Myofascial Pain
What is fascia?
Fascia, now increasingly regarded as the largest organ of the body rather than the skin, is a thin connective tissue primarily composed of collagen, similar to ligaments and tendons. Located beneath the skin, fascia exhibits a cobweb-like appearance under a microscope. It consists of multiple layers separated by a viscous substance known as hyaluronic acid.
Types of Fascia
Fascia can be classified into three distinct types:
- Visceral Fascia: This type surrounds organs within cavities such as the abdomen, pleura, and pericardium (Gatt et al., 2022).
- Deep Fascia: Enveloping bones, muscles, nerves, and blood vessels (Gatt et al., 2022).
- Superficial Fascia: Located directly beneath the skin (Gatt et al., 2022).
The structural design of fascia, comprising collagen, elastin, and hyaluronic acid, provides it with unique properties. Collagen renders it tough and rigid, while elastin allows for a degree of elasticity. The hyaluronic acid enables the tissues of the body to glide smoothly over each other, all while maintaining an internal framework that holds bones, organs, muscles, and blood vessels in place. For instance, the superficial fascia connects to the dermis, facilitating its frictionless movement while preventing the skin from detaching from the underlying body structure.
Fascia and Aging
As the body ages, the hyaluronic acid between the layers of fascia tends to become "stickier." This change can be likened to honey, which transitions from being fluid and malleable when fresh to becoming more gelatinous and less pliable as it dries. Over time, the tightening and drying of hyaluronic acid around muscles can result in painful adhesions, significantly restricting mobility. Due to its high innervation, these adhesions can cause debilitating pain.
Factors Influencing Fascia Changes
While aging is a primary factor contributing to reduced fascia pliability, other factors include a sedentary lifestyle, physical trauma, surgical procedures, repetitive motions (such as those involved in athletic activities), dehydration, and even emotional stress.
Emerging Perspectives on Fascia
Historically considered a substance of limited importance, fascia is now recognised as playing a crucial role in the body's functioning. However, research into its more intricate characteristics remains limited. Bordoni and Simonelli (2018) discuss studies indicating that biological changes within the body may occur in response to emotional triggers, suggesting the body's ability to anticipate events—a phenomenon sometimes referred to as a "sixth sense." This research alludes to the possibility of past events being stored within the cellular structure of fascia, implying a connection between quantum physics and biology. Continued exploration of this intersection could provide insights into this under-researched field.
What is myofascial pain?
Myofascial pain syndrome (MPS) is a non-articular musculoskeletal pain disorder originating from muscles and the surrounding fascia. It is characterised by the presence of myofascial trigger points, which are hyperirritable spots within skeletal muscle. Despite ongoing research, the precise aetiology and mechanisms underlying the condition remain are not well understood. However, several contributing factors have been identified.
Contributing Factors
The development of MPS may be associated with the following:
- Structural Deformities: Conditions such as spondylosis or osteoarthritis.
- Ergonomic Issues: Poor posture, improper form during physical activity, and repetitive motions.
- Systemic Deficiencies: Nutritional deficits, including deficiencies in vitamin D or iron.
- Traumatic Events: Physical trauma, such as collisions between dogs, or emotional stressors, including rehoming, the loss of an owner, or the death of another pet within the household.
Myofascial Trigger Points
According to Lavelle et al. (2007), "a myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena." These trigger points can make diagnosis challenging, as the referred pain often mimics symptoms of other conditions.
Trigger points form when sarcomeres within a muscle contract and fail to relax. This sustained contraction compresses the blood supply, reducing oxygen delivery to the muscle. Slow-twitch muscle fibres, which rely on oxygen for energy production, experience an energy deficit under these conditions. This metabolic crisis activates pain receptors within the muscle, creating a distinct pattern of pain along a neural pathway.
By understanding the multifaceted nature of myofascial pain syndrome, including its potential causes and physiological mechanisms, clinicians can develop more targeted and effective approaches to its diagnosis and management.
Symptoms of trigger points
- Fasciculation of the skin
- The dog may be unwilling to be groomed or touched in a particular area
- Yelping or screaming when handled
- An exaggerated nociceptive response to handling
- ‘Motorbike leg’ sometimes described as a ‘tickly spot’
- Coat changes over a specific area
- Tiring quickly when on a walk
- Not wanting to exercise
- Potential weight gain due to lack of exercise
- Stiffness when getting up
- Weakness of the hindlimbs
- Reduced coordination
- Reduced proprioception
- A reduction in sports performance for example, being slower around an agility course
Information Sourced From
Gatt, A., Agarwal, S. and Zito, P.M. (2022) Anatomy, fascia layers, National Center for Biotechnology Information. U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/30252294/
Bordoni, B. and Simonelli, M. (2018) The awareness of the Fascial System, Cureus. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281443/#REF26
John Hopkins Medicine (2021) Muscle pain: It may actually be your fascia, Muscle Pain: It May Actually Be Your Fascia | Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/muscle-pain-it-may-actually-be-your-fascia
Daprato, C. (2017) The role of fascia in movement and function, YouTube. University of California television . Available at: https://youtu.be/raCBeQ-gXfs
Hsieh, Y.-L. et al. (2007) “Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs,” American Journal of Physical Medicine & Rehabilitation, 86(5), pp. 397–403. Available at: https://doi.org/10.1097/phm.0b013e31804a554d.
Physiopedia contributors (2022) Trigger points, Physiopedia. Available at: https://www.physio-pedia.com/Trigger_Points#cite_note-:1-5
Shah, J.P. et al. (2015) “Myofascial trigger points then and now: A historical and scientific perspective,” PM&R, 7(7), pp. 746–761. Available at: https://doi.org/10.1016/j.pmrj.2015.01.024.
Sports-Admin (2018) What are trigger points, Sports Therapy Scotland. Available at: https://www.sportstherapyscotland.co.uk/what-are-trigger-points/
Sterling, D. (2018) Fascia & the mystery of chronic pain: Dana Sterling: Life talk, YouTube. Available at: https://youtu.be/v54l3wDTJHg
Tozzi, P. (2014) “Does fascia hold memories?,” Journal of Bodywork and Movement Therapies, 18(2), pp. 259–265. Available at: https://doi.org/10.1016/j.jbmt.2013.11.010.
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