Physical Medicine and Rehabilitation for Myofascial Pain Treatment & Management

Updated: May 21, 2017
  • Author: Jennifer E Finley, MD, FAAPMR; Chief Editor: Dean H Hommer, MD  more...
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Treatment

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]

A retrospective study by Halder et al indicated that treatment combining onabotulinumtoxinA (BOTOX®) injections with myofascial release physical therapy under anesthesia is effective against myofascial pelvic pain in women. Average pelvic pain scores in the study decreased from 6.4 to 3.7, while the number of trigger points were reduced. Moreover, patient self-reported pelvic pain was characterized as improved by 58% of patients. Patients with chronic bowel disorders were most likely to report no pain improvement, while patients who had undergone past treatment with an incontinence sling were most likely to report pain reduction. [33]

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. [34, 35, 36]
  • Osteopathic manipulation techniques may include integrated neuromusculoskeletal release, myofascial release, strain-counterstrain, muscle energy, and high-velocity/low-amplitude manipulation.
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