Myofascial Pain Syndrome
Ongoing muscle pain from tight, tender knots called trigger points, often in the neck, shoulders and back.
Myofascial pain syndrome is a chronic muscle pain condition caused by trigger points, tight and tender spots in a muscle that hurt when pressed and can send pain to other areas. It commonly affects the neck, shoulders and back, and it can cause tension headaches. Dr. Patel treats it with physical therapy, posture and stretching work and, when knots persist, trigger point injections, while checking for spine problems that keep the muscles tight.
- Where it isNerves & muscles
- Treatment options04
- Who you seeAnup H. Patel, D.O.
- First visitExam and imaging review
Myofascial Pain Syndrome
Muscles are wrapped in a thin layer of connective tissue called fascia. Myofascial pain is pain that comes from muscles and their fascia. In myofascial pain syndrome, small areas inside a muscle become tight and irritable and cannot relax. These are called trigger points. You can often feel them as a firm knot or a tight band when you rub the muscle, and pressing on one usually causes sharp, aching pain.
Trigger points can also refer pain, which means they cause pain somewhere else. A knot in the upper shoulder muscle can cause a headache at the temple. A trigger point in the buttock can send pain down the back of the thigh. This is why myofascial pain is often mistaken for a joint or nerve problem, and why a careful hands-on exam matters.
Trigger points usually develop after a muscle has been overloaded, strained or held in one position for too long. Overexertion, strenuous activity, poor posture, long hours at a desk, stress, poor sleep and injuries such as whiplash are common contributors. Sometimes muscles tighten to guard a painful joint or disc in the spine. In that case, the muscle pain may keep coming back until the deeper source is treated.
Myofascial pain syndrome is different from fibromyalgia, which causes widespread pain and tenderness along with fatigue and sleep problems, though the two can occur together. Dr. Patel examines the muscles, the spine and your posture. Care starts with physical therapy, stretching and changes to daily habits. When therapy alone is not enough, trigger point injections can relax stubborn knots, and they often make therapy easier.
What it feels like · Why it happens
Mention these at your first visit. It saves time and helps focus the exam.
- Overexertion and strenuous physical activity
- Repetitive motions at work or in sports
- Poor posture, such as a forward head position at a desk or screen
- Muscle strain or injury, including whiplash and falls
- Long periods of inactivity or immobilization
- Emotional stress, which increases muscle tension
- Poor sleep
- Muscles guarding a painful spine joint, disc or nerve
How Dr. Patel finds the source
Treatment only works when it is aimed at the right thing. This is how the source is confirmed.
- Step 01
A history of where the pain is, how it started and what makes it worse
- Step 02
A hands-on exam to find trigger points, taut bands and referred pain patterns
- Step 03
Checking posture, muscle balance and range of motion
- Step 04
A neurological exam to rule out a pinched nerve
- Step 05
Examining the spine and joints that might be driving muscle guarding
- Step 06
Imaging only when needed to rule out other causes, since trigger points do not show on X-ray or MRI
- Step 07
Blood tests in some cases, such as thyroid or vitamin D, when another cause of muscle pain is possible
Your path to relief
Care moves one step at a time, from the least invasive option up, and only as far as you need.
First-line care
- Physical therapy with stretching, strengthening and posture training
- Heat, massage and myofascial release techniques
- Regular, gentle aerobic exercise
- Changes to your desk, chair and screen setup
- Stress management and relaxation techniques
- Better sleep habits
- Short-term anti-inflammatory medication or a muscle relaxant, when appropriate
- Electrical stimulation or a TENS unit for some people
Back to function
As a rehabilitation physician, Dr. Patel pairs every treatment with a plan to rebuild strength, movement and daily activity, so relief lasts.
Physical medicine & rehabilitation
Trigger Point Injections
Small injections into tight, tender muscle knots to help the muscle relax and ease pain.
Occipital Nerve Block
An injection at the back of the head that calms irritated occipital nerves to ease and diagnose headaches.
Medial Branch Blocks
A short-acting test that numbs the nerves to the spine’s facet joints to see if they cause your pain.
When to call
When to see a specialist
- Muscle pain has lasted more than a few weeks
- You can feel tender knots that keep returning
- You have frequent tension headaches
- Pain limits work, exercise or sleep
- Massage or stretching helps only briefly
- Physical therapy has not been enough
- Muscle pain started after a car accident or fall
Go to the emergency room if
- Chest, jaw, upper back or left arm pain with shortness of breath, sweating or nausea; call 911
Questions
What is a trigger point injection?
Do trigger point injections hurt?
How long does relief last?
Is myofascial pain the same as fibromyalgia?
Can stress cause muscle knots?
This page explains a condition or treatment in general. It is not a diagnosis or medical advice for you. Dr. Patel will explain what applies to you at your visit.
Nerves & muscles
Carpal Tunnel Syndrome
Numbness, tingling and weakness in the hand from pressure on the median nerve at the wrist.
Peripheral Neuropathy
Burning, tingling or numbness in the feet or hands from damaged nerves, often linked to diabetes.
Complex Regional Pain Syndrome (CRPS)
Severe burning pain, swelling and skin changes in an arm or leg, usually after an injury or surgery.