Myofascial pain syndrome (MPS) is a poorly defined condition that requires the presence of myofascial trigger points (TrPs) – “knots” in muscles which can also cause pain referral.

Diagnosis

Diagnosis of myofascial pain syndrome is made exclusively from the patient’s history and physical exam. We would recommend that a thorough chiropractic history and physical examination is performed to assess the problem and differentiate the problem from other possible causes.

Evidence based summary for manual therapy [53]

Only two truly randomized controlled trials have assessed the effectiveness of manual therapy beyond the immediate post-treatment period [10, 11]. One trial assessed the effectiveness of massage combined with other therapies, while the other trial assessed the effectiveness of self treatment with ischemic compression. Current evidence based guidelines conclude there is inconclusive evidence in a favourable direction regarding the effectiveness of massage for the treatment of myofascial pain syndrome [12].

As the evidence base stands there is no quality randomised control trials completed that provide a high or moderate proof of the benefits of chiropractic manipulation or massage for the relief of myofascial pain syndrome.

However to date, the Committee of Advertising Practise (CAP) accepts that the holistic approach that chiropractors take, they may claim to treat general aches and pains including muscle spasms and cramp.

Other effective non-invasive physical treatments or patient education

There is substantial evidence supporting laser therapy for TrPs and MPS. There is moderate evidence for TENS, acupuncture [12] and magnets.

Back-in-Action clinical comment

In our view the most common cause of muscles over tightening is that the nerves leaving the spinal cord and brain stem to control those muscles are overworking. To function correctly the nervous system requires the correct fuel, oxygen and the right amount of stimulation. Increases in muscle tension can therefore be caused by a many mechanisms including problems with the balance system, other nervous system imbalances, postural issues, psychological stress, breathing problems and diet and nutritional influences.

While we cannot guarantee results, in our clinical experience, in addition to massage and/or acupuncture (dry needling), we find a combination of muscle release techniques, chiropractic adjustments, cranial work, exercise, functional neurological approaches, postural balancing, ergonomic improvement, lifestyle advice, relaxation, breathing techniques and nutritional advice often seems to benefit patients.