Myofascial Pain

Myofascial Pain
Myofascial Pain in the buttock muscles is a common problem in runners that few of them ever really know about! If you suffer with a dull or achy pain in the very lower back, glutes or hips which may seem to radiate to other areas around the pelvis or down the leg, then this could be myofascial pain. What is it? The word ‘Myofascial’ refers to the muscles and their surrounding fascia. Fascia is a type of connective tissue which surrounds all of our muscles and organs in one continuous expanse throughout the body. Myofascial pain is closely associated with words you have probably heard before – such as Trigger points or ‘knots’ in the muscle. Trigger points develop over time due to increased stresses on the muscle. What they are is like an isolated muscle spasm, where the muscle fibres have tensed up in a small area of the muscle. They can then become worse and become stuck in a cycle of pain due to the tension cutting off the blood supply to the area. Trigger points can cause a surprising amount of discomfort and as well as being painful at the point, can radiate pain throughout an area, sometimes way further than you would think! Symptoms of Myofascial Pain in the Glutes A dull aching pain Pain can be located in any of the gluteus muscles Pain can radiate down the leg, into the upper back and round to the front of the pelvis depending on the location of the Trigger point Worse after activity Reduced range of motion into hip rotation and abduction A tight feeling on stretching the muscles The area is tender to press Pain Referral Patterns In this case I think that a picture paints a thousand words (as the saying goes!) so I have included images demonstrating the position of some of the most common trigger points and where they can refer pain to. Apologies for the crudeness of these images – photoshop is not my strongest point! But I still think they give you the general gist of pain referral. Gluteus Medius, Piriformis, Tensor Fascia Latae and Gluteus Maximus Trigger Points (X) and their pain referral patterns (in blue) These muscles, along with Gluteus Medius, are the most common culprits for developing trigger points and these points referring pain throughout the hip and down the leg. Treatment of Myofascial Pain Trigger point therapy is the best form of treatment for myofascial pain, along with myofascial release techniques and stretches. Trigger point therapy This is a form of treatment which is usually associated with massage and can be applied within a massage treatment, or on its own. Trigger point therapy (TpT) involves applying pressure directly to the trigger point (knot) and holding the pressure for between 10 and 20 seconds. Usually in this time you will feel at least some tension and discomfort ease as the knot releases. A sports massage professional should be able to do this for you, but the great thing about trigger point therapy is that in a lot of cases you can do it yourself. Tools such as foam rollers and massage balls (or just tennis / golf balls etc) are great for this. Simply roll them around the tender area and hold the pressure on the more sore spot. If it doesn’t release within 20 seconds, remove the pressure, work somewhere else and then come back to it. I wouldn’t do more than 3 x 20 seconds per trigger point as you will end up being pretty sore afterwards! I also recommend stretching after trigger point therapy. This serves to elongate the muscle fibres which have just been released. The reasons that applying direct pressure to trigger points helps to release them is fairly complicated and involves theories on ischemia (reduced blood flow) followed by a sudden influx of blood once the pressure is released, as well as neurological adaptations. Massage Massage in itself will usually also help with trigger points although it is less specific and doesn’t apply direct pressure to the trigger point. But it does help with stretching out the tight bands of muscle and increasing blood flow to the area. Stretching Stretching the affected muscles several times a day will also help to improve flexibility and range of motion, helping to loosen the entire muscle, as well as the tight bands in which the trigger points develop. Stretch at least three times a day, holding each stretch for 30 seconds and repeating three times. Acupuncture / Dry Needling Acupuncture has been used to treat trigger points for many years and is usually pretty successful. I’m not trained in this so can’t comment too much, but I have had clients who have had acupuncture both privately and on the NHS and have found it helpful. Fine needles are inserted into trigger points to help release them. This form of acupuncture is sometimes called dry needling and is the western, or medical form of acupuncture, as opposite to the more traditional Chinese form which works more on energy pathways and ‘Chi’. Strengthening If trigger points keep developing in the glutes then you need to consider why this is happening. It may be just due to a period of increased training, which will soon ease when you reduce your training again. But if they are more constant, you may find that these muscles are overworking – often due to weakness elsewhere. Take TFL for example. If you find you keep getting a trigger point in the Tensor Fascia Latae muscle, it could be that your Gluteus Medius is weak and that TFL is taking more than it’s fair share of the workload when it comes to stabilising the pelvis and abducting the hip. Focus on isolating GMed in your strength training and this should reduce the strain on TFL. Original article and pictures take http://www.rehab4runners.co.uk/running-injuries/hip-groin-pain/myofascial-pain-buttocks/ site