Myofascial pain syndrome is a commonly misdiagnosed and unconsidered cause of chronic pain. It occurs when a chronically tense muscle develops knots called trigger points that cause localized pain and may refer pain to other parts of the body by affecting surrounding nerves and muscles.
Myofascia is the connective tissue that surrounds muscles. When a muscle and its myofascia are injured, either by overuse or trauma, they become chronically tense. The tight muscle fibers can develop into trigger points along the muscle; these knots are essentially small patches of the muscle that are in constant, isolated spasm.
Since myofascial pain syndrome is a fairly new discovery in the medical field, many instances of the condition are misdiagnosed, leading to failed treatments. It is important to be aware of this condition and be sure your doctor is as well.
Pelvic Myofascial Pain Syndrome
The cause of mysterious chronic pelvic pain may be myofascial pain syndrome. The pain may be experienced locally in the anus, genitals and bladder. It may extend to the lower back, abdomen, buttocks and thighs, since 1) trigger points can affect nerves that travel to those regions and 2) the muscles of the pelvic floor work together with muscles of the lower back, abdomen and buttocks. As part of the core, these muscle affect one another. If trigger point pain has led the pelvic muscles to go unused, extra stress is placed on the other core muscles. This could cause strain and trigger points to spread throughout the region.
Trigger points in the pelvis can cause urological, gynecological and bowel problems, such as difficulty voiding, incontinence and pain during sex. Myofascial pain syndrome of the pelvis may be misdiagnosed as irritable bowel syndrome, endometriosis, prostatitis or other conditions involving pelvic organs. For women, the chronic pelvic pain associated with myofascial syndrome is not connected to their menstrual cycles.
The pelvic floor is a hammock of sorts consisting of muscles and other tissues that stretches between the pubic bone and the sacrum. This floor is responsible for controlling the bladder and bowels as well as stabilizing the pelvis. The muscles may develop knots due to trauma, past surgeries, joint problem, biomechanical problems such as walking pattern or improper exercise, or, for women, pregnancy. Psychological stress may also contribute to pelvic trigger points, as some people respond to stress by unconsciously tensing their pelvic muscles.
Myofascial pain syndrome may be considered after reproductive diseases, infection of the pelvic organs and prostate enlargement have been ruled out. There is no official way to test for myofascial trigger points in the pelvis, but a physical examination of the pelvic muscles is the most straightforward way to identify trigger points. These points hurt when they are touched.
Trigger point diagnosis and treatment often involves a form of massage that applies firm, steady pressure to the point until it relaxes. In the pelvic area, this type of technique may be uncomfortable for some. While some practitioners perform massage externally, others may direct patients on self-massage techniques that involve penetration. Your comfort level will determine whether these approaches are suitable for you. A demonstration of external pelvic trigger point massage can be viewed here: http://www.youtube.com/watch?v=cWJwGvFDGLg.
There are also self-myofascial release (SMR) techniques that use a firm ball to relax the pelvic muscles. See http://www.youtube.com/watch?v=YzU46_qN0-k for an idea of what pelvic SMR looks like.
A physical therapist may prescribe stretches to restore flexibility to the muscles of the pelvis. If stress and anxiety are to blame for myofascial syndrome, these factors must be addressed as part of treatment. If none of these treatments are effective, you may require trigger point injections.
If you have chronic pelvic pain that is not attributed to reproductive disease, infection or prostate complications, it is possible that you suffer from a musculoskeletal problem in the pelvic region. Be sure to share this possibility with your health care providers.
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