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Physical Medicine and Rehabilitation for Myofascial Pain Treatment & Management

  • Author: Jennifer E Finley, MD, FAAPMR; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Mar 17, 2015
 

Rehabilitation Program

Physical Therapy

Physical therapy for patients with myofascial pain focuses on correction of muscle shortening by targeted stretching, strengthening of affected muscles, and correction of aggravating postural and biomechanical factors. Modalities can be useful in decreasing pain, allowing the patient to participate in an active exercise program.[24]

Corrections of leg-length discrepancies with a heel lift or the use of dynamic insoles also may be helpful. Various other techniques and procedures, including the following, have been demonstrated to be effective in some patients:

  • Phonophoresis [25]
  • Massage and exercise [26]
  • Stretching
  • Electrical muscle stimulation (EMS) using interferential current (IFC), functional electrical stimulation/electrical nerve stimulation (FES/ENS), or high-frequency transcutaneous electrical nerve stimulation (TENS) [27]
  • Ultrasonography [26, 28, 29]
  • EMG biofeedback [30]
  • Low-energy laser [31]

A study by Chan et al indicated that a program of self-massage and home exercise aids in the treatment of MP dysfunction syndrome (MPDS). The study included 31 control patients, who received six sessions of heat therapy and transcutaneous electrical nerve stimulation (TENS), and 32 patients who received the same treatment, as well as undergoing a program of self-massage and home exercise. The latter group showed greater improvement than the other patients, including significant increases in the pressure pain threshold of trigger points (TrPs) and significant improvements in the neck disability index and the patient-specific functional scales.[32]

Occupational Therapy

Occupational therapy can be helpful in assessing and setting up ergonomically correct workstations for patients with myofascial pain. Properly set up work sites can help to decrease aggravating postural factors.

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Medical Issues/Complications

Trigger points (TrPs) can result from noxious stimuli, such as a herniated disc. Inquire about such precipitating factors in the patient's environment.

The treatment of TrPs can provide temporary relief of visceral pain referred from other organs and can mask the pain of serious conditions (eg, appendicitis, myocardial infarction).

Complications of TrP injections are rare and depend on the area being injected. They include local pain, bleeding, bruising, intramuscular hematoma formation, infection, and, more rarely, neural or vascular injury, or penetration of an underlying organ (which could lead to pneumothorax).

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Consultations

Consultation with a specialist in physical medicine and rehabilitation may be indicated and should be arranged as needed.

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Other Treatment

See the list below:

  • Acupuncture may be helpful. [33, 34, 35]
  • Osteopathic manipulation techniques may include integrated neuromusculoskeletal release, myofascial release, strain-counterstrain, muscle energy, and high-velocity/low-amplitude manipulation.
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Contributor Information and Disclosures
Author

Jennifer E Finley, MD, FAAPMR Consulting Physiatrist and Sports Medicine Physician

Jennifer E Finley, MD, FAAPMR is a member of the following medical societies: American Academy of Medical Acupuncture, American College of Sports Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Martin K Childers, DO, PhD Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

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