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If you’re like most people, you work out to keep in shape and maintain a desired body shape. A common barrier to those goals can be muscle imbalances. The body tries to compensate for these muscle imbalances, which can lead to problems. In the shoulders and arms, this often leads to a diagnosis of Upper Crossed Syndrome (UCS). SymptomsBesides the obvious, UCS can even be the root cause of daily headaches, poor posture, difficulty breathing, discomfort and increase the risk of a significant injury. CausesEveryone is at risk, because we spend more time in protraction (working with muscles in front of body) versus retraction. During our daily lives, we spend more time in flexion (bent joints) and less in extension (straight joints). Over time, the muscles closer to the core can become shortened and tightened, while the muscles further away become lengthened and weakened. Individuals especially at risk include: students, golfers, cyclists, weight lifters (especially using the bench press), hockey players, volleyball players, tennis players and swimmers (whose power muscIes are close to the core), computer workers, office workers and people with decreased posture. Treatment and PreventionThe goal of treatment and prevention is to improve the muscles further away from the core. Typically, I prescribe specific home exercises for UCS to:
Exercises may include things like rows, walkouts and much more. It is important to perform the stretches routinely. Otherwise, the tight muscles close to the core will continue to overpower the weak muscles, and it will be much harder to strengthen. Maintenance is the key. A home exercise program is important to fix the current problem and prevent future problems. With muscle imbalances, the results will not occur overnight. They take a long time to come on and therefore will take a long time to get better. Myofascial pain syndrome is a common debilitating disease of the muscles and associated soft tissues. Pain radiates from one or more trigger points stimulated by pressure, or by nothing at all. Although frequently confused with fibromyalgia, it is not the same syndrome.
OverviewWhat is myofascial pain syndrome?Myofascial pain syndrome is a pain condition that affects your muscles and fascia. “Myo” means muscle and “fascial” means fascia. Your fascia is the thin, white connective tissue that is wrapped around every muscle. Here’s an easy visual: If your body was an orange, your skin would be the outside orange peel, your muscles would be the fleshy orange fruit itself and the thin white membrane surrounding each orange segment would be the fascia. Fascia surrounds every level of muscle tissue —muscle fibers, single muscles and muscle groups. Muscle pain isn't picky — it can strike anyone at any time in their life. Everyone from the mother carrying her child and the roofer laying shingles to the best friend helping lift boxes during a move can experience muscle pain. Unfortunately, for some people, this pain can be unbearable and it sticks around long after it should have faded. If you experience muscle pain that won't go away for a long period of time, it could be myofascial pain. What does the fascia do?Simply put, your fascia holds your muscles together, which allows them to contract and stretch. Fascia also provides a slick surface so that individual muscle fibers, single muscles and muscle groups can slide against each other without creating friction, tearing or causing other problems. Actually, fascia is everywhere inside your body. Besides your muscles, all organs and blood vessels are connected to or surrounded by fascia. Fascia is a complex substance. It contains nerve endings. Scientists are still discovering all of the functions and roles of fascia. What happens when a person experiences myofascial pain syndrome? How does it start?Myofascial pain is a common syndrome. If you have myofascial pain syndrome, you may feel pain and tenderness in muscles in a certain area of your body. This pain and tenderness is often related to one or more “trigger points.” To the touch, trigger points feel like small bumps, nodules or knots in your muscle. If you could look at a trigger point under a microscope, you’d see that it lies within a taut band, which is a tight strand of muscle that feels like a cord or tendon. The trigger point itself — the “knot” — is actually many nearby segments of muscle fibers that are stuck in the contracted state. When muscle fibers are stuck in contraction, blood flow stops. If blood flow to the area stops, that area of muscle is not getting the oxygen it needs. Waste materials also build up in these fibers. This irritates the trigger point, which reacts by sending out a pain signal. Your brain responds by telling you not to use that muscle. Lack of use actually causes the muscle to tighten, become weak and it causes a loss in your range of motion. Muscles around the affected muscle have to work harder to do the work of the affected muscle. Trigger points can develop in these muscles too and add to the localized pain you feel. Trigger points can develop in all muscles, and in many muscles at the same time. This is one of the reasons why it may seem like your pain in shifting or moving around. Trigger points can also be tricky in that pain can occur at the site of the trigger point (when lightly pressed) or cause pain in a nearby area. This is called referred pain. How common is myofascial pain syndrome?Myofascial pain occurs in about 85% of people sometime during their life. Even this high percentage may not be accurate. Myofascial pain is often underdiagnosed, misdiagnosed or overlooked because it’s hidden in another type of diagnosis such as headache, neck and shoulder pain, pelvic pain, limb pain or nerve pain syndrome. Men and women are equally affected, though middle-aged inactive women are at the highest risk. Where does myofascial pain syndrome most commonly occur?Myofascial pain and trigger points can develop in any muscle in the body. However, the most commonly affected muscles are those in the upper back, shoulder and neck. These muscles include the:
Symptoms and CausesWhat are the symptoms of myofascial pain syndrome?Symptoms are different for each person with myofascial pain syndrome. Sometimes the pain happens suddenly and all at once, and that is called a “flare-up” of symptoms. At other times it’s a constant, dull pain that sort of lingers in the background. Symptoms of myofascial pain syndrome include:
People with myofascial pain syndrome often have other health problems that coincide. Commonly reported problems include:
What causes myofascial pain syndrome?The jury is still out about all of the causes, contributing factors and exactly how the pain mechanism works. Causes of myofascial pain syndrome include:
Other factors thought to contribute to the development of myofascial pain syndrome include:
Is myofascial pain syndrome an autoimmune disease?It is not. Inflammation of the muscle or fascia is not caused by your body’s immune system incorrectly attacking healthy cells. Examples of autoimmune diseases are lupus, type 1 diabetes, celiac disease and multiple sclerosis. Diagnosis and TestsHow is myofascial pain syndrome diagnosed?Myofascial pain syndrome is often an underdiagnosed and overlooked condition. It might be mistaken for a problem with your nerves, bones, ligaments or tendons — but it’s not. It’s a problem in your muscles. There are no tests — no imaging tests, laboratory tests/ blood work, electromyography or muscle biopsy — that can diagnose myofascial pain syndrome. In addition, there are no visible signs, such as redness, swelling or unusual muscle warmth. The best method your healthcare provider can use to detect this syndrome is to physically examine your muscles — to feel for the taut bands of muscles and then find the exact spots of tenderness. Finding and applying pressure to a trigger point will result in pain, felt at the immediate spot or in an area a short distance away (referred pain). There are four types of trigger points:
Questions your healthcare provider may ask to diagnose myofascial pain syndrome:Your healthcare provider may order a few tests to rule out other conditions and ask you questions about your pain, including:
Your healthcare provider may check your gait (how you walk) and your posture to see if there is a balance of muscle use and look for signs of muscle weakness. You may also be asked about other health problems that can contribute to myofascial pain syndrome including how much and how well you sleep and if you feel stressed, anxious or depressed. What’s the difference between myofascial pain syndrome and fibromyalgia?Myofascial pain and fibromyalgia pain feel similar. Both have trigger points that emit pain. However, while myofascial pain is contained in one specific area (or, if more than one area, those areas are typically on the same side of the body), fibromyalgia pain is felt throughout the entire body. A patient with fibromyalgia has more trigger points, general pain, worse fatigue and sleep issues, headaches, an irritable bowel, a sensation of swelling and sometimes a burning, prickling or tingling feeling. Some researchers believe that myofascial pain syndrome can transition into fibromyalgia. Management and TreatmentHow is myofascial pain syndrome treated?If you have myofascial pain syndrome, treatment will be more successful if you see your healthcare provider early after symptoms develop — before trigger points are established. Many treatments are available and your medical professional will likely use a combination of the following to manage your pain and restore affected muscles:
Prescription medication options may include:
Treatments you can do at home include:
The duration of myofascial pain syndrome varies from person to person. With treatment, it may go away after a day or a few weeks, but it can take longer for some. How fast your myofascial pain syndrome resolves depends on a number of factors, including:
Who will treat/manage my myofascial pain syndrome?Healthcare providers typically capable of managing myofascial pain syndrome include physiatrists (medical doctors who specialize in physical medicine and rehabilitation), pain management specialists, rheumatologists or orthopedists and physical therapists. PreventionCan myofascial pain syndrome be prevented?There are certain factors that can put you more at risk for developing myofascial pain syndrome. Managing these risk factors may not prevent you from developing the syndrome, but could help reduce the severity of the condition. Many of the prevention suggestions to follow are also pain management strategies:
Some foods cause inflammation, and inflammation increases myofascial pain. Some foods to avoid include:
Check your cupboards and your fridge. Empty it of any foods that will increase your myofascial pain syndrome symptoms. Outlook / PrognosisWhat can I expect if I have myofascial pain syndrome?Each person’s pain — location of pain and severity — is unique. Pain can flare up from time to time or be ongoing and long lasting. Successful treatment usually requires finding healthcare providers you are comfortable with and following their treatment and management plan for reducing your pain. Living WithHow do I take care of myself?Living with myofascial pain syndrome is uncomfortable at best, unbearable at worst. Take care of yourself by following your healthcare provider’s treatment plan and using your at-home remedies listed above. Exercise, change your diet, soak in warm water, get massages, etc. You’ll likely have to experiment to figure out what treatments work best to reduce your pain. What questions should I ask my healthcare provider?
A note from Cleveland Clinic Everyone experiences pain during their lifetime. But when that pain is unbearable or long-lasting, that’s when you need to consult your healthcare provider. Fortunately, most pain —including myofascial pain — can be reduced or eliminated with the right treatment! See your healthcare provider as soon as possible for evaluation and treatment. Share Facebook Twitter LinkedIn Email Print Last reviewed by a Cleveland Clinic medical professional on 07/06/2020. References
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What does it mean when you have pain on one side?Side pain can be a symptom of a wide variety of mild to serious diseases, disorders and conditions, such as infection, infarction, inflammation, indigestion, trauma, intestinal obstruction, and cancer. Side pain can occur on one or both sides of the torso at a time.
What is the reason for right side body pain?Liver disease, liver cancer, or a liver infection may cause abdominal pain. These conditions may cause pain in the right side of your upper abdomen. Upper right abdominal pain usually feels dull and chronic.
How do you know if it's muscle pain or something else?The key thing to note when differentiating between soreness and pain is time. Natural soreness from physical activity has a much shorter duration of time- typically a few days. Soreness should last anywhere from one to three days, whereas pain may come on quickly while engaged in physical activity or shortly after.
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