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Myofascial Pain in Athletes: Follow-up
Updated: Feb 8, 2008
Follow-up
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The athlete should avoid strenuous activity during sports, and they should always use stretching techniques prior to competitions or practice.
Complications
The single muscle MPSs usually are acute and follow an episode of muscle overload. In some cases, the pain persists and spreads to other, usually synergistic, muscles. This is referred to as a chronic regional myofascial syndrome.
Many perpetuating factors encourage transformation to a more widespread muscle pain problem. Mechanical factors include postural stress, muscle imbalances, and skeletal asymmetries. These can put additional stress on surrounding muscles, leading to spread of dysfunction and pain. Systemic perpetuating factors purportedly include anything jeopardizing the energy supply to muscle (ie, anemia, endocrine imbalances, low thyroid function, vitamin deficiencies).
Chronic regional myofascial syndromes are conceptually close to the malignant, metastasizing fibromyalgia referred to by Bennett.
Prevention
Patients should avoid the mechanical and systemic factors mentioned in Complications.
Education
The ultimate goal is to educate patients and (1) to provide them with the means to manage their own muscle pain disorder, (2) to eliminate their dependence on healthcare providers, (3) to eliminate contributing factors, providing prolonged stretch of the affected muscle, and aerobic exercises.
On performing a task, the patient must learn to keep the muscles mobilized, and not held fixed in a contracted position. Muscle fibers need to alternately contract and relax to provide blood flow and replenish their energy supply.
For excellent patient education resources, visit eMedicine's Muscle Disorders Center. Also, see eMedicine's patient education article, Chronic Pain.
Miscellaneous
Medicolegal Pitfalls
- As with most diagnoses in medicine, the most important aspect is a complete history and careful physical examination, in this case emphasizing the musculoskeletal and neurologic components.
- Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs, or esophagus. However, musculoskeletal causes of chest pain must be considered. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations, or myofascial structures.
- In summary, the points to remember about MTrPs include the following:
- Pain is within or over muscles or their attachments not in the joints.
- Results of the neurologic examination, including sensation, and reflexes are normal. However, strength is usually weak and joint examination is often restricted.
- Laboratory findings are within normal limits.
Special Concerns
- Flat palpation is used to locate the TrP for injection; its position can be confirmed precisely by pushing the nodular TrP back and forth between 2 fingers (see Image 6).
- Then, the TrP can be fixed for injection by pinning it down midway between the fingertips (see Image 6). This identifies the plane that passes through the TrP perpendicular to the skin. The needle can be aimed half way between the fingers precisely in that plane and angled to whatever depth is necessary to reach the TrP.
More on Myofascial Pain in Athletes |
| Overview: Myofascial Pain in Athletes |
| Differential Diagnoses & Workup: Myofascial Pain in Athletes |
| Treatment & Medication: Myofascial Pain in Athletes |
 Follow-up: Myofascial Pain in Athletes |
| Multimedia: Myofascial Pain in Athletes |
| References |
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References
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Further Reading
Keywords
myofascial pain syndromes, trigger points, MPS, myofascial trigger points, TrPs, MTrPs
