Physical Medicine and Rehabilitation for Myofascial Pain Treatment & Management
- Author: Jennifer E Finley, MD, FAAPMR; Chief Editor: Consuelo T Lorenzo, MD more...
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.
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:
Massage and exercise 
Electrical muscle stimulation (EMS) using interferential current (IFC), functional electrical stimulation/electrical nerve stimulation (FES/ENS), or high-frequency transcutaneous electrical nerve stimulation (TENS) 
Ultrasonography [26, 28, 29]
EMG biofeedback 
Low-energy laser 
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.
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.
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).
Consultation with a specialist in physical medicine and rehabilitation may be indicated and should be arranged as needed.
Dorsher PT. Myofascial referred-pain data provide physiologic evidence of acupuncture meridians. J Pain. 2009 Jul. 10(7):723-31. [Medline].
Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil. 1998 Jul. 79(7):863-72. [Medline].
Alonso-Blanco C, Fernández-de-Las-Peñas C, Morales-Cabezas M, Zarco-Moreno P, Ge HY, Florez-García M. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 2011 Jun. 27(5):405-13. [Medline].
Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008 Jan. 89(1):16-23. [Medline].
Gerwin RD. A review of myofascial pain and fibromyalgia--factors that promote their persistence. Acupunct Med. 2005 Sep. 23(3):121-34. [Medline].
Graff-Radford SB. Myofascial pain: diagnosis and management. Curr Pain Headache Rep. 2004 Dec. 8(6):463-7. [Medline].
Simons DG, Travell JG, Simons LS. Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Baltimore, Md: Williams & Wilkins; 1999.
Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004 Dec. 8(6):468-75. [Medline].
Myburgh C, Larsen AH, Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil. 2008 Jun. 89(6):1169-76. [Medline].
Hameroff SR, Crago BR, Blitt CD, et al. Comparison of bupivacaine, etidocaine, and saline for trigger-point therapy. Anesth Analg. 1981 Oct. 60(10):752-5. [Medline].
Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994 Jul-Aug. 73(4):256-63. [Medline].
Venâncio Rde A, Alencar FG, Zamperini C. Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2008 Apr. 26(2):96-103. [Medline].
Wreje U, Brorsson B. A multicenter randomized controlled trial of injections of sterile water and saline for chronic myofascial pain syndromes. Pain. 1995 Jun. 61(3):441-4. [Medline].
Diraçoglu D, Vural M, Karan A, Aksoy C. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. J Back Musculoskelet Rehabil. 2012 Jan 1. 25(4):285-90. [Medline].
Tekin L, Akarsu S, Durmus O, Cakar E, Dinçer U, Kiralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clin Rheumatol. 2013 Mar. 32(3):309-15. [Medline].
Rha DW, Shin JC, Kim YK, Jung JH, Kim YU, Lee SC. Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography. Arch Phys Med Rehabil. 2011 Oct. 92(10):1576-1580.e1. [Medline].
Aoki KR. Evidence for antinociceptive activity of botulinum toxin type A in pain management. Headache. 2003 Jul-Aug. 43 Suppl 1:S9-15. [Medline].
Lang AM. Botulinum toxin therapy for myofascial pain disorders. Curr Pain Headache Rep. 2002 Oct. 6(5):355-60. [Medline].
Jeynes LC, Gauci CA. Evidence for the use of botulinum toxin in the chronic pain setting--a review of the literature. Pain Pract. 2008 Jul-Aug. 8(4):269-76. [Medline].
Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome. Pain. 1994 Oct. 59(1):65-9. [Medline].
Avendano-Coy J, Gomez-Soriano J, Valencia M, et al. Botulinum toxin type A and myofascial pain syndrome: a retrospective study of 301 patients. J Back Musculoskelet Rehabil. 2014. 27(4):485-92. [Medline].
Affaitati G, Fabrizio A, Savini A, et al. A randomized, controlled study comparing a lidocaine patch, a placebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds. Clin Ther. 2009 Apr. 31(4):705-20. [Medline].
Fleckenstein J, Zaps D, Ruger LJ, et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010 Feb 11. 11:32. [Medline]. [Full Text].
Ay S, Dogan SK, Evcik D, Baser OC. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int. 2011 Sep. 31(9):1203-8. [Medline].
Gam AN, Warming S, Larsen LH, et al. Treatment of myofascial trigger-points with ultrasound combined with massage and exercise--a randomised controlled trial. Pain. 1998 Jul. 77(1):73-9. [Medline].
Lee SH, Chen CC, Lee CS, et al. Effects of needle electrical intramuscular stimulation on shoulder and cervical myofascial pain syndrome and microcirculation. J Chin Med Assoc. 2008 Apr. 71(4):200-6. [Medline].
Srbely JZ, Dickey JP, Lowerison M, et al. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain. 2008 May 26. [Medline].
Ay S, Dogan SK, Evcik D, et al. Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int. 2010 Mar 31. [Medline].
Flor H, Birbaumer N. Comparison of the efficacy of electromyographic biofeedback, cognitive- behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol. 1993 Aug. 61(4):653-8. [Medline].
Rayegani S, Bahrami M, Samadi B, Sedighipour L, Mokhtarirad M, Eliaspoor D. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med. 2011 Sep. 47(3):381-9. [Medline].
Chan YC, Wang TJ, Chang CC, et al. Short-term effects of self-massage combined with home exercise on pain, daily activity, and autonomic function in patients with myofascial pain dysfunction syndrome. J Phys Ther Sci. 2015 Jan. 27(1):217-21. [Medline]. [Full Text].
Birch S, Jamison RN. Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. Clin J Pain. 1998 Sep. 14(3):248-55. [Medline].
Ma C, Wu S, Li G, et al. Comparison of miniscalpel-needle release, acupuncture needling, and stretching exercise to trigger point in myofascial pain syndrome. Clin J Pain. 2010 Mar-Apr. 26(3):251-7. [Medline].
Chou LW, Hsieh YL, Chen HS, Hong CZ, Kao MJ, Han TI. Remote therapeutic effectiveness of acupuncture in treating myofascial trigger point of the upper trapezius muscle. Am J Phys Med Rehabil. 2011 Dec. 90(12):1036-49. [Medline].
Leite FM, Atallah AN, El Dib R, et al. Cyclobenzaprine for the treatment of myofascial pain in adults. Cochrane Database Syst Rev. 2009 Jul 8. CD006830. [Medline].
Lin YC, Kuan TS, Hsieh PC, Yen WJ, Chang WC, Chen SM. Therapeutic effects of lidocaine patch on myofascial pain syndrome of the upper trapezius: a randomized, double-blind, placebo-controlled study. Am J Phys Med Rehabil. 2012 Oct. 91(10):871-82. [Medline].
Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain. 1996 May-Jun. 65(2-3):259-64. [Medline].
Danto JB. Review of integrated neuromusculoskeletal release and the novel application of a segmental anterior/posterior approach in the thoracic, lumbar, and sacral regions. J Am Osteopath Assoc. 2003 Dec. 103(12):583-96. [Medline]. [Full Text].
Facco E, Ceccherelli F. Myofascial pain mimicking radicular syndromes. Acta Neurochir Suppl. 2005. 92:147-50. [Medline].
Hsueh TC, Cheng PT, Kuan TS, et al. The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. Am J Phys Med Rehabil. 1997 Nov-Dec. 76(6):471-6. [Medline].
Saggini R, Giamberardino MA, Gatteschi L, et al. Myofascial pain syndrome of the peroneus longus: biomechanical approach. Clin J Pain. 1996 Mar. 12(1):30-7. [Medline].
Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004 Feb. 14(1):95-107. [Medline].