Myofascial pain syndrome and its effective treatment through prolotherapy

 

Myofascial pain syndrome - this disease previously has had different names: rheumatism of joints or muscles; recurrent trauma syndrome (stretching, stress); myofassitis, myogelosis, muscle tension pain, overload syndrome. Most of the times, synonym of this disease was presenting damaged area: tennis elbow (or golfer’s elbow); occipital neuralgia; slipping rib syndrome; shoulder-back periarthritis (frozen soulder); intense headache; lumbago and so on.

In the myofascial pain syndrome, spasm areas are formed in the muscles (trigger points-TT). TT increase muscle tone, reduces its strength, contributes to the reflected pain (usually around the joint or the joint itself) and vegetative disorders.

Common complaints include pain and stiffness on the back, spine and the joints, headaches, difficulty swallowing, shortness of breath, irregular heartbeat, constipation. Sometimes the pain can be severe.

What causes Myofascial pain syndrome?

There are several reasons:  
 - First reason: Human beings are formed through movement – children can be seen as example. Our muscles are not meant for long-term inactivity. Ask a small child to be inactive for ten minutes, which will be very difficult for him/her because it would be very unusual for his/her body. Regular person usually seats at his/her desk for hours without any movement.
 - Second reason: Human is also not adaptable to monotonous movements, even not fast and not strong- monotonous movements cause chronic fatigue in muscles .  
 - Third reason: Carrying excessive weight, sudden movement, lifting heavy weight, hypothermia and direct muscle injury: falling, cut, road accidents, surgeries and other muscle injuries.
 - Fourth and in my opinion most important reason: Impossible to remove it by physical movements by human beings, and that is stress. In ancient times, people were reacting to any significant events by gestures – danger, joy, pain.  If this significant event does not really require competing with a physical reaction or escape, then a person has resorted to ritual dances that disperse his feelings. Why? Because with strong emotions, components that regulate muscles for physical reactions, penetrates to the blood (fighting, running). If the person is still inactive at that moment, these components cause muscle spasm. Everyone has long known it. However, in medicine, it is usually said that the cause of vein spasms is small muscles, where blood pressure gets high as a result of spasms of the veins, becoming a risk factor for stroke and infarction. However, the fact of the matter is that, during stress, tones of the largest muscles such as (skeleton) face, head, neck and back rise- expressing its readiness for movement, while there is no movement. Unlike the ancient human being, the modern human being reacts to stress: he/she smokes, consumes alcohol, and eats sweets. In this case, when the stress is not removed from the body by physical exercise, muscle spasm remains for a long time – and the tension can be felt when touching the muscle. In medical term, it is increased muscle tone. 

Development of myofascial pain syndrome

After a few weeks or even months, a small spasmoid painful area occurs in muscle – trigger point (TT). If all of this occurs gradually, then the person will only remember it if the movements of the joints are limited and painful. For example, struggling when wearing a sock, or getting something from top of the shelf. It is very painful when the pressure is applied on trigger point (usually there is no pain if pressure is not applied on trigger point). It’s a small problem of trigger points. Trigger point usually shoots pain towards or to the joints. In other words, person does not feel the pain where actually pain is (for example, if the trigger point is on the neck, then the person feels it on his hands, back, or heart area. 

Another discomfort that trigger point gives (mainly head and neck muscles) –are various sensitivity disorders and vegetative symptoms: headaches, increased arterial pressure, loss of focus and memory, dizziness and high fatigue, mouth dryness, irritability and dry cough, difficulty swallowing, pain in the throat, feeling of choking, strong sweating or skin dryness, vision and hearing disorders, irregular heartbeat, constipation and diarrhea with gastrointestinal disorders and other symptoms.

Finally, the third discomfort is muscle dysfunction, when muscle in triggered spasm area is not functioning as regular, becomes weak or other muscles acts with this muscle’s functions.

Because of the extra muscle activity of the other muscles, the muscles become tired quicker and therefore, spasms become faster. Those muscles even develop a trigger point after a while.  

Half of the body starts to ache. The neck muscles and some back muscles pair and participate in the pathological process from both sides at the same time. Therefore, if spasmodic muscle left untreated, all other muscles throughout the body will be affected. There is weakness, disturbed sleep pattern and constant fatigue, but towards the evening, the discomfort usually eases.

The treatment of all muscles is described in detail by Travell and Simons’ in “ Myofascial Pain and Dysfunction : The Trigger Point  Manual”. These talented writers are not the creators of myofascial pain syndrome. However, they have written this book so, all doctors who are working in a field of muscles, joints, and aches must have a copy on their desks. One third of the population of United States has Myofascial Pain Syndrome. I think this figure is much higher in Russia. Therefore, Myofascial Pain Syndrome, should be excluded first in patients with chronic pain because in almost 90 percent of the time, it is Myofascial Pain Syndrome that causes the pain.

You can find answers to your questions about the illness in the above-mentioned books. This two volume book and other numerous books that are published for the patients as well as the doctors by writers with own experience. Some of the mentioned books have been translated into Russian. Most popular book for the patients is, “Trigger points: Treatment of chronic pain without medicine” (This book has been published under a different title – “How to be free of chronic pain:  self massage of trigger points”) written by K. Davies and A. Davies. Also translated: “The latest massage encyclopedia. Pressure and Stretch technique. Tension points” by D. Finando and “Clinical Mastery in the treatment of myofascial pain”  by L. Ferguson and R. Gervin.

Question arises: How come such a common issue as muscle pain has not been properly studied to this day because it has been around from the very beginning of existence of human and human kind. Answer: There is no specific area in medical science that studies muscles even though human body comprises 40 percent of muscles. Thus, many “alternative (traditional) medical science” appeared with many names and directions and blossomed: manual therapy, osteopathy, kinesiotherapy, prolotherapy.

Treatment and self-treatment after training with an expert

1. Effecting trigger point directly. Puncture the trigger point with a dry needle or stretching the muscle after cooling the skin. Treatment and self-treatment- Deep massage of the trigger point.
2. Special gymnastics to relax muscles and restore stereotype of the right movement.
3. Getting rid of bad habits (wrong postures and movements), warming up the muscles, normalization of sleeping pattern and nutrition.

The result of treatment and self-treatment depends on the patient and how he/she understands the nature of the pain and how determined he/she is.

Effective treatment of myofascial pain syndrome through prolotherapy:

Prolotherapy is a non-surgical treatment method and is used efficiently in the treatment of degenerative disc disease. Prolotherapy is based on the self-renewal and restoration-proliferation of the body. Using a needle, damaged joint, ligaments, and tissues around the spine is being injected with hypertonic sugary solution, accelerates the healing process thus restoring the damaged tissues. Ultimately, the joint and ligamentous apparatus of the spine gets healed, becoming much stronger. Prolotherapy treatment is an alternative to surgery. It is a treatment of degenerative diseases of the spine, bulging of the disks, protrusion and hernia. Prolotherapy is also an ideal treatment for the patients who already had a surgery but still experiencing some pain.

The treatment period is 3-6 sessions depending on the severity of the disease. Each session is between 25-40 minutes. Straight after the required procedure, the patient can go back to his/her normal life. Even though, prolotherapy treatment has been brought to Azerbaijan and practiced here by myself since 2014, it is being successfully practiced in United States of America since 1940s and in Turkey since 2008.

There are three types of prolotherapy:
 - With hypertonic solution
 - With platelets-rich plasma (PRP)
 - With stem cells

Studies show that, chronic pains that are difficult to treat, as well as fibromyalgia and myofascial pains, can be treated through prolotherapy effectively and harmlessly. After prolotherapy, patients become pain free and live their lives to the fullest.