  • Overuse of muscles

  • Mechanical asymmetry such as leg length discrepancy

  • Repetitive stress injury

  • Over-exercising

  • Anxiety and depression


Myofascial pain syndrome is characterized by painful trigger points that can be very tender to the touch and are associated with deep aches and spasms. The syndrome usually begins in one part of the body and spreads. Stress and activity can potentiate the symptoms. Additionally, people with myofascial pain syndrome can also suffer from depression, fatigue, and behavioral issues.


Physical exam reveals pain upon application of pressure to the trigger points. Trigger points can be classified into four main categories:

Active trigger points: Present with significant tenderness within skeletal muscles and are associated with local or regional pain.

Latent trigger points: An inactive trigger point that has the potential to become symptomatic. These may cause muscle weakness and restrict movement.

Secondary trigger points: Irritable foci in a muscle that becomes symptomatic in association with an active trigger point in another muscle.

Satellite myofascial points: Irritable foci in a muscle that become dormant because the muscle shares the same region as other trigger points.


Over-the-counter pain medications such as non-steroidal anti-inflammatories and Tylenol may reduce pain. Other medications for treating depression, sleep disorders, and muscle spasms may be beneficial depending on the associated symptoms. Physical therapy can help patients with myofascial pain syndrome as well. Techniques and procedures include the stretch and spray technique, which involves spraying the area over the trigger point with a cooling substance and then stretching the muscle. Trigger point injections can be performed by interventional pain management physicians or other appropriately trained and qualified doctors. The injections are made directly into the trigger point and may include a local anesthetic such as Xylocaine or Marcaine and steroid. When a needle is inserted into the trigger point but no medication is injected, the technique is known as “dry needling”. Dry needling can alleviate the pain associated with trigger points in some instances. A combination of physical therapy and trigger point injections can be very effective.