Myofascial Pain Syndrome
December 8, 2014 1:58 PM
I have Myofascial Pain Syndrome. Do you? I have questions!
I've been struggling with chronic daily headache and migraine for almost five years now. After a long saga and now a new headache clinic, it is thought that extreme muscle tension in my shoulders, neck, and jaw, is causing the daily headaches, while the migraines are a separate issue. I started with a physical therapist a few weeks ago, and today he confirmed a diagnosis of Myofascial Pain Syndrome. When I asked what the plan was, he said that job #1 is to get the muscles to calm down enough to start strengthening them. Today and last week my appointment was spent with him working the muscle knots, which hurt like a motherfuck but seemed to improve things last week. Today, though, things were a lot tighter and hurt a lot more...he wasn't able to finish in the time we had, and I'm having some residual pain.
Other info: I'm a pianist and organist who also has an office job sitting at a computer for 20 hours a week. Obviously I can't change these things, but I'm working on ways to make the ill effects less terrible. I also have a diagnosis of TMJ and am finally going to get a bite guard in the next month or two. I have a history of anxiety, ADHD (which I am now finally medicated for), and poor posture due to large breasts. I've had significant weight loss (73 lbs) in the last two years and am in the best shape of my life.
So, I'm wondering if you've dealt with MPS, what was your treatment plan, did it work, and how long did it take?
I've been struggling with chronic daily headache and migraine for almost five years now. After a long saga and now a new headache clinic, it is thought that extreme muscle tension in my shoulders, neck, and jaw, is causing the daily headaches, while the migraines are a separate issue. I started with a physical therapist a few weeks ago, and today he confirmed a diagnosis of Myofascial Pain Syndrome. When I asked what the plan was, he said that job #1 is to get the muscles to calm down enough to start strengthening them. Today and last week my appointment was spent with him working the muscle knots, which hurt like a motherfuck but seemed to improve things last week. Today, though, things were a lot tighter and hurt a lot more...he wasn't able to finish in the time we had, and I'm having some residual pain.
Other info: I'm a pianist and organist who also has an office job sitting at a computer for 20 hours a week. Obviously I can't change these things, but I'm working on ways to make the ill effects less terrible. I also have a diagnosis of TMJ and am finally going to get a bite guard in the next month or two. I have a history of anxiety, ADHD (which I am now finally medicated for), and poor posture due to large breasts. I've had significant weight loss (73 lbs) in the last two years and am in the best shape of my life.
So, I'm wondering if you've dealt with MPS, what was your treatment plan, did it work, and how long did it take?
I recently wrote this comment about Rolfing, which is a type of massage or at least sits within the realm of manual therapy. While physical therapists are within the realm of "real medicine" unlike rolfers, a lot of their views are still outdated, and the myofascial pain syndrome construct is outdated in a way similar to rolfing, even if it's still in broad use.
I'm replying specifically because you noted you're worse after your treatment. That is worrying. Do another session, but if you're not feeling better or are worse yet again, I don't recommend you going back (disclaimer: I am only a massage therapist, I am not your doctor, etc). I agree with your PT that getting your muscles calmed down (although it's really your nervous system) is the priority, so if his or her treatments are only causing more pain and tension...
If you're interested in some reading, this book is pretty up to date science wise, and is written for a lay audience.
posted by MillMan at 2:41 PM on December 8, 2014
I'm replying specifically because you noted you're worse after your treatment. That is worrying. Do another session, but if you're not feeling better or are worse yet again, I don't recommend you going back (disclaimer: I am only a massage therapist, I am not your doctor, etc). I agree with your PT that getting your muscles calmed down (although it's really your nervous system) is the priority, so if his or her treatments are only causing more pain and tension...
If you're interested in some reading, this book is pretty up to date science wise, and is written for a lay audience.
posted by MillMan at 2:41 PM on December 8, 2014
The bite guard really helped me. It takes a while to get your bite fully adjusted, so there may be a little more pain as they continually refit and adjust it until it's right, but it's worth it. Not only am I rarely waking up with a headache now, but my teeth have been protected for the excessive wear that would have occurred had I continued clenching my jaw over the past 25 years.
I still get occasional cluster migraines, but I am slowly finding out what triggers them and working to avoid the triggers. One of my triggers is Stevia, which is not supposed to trigger migraine, so, y'know, bodies are weird and all.
posted by blurker at 2:57 PM on December 8, 2014
I still get occasional cluster migraines, but I am slowly finding out what triggers them and working to avoid the triggers. One of my triggers is Stevia, which is not supposed to trigger migraine, so, y'know, bodies are weird and all.
posted by blurker at 2:57 PM on December 8, 2014
This blogger has written about her own management of MPS and recently made an open offer to talk to any readers privately about it.
posted by serelliya at 3:57 PM on December 8, 2014
posted by serelliya at 3:57 PM on December 8, 2014
From a musician's pov, the Alexander Technique has been invaluable to me and many of my collaborators. I don't know anything about this teacher, who i found with a quick google, but she's local.
posted by j_curiouser at 4:23 PM on December 8, 2014
posted by j_curiouser at 4:23 PM on December 8, 2014
Long term you're going to have to move more and differently to maintain the results. The easiest thing is probably regular yoga practice which is basically the practice of bending your body all ways in one easy session. Ease into it though.
And haha if you think the pt's current massage based methods hurt wait till you run into a really good myo fascial release person. It hurts so much more, but is commiserately quicker and longer lasting. Both methods have their benefits and applications so if you're happy with your pt stay there.
posted by fshgrl at 5:41 PM on December 8, 2014
And haha if you think the pt's current massage based methods hurt wait till you run into a really good myo fascial release person. It hurts so much more, but is commiserately quicker and longer lasting. Both methods have their benefits and applications so if you're happy with your pt stay there.
posted by fshgrl at 5:41 PM on December 8, 2014
Obviously I can't change these things, but I'm working on ways to make the ill effects less terrible.
The thing is, it's easy to say that you should do certain exercises, etc, and that will take care of the issue but I think you need to get to the root of the problem: you need major lifestyle change. Really. You need to change your life so that you aren't sitting with your shoulders up to your ears 16 hours a day, and actually do whatever will make that happen--new equipment, a different schedule, take actual breaks, give up anything that is not strictly necessary and makes your problem worse. This is really hard to do, because you're invested in the job/hobbies/identities that are ultimately contributing to your stress levels and therefore causing you pain (and also you need money), but if you continue doing all of your regular activities in the same way and just add "treatment" on top of it, you're treading water.
That said, what I did:
Got a new, much less stressful job. Not easy, but totally worth it.
Gave up all of my hobbies that used my hands and required sitting (stopped playing music, knitting, playing games online) and found less physically taxing ones (reading, singing, birdwatching, fitness).
New equipment: got a new keyboard, started using voice recognition so I can walk around the room, switched to a trackball, and installed an add-on to remind me to take breaks.
Fitness: strength training has helped my posture tremendously. If a breast reduction is an option for you, that might be something to investigate as well, but strengthening your upper back muscles will help regardless. I also took up yoga and rearranged my schedule to spend a half hour every day doing yoga/stretching. This has helped a lot with keeping the baseline anxiety down as well.
I did not find that the bite guard reduced my TMJ symptoms at all, I just grind my teeth with it in. It reduces wear and tear on my teeth, but doesn't do anything for the base problem (stress = nightmares = grinding).
posted by epanalepsis at 6:34 AM on December 9, 2014
The thing is, it's easy to say that you should do certain exercises, etc, and that will take care of the issue but I think you need to get to the root of the problem: you need major lifestyle change. Really. You need to change your life so that you aren't sitting with your shoulders up to your ears 16 hours a day, and actually do whatever will make that happen--new equipment, a different schedule, take actual breaks, give up anything that is not strictly necessary and makes your problem worse. This is really hard to do, because you're invested in the job/hobbies/identities that are ultimately contributing to your stress levels and therefore causing you pain (and also you need money), but if you continue doing all of your regular activities in the same way and just add "treatment" on top of it, you're treading water.
That said, what I did:
Got a new, much less stressful job. Not easy, but totally worth it.
Gave up all of my hobbies that used my hands and required sitting (stopped playing music, knitting, playing games online) and found less physically taxing ones (reading, singing, birdwatching, fitness).
New equipment: got a new keyboard, started using voice recognition so I can walk around the room, switched to a trackball, and installed an add-on to remind me to take breaks.
Fitness: strength training has helped my posture tremendously. If a breast reduction is an option for you, that might be something to investigate as well, but strengthening your upper back muscles will help regardless. I also took up yoga and rearranged my schedule to spend a half hour every day doing yoga/stretching. This has helped a lot with keeping the baseline anxiety down as well.
I did not find that the bite guard reduced my TMJ symptoms at all, I just grind my teeth with it in. It reduces wear and tear on my teeth, but doesn't do anything for the base problem (stress = nightmares = grinding).
posted by epanalepsis at 6:34 AM on December 9, 2014
Thanks for all the answers so far. A couple of things:
--I do see a neurologist for the migraines. I recently had a repeat MRI to check on lesions in my brain, which have apparently not progressed in 3 years. She also thinks there's a possibility that I may have idiopathic intracranial hypertension, but I haven't had any testing for that yet. I think that there are two separate headache issues going on...the chronic daily headache which is tension-related, and the migraines, which are less frequent and more easily tracked to specific triggers.
--Things weren't necessarily worse yesterday after my PT appointment, but I did have some pain. The previous week I did not have any pain afterwards and felt great, but yesterday there was a lot more tension and knots going in and he wasn't able to address everything in the time we had, so to me it's not surprising that I didn't have the same level of relief.
--My job is generally not stressful. I'm able to get up and take breaks as needed, and while I think my desk/computer situation could be more ergonomic, overall it's better than most. And giving up my job? Giving up playing the organ and piano (which is also my job, not a hobby)? These are things that are not going to happen. I'm taking steps to improve how I do these things and minimize the effects on my pain, but that's all I can do.
--I will look into the Alexander Technique...I've heard about it but don't know any details.
Again, thanks for all the answers so far!
posted by altopower at 7:15 AM on December 9, 2014
--I do see a neurologist for the migraines. I recently had a repeat MRI to check on lesions in my brain, which have apparently not progressed in 3 years. She also thinks there's a possibility that I may have idiopathic intracranial hypertension, but I haven't had any testing for that yet. I think that there are two separate headache issues going on...the chronic daily headache which is tension-related, and the migraines, which are less frequent and more easily tracked to specific triggers.
--Things weren't necessarily worse yesterday after my PT appointment, but I did have some pain. The previous week I did not have any pain afterwards and felt great, but yesterday there was a lot more tension and knots going in and he wasn't able to address everything in the time we had, so to me it's not surprising that I didn't have the same level of relief.
--My job is generally not stressful. I'm able to get up and take breaks as needed, and while I think my desk/computer situation could be more ergonomic, overall it's better than most. And giving up my job? Giving up playing the organ and piano (which is also my job, not a hobby)? These are things that are not going to happen. I'm taking steps to improve how I do these things and minimize the effects on my pain, but that's all I can do.
--I will look into the Alexander Technique...I've heard about it but don't know any details.
Again, thanks for all the answers so far!
posted by altopower at 7:15 AM on December 9, 2014
This thread is closed to new comments.
What helped me was lying on a back-sized ice pack after getting home from the PT's office and being really, really diligent about the stretches and exercises they prescribed. It did get better, but it was a slow process. I've slacked off on the exercises over the years and I'm back to having problems; something to keep in mind.
As for the migraine issue, don't let the physical therapist summarily dismiss your neck/shoulder issues as a potential migraine cause. My migraines (I'm convinced) are triggered by -- or at least related to -- a specific set of muscles on my left side. (Flexeril helps a little bit if I take it when I first feel the thing coming on.) I have a coworker with the same kind of migraine, and I have spoken with a neurologist who says that it's actually a rather common form of migraine. So, the PT may be right, but he may also be looking at things through a purely physical-therapisty lens, and it might be worth consulting a neurologist about the migraines.
Oh -- and a PS: Get your work station checked out by an ergonomics person if you haven't already. Sometimes something as simple as adjusting the height of your computer monitor can reduce the strain on the neck and shoulder muscles.
Hope it gets better soon.
posted by mudpuppie at 2:20 PM on December 8, 2014