Upper Back Pain Treatment - Myofascial Release Therapy
The dental profession has recognised Myofascial pain as the main cause behind TMJD (temporomandibular disorder – a presentation involving the mastication muscles and the temporomandibular joint and characterised by jaw pain, clenching, ear ache, face pain, tinnitus).
This makes sense for us therapists through in clinic experience but also when we look at the supporting data, that points towards Myofascial Trigger points as a major player not only in TMJD but generally in patients experiencing upper body pain or headache/migraine pain.
In Myofascial Trigger Point pain (TrPs) the presenting symptoms can be either referred (often the case in headache/migraine presentations as well as TMJD presentations) or local to the location of such TrPs. In a client complaining of tooth ache, headache or TMJ pain (with no apparent clinical pathology to explain the symptoms) specially when described as deep, dull and achey, Myofascial trigger point should be considered if not as the main causation as a definite contributing factor and should be addressed accordingly by the right specialist before any other more invasive treatment method.
This is unfortunately still not the case now a days with most patients likely presenting myofascial trigger point pain not being guided in the right direction by their first contact specialist, usually family doctor, dentist or otolaryngologist (ENT). The reason for this I ignore, most likely lack of knowledge by the medical professional in most instances or lack of presence of specialised Myotherapist professionals within the medical system that patients could be referred to.
Either way, patients presenting Myofascial Trigger point pain are usually left in limbo, without a clear answer or treatment plan to tackle the issue and sent home. If patient persists they usually end up referred through the painfully long and useless chronic pain route to find out that it ends up going nowhere or they end up being misdiagnosed and undertaking a surgical procedure they didn’t need in the first instance. The lucky ones often find their way into the Myotherapist treatment room as a desperate last resource after having tried “everything else”; when indeed this should have been their first treatment option. Clients often present complications derived from a surgical procedure.
Myofascial trigger point pain, musculoskeletal as it is, might seem harmless and it’s clearly not a priority in an overflowing medical system; it is though not harmless at all. Myofascial Trigger point pain should not be underestimated, its intensity can be debilitating and limiting as well as playing a major role in mental health. As a clear example, it has been estimated that 12.5% of all work absence in the UK is attributable to back pain.
The Role of Myofascial trigger point pain in emotional processing
We also know that the fascia (the tissue directly affected in Myfascial trigger point pain) plays a major role in interoception (the ability to be able to sense and feel our own body, sense thirst, our heart beat, sense our belly, etc.)
The fascia has a great amount of the type of sensory receptors (unmyelinated free nerve endings) responsible for interoception and what’s more important, this information feeds straight to the part of the brain in charge of emotional processing, the insular cortex. This realisation points out to a deep relationship between the myofascial tissue and the way we feel.
The fact that myofascial trigger point pain is indeed a musculoskeletal presentation doesn’t mean it’s not important.
Myofascial Trigger points and central sensitisation
The Myofascial tissue has more sensory receptors than the skin and 10 times more sensory receptors than muscle. It’s clear that the brain and the nervous system are deeply connected with the myofascial system, our brain is listening to our body and vice-verse.
This points towards the formation of myofascial restrictions and the releasing of such restrictions to be interconnected with nervous system control, rather than it being purely mechanical.
The opposite is also true, with myofascial restrictions being a source of nociception, or pain processed in the brain.
A constant nociceptive input helps perpetuate peripheral and central sensitisation.
The connection between stress and illness and the Myofascial tissue
There is plenty of scientific evidence that supports a connection between prolonged stress or traumatic episodes with certain autoimmune presentations, like for example MS (Multiple sclerosis), fybromialgia, rheumatoid arthitis or chronic fatigue amongst others. Dr. Gabor Maté writes about it in his brilliant book “when the body says no”.
In clinic we get to touch and feel many different bodies, the tissue doesn’t lie. It is clear to us therapists that clients presenting with a diagnosis of such autoimmune conditions share similar qualities to their myofascial tissue; it feels particularly stiff, inflamed and not as responsive to treatment as that of a client not presenting with an autoimmune condition.
This stiffness of the myofascial tissue is also present in clients with high levels of stress.
Stimulation of the Sympathetic nervous system (overstimulation in cases of stress and trauma) leads to production of an enzime called TGF-beta-1 which function is also the stimulation of myofibroblast contraction (myofibroblasts are the most common cell type present in the myofascial tissue and responsible for its contractile properties).
Inflammation of the myofascial tissue in a prolonged way (as it is the case in autoimmune conditions or in prolonged stress) contributes to peripheral and central sensitisation and the cycle of pain and illness.
It goes like this:
Stress or trauma trigger the central nervous system (sympathetic nervous system) which trigger the myofascial system which in exchange triggers the stress response further.
Or like this:
The myofascial tissue gets injured or inflamed triggering the sympathetic nervous system that if prolonged overtime can lead to peripheral and central sensitisation feeding the response further even if the original stressor is dealt with.
There is clearly a link between stress and illness and the myofascial tissue seems to be at least one of the ways the brain is relating this stress with the body and vice-verse.
Tension headaches, head, neck and face
In relation with the upper body which is our topic for this post, Myofascial trigger points seem to be a very dominant source of pain and symptoms in this area.
Migraine and tension headaches have a high to very high change of being associated with Myofascial Trigger points.
Head and neck pain associated with direct trauma has moderate to high chance.
Cervicogenic headache has high chances of a Myofascial origin.
The chance of a Myofascial connection is also high in head, neck or facial pain associated with disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures, including the TMJ
Shoulder or upper trapezius location
Our experience in clinic shows that upper trapezius location is a common area hosting Myofascial trigger points and pain.
Our lifestyle and stress levels don’t play in favour of our upper trapezius, Sternocleidomastoid muscle, levator scapulae and scalens muscles.
Upper trapezius is indeed one of the most loaded muscles in the body, though it’s function is not to bear weight.
Combined treatment approach
A multidisciplinary treatment approach that addresses the Myofascial tissue, the nervous system (mind) and the movement or functional system seems to be the most effective way of dealing with Myofascial trigger point pain related presentations.
Myofascial trigger point pain referred patterns
Here are some examples of Myofascial trigger point pain referred patterns for the head and upper back that can be released and addressed by the right specialist.
This patterns of pain help us identify the possible origin of the pain and the location of the Myofascial trigger point or restriction to then release it accordingly.
Although in most cases the symptoms subside between a series or 1-6 session, depending on the person, life wouldn’t be that simple and there are cases in which a more complex presentation is perpetuating these Myofascial trigger points. Reason to reiterate a combine treatment method as the most effective way to approach these scenarios, where mind/stress and the fascia are addressed simultaneously.
Masseter muscle referred trigger point pain pattern.
Sternocleidomastoid muscle myofascial trigger point referred pain pattern
References:
Gwenllian Wynne-Jones et al 2014 Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occup Environ Med. 71(6): 448–456.
Fairweather, R. and Mari, M.S. (2015). Massage fusion : the Jing method for the treatment of chronic pain. Edinburgh: Handspring Publishing.
Travell, J.G. (1999). Myofascial pain and dysfunction / 1, Upper half of Body. Baltimore: Williams & Wilkins.
Gabor Maté (2019). When the body says no. Brunswick, Victoria: Scribe Publications.
About the author
Rocio Santiago
MA in Nursing, Dip. Soft Tissue Therapy
Ro initially began her career as a nurse. Following this and after a difficult time in her life that resulted in a career change, Ro went on to train at one of the leading soft tissue therapy schools in Europe, completing a 3 year degree level course and specialising in effective soft tissue manipulation for the treatment of musculoskeletal pain.
The treatment method Ro uses consists of a combined approach using different specialised techniques, myofascial release and trigger point work among others, with the intention and focus on providing effective results in the least possible amount of time.
Combining her training, science background and life experience, her treatment method is based in science and built using a whole body approach, where mind and body are addressed as one.
Ro has been seeing clients as a soft tissue therapist for 8 years, successfully treating a wide range of conditions.