Myofascial Pain Syndrome (MPS)Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
With pain and apparent inflammation within the soft tissues and muscles of the body, myofascial pain syndrome (MPS) is a chronic condition affecting the fascia, which is the connective tissue surrounding the muscles. Thus, MPS may incorporate one muscle group or multiple groups, and the place in which patients feel the most pain may not be the site of the original injury. This is because the nature of myofascial pain syndrome is such that it prompts the formation of trigger points that cause referred pain, which is pain in other areas of the body.
Several causes contribute to MPS such as injury to an intervertebral disc, repetitive movements and overuse, fatigue or a decrease in activity (when wearing a sling or cast during recovery from an injury). In turn, heart attacks and stomach irritation play a role in myofascial pain.
An understanding of MPS requires some knowledge about the body’s trigger points, or tender points. These are localized areas of the body that, when pressure is applied, generate pain and sensitivity. When classifying myofascial pain syndrome, four types of trigger points are considered. An active trigger point is a region of significant tenderness in the muscle, which creates pain in that particular area or region. A latent trigger point is an otherwise inactive area that acts like a trigger point. A secondary trigger point is a hot spot within the muscle that becomes very irritable as a result of another trigger point or overuse of another muscle group. Yet, a satellite myofascial point is a spot in a muscle that becomes dormant because it is located in an area with another type of trigger pain.
While physiological symptoms of myofascial pain syndrome are notably pain and tenderness (with presumed inflammation), there is also a psychological component. Patients with MPS often experience co-morbid conditions such as depression, general fatigue, insomnia and behavioral interferences.
Treatment and Rehabilitation for Myofascial Pain Syndrome (MPS)
Physiatrists are in a unique position for identifying and classifying myofascial pain syndrome. They bridge many disciplines and expertise regarding a wide variety of conditions that affect the body. As physical medicine and rehabilitation (PM&R) specialists, physiatrists favor a conservative blend of treatment modalities that work to minimize pain and maximize function, both physically and mentally.
Determining the location of a patient’s trigger points is vital in order to develop a suitable strategy for continued pain management and rehabilitation. While over the counter and prescription pain relievers can be effective, the use of ice or heat therapy, ultrasound or steroid injections (into the trigger point) prove helpful as well. Dry needling and acupuncture are two additional techniques to relieve pain. To enhance the effectiveness of treatment, physiatrists may also prescribe antidepressants and/or sedatives to relieve pain, relax muscles and improve sleep.
When pain is managed and patients experience rest, rehabilitation for MPS incorporates physical therapy, which involves stretching, posture training, massage or a combination of all therapies. While patients gain flexibility and muscle strength, physical therapy also helps manage their ongoing pain, as tension is released from the muscles and healthy blood flow is restored.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
For comprehensive treatment and rehabilitation for MPS, contact the Howard Liss, M.D. Rehabilitation Institute today.