Causes of Pain in Soft Tissue

Physiological Factors for Consideration by the Neuromuscular Therapist & Client

“ The musculoskeletal system is the means whereby we act out and express our human existence – ‘The primary machinery of life’ is what osteopathy’s greatest researcher Irwin Korr called it. While, medically speaking, the musculoskeletal system may lack the glamour and fascination of vital organs and systems, the fact is that these organs and systems exist only to service this great machine through which we live and function.

It is by our musculoskeletal system (not our kidneys or livers) that we perform tasks, play games, make love, impart treatment, perform on musical instruments, paint and, in these and a multitude of other ways, interact with each other and the planet.

The musculoskeletal system is also by far the greatest energy user in the body as well as being one of our primary sources of pain, discomfort, and disability.”
Leon Chaitow ND, DO

Always begin with a thorough medical evaluation to rule out serious diseases.

To achieve results in relieving myofascial pain syndromes (a cycle of pain related to muscles and connective tissue), we must consider a number of physiological factors that can cause or intensify pain in the body. If only one or two of these areas are addressed, we may struggle in our recovery or eventually regress to our previous level of discomfort.

Pain can return because one or more of the underlying causes continue to irritate the nervous system. The challenge is in trying to discover and remedy these factors and sometimes it’s just not easy.

The massage therapist directly addresses some of these factors and others can be remedied by the client’s thoughtful commitment to changes in lifestyle and self-care to produce long-lasting results. Therapist and client will do well to consider the following when trying to resolve chronic myofascial pain:

– When muscle spasms or chronically tight, bound-up tissues constrict blood flow, the tissues are deprived of normal amounts of oxygen and nutrients. This can irritate the nerves, leading to a cycle of pain and inflammation. Pain reflexively elicits spasms that limit movement and can lead to the formation of fibrotic tissues and adhesions that also restrict the flow of blood.

This decrease in circulation also prevents the normal removal of metabolic waste by-products that result from chemical changes when energy is produced in the tissues. The accumulating waste can toxify the tissues and contribute to the formation of trigger points.

Deep tissue massage therapy excels at releasing constricted tissues and aiding fluid circulation.

Trigger Points – are areas of increased metabolic waste deposits in the tissues that can irritate the nerves by electrochemical stimulation. Trigger points are a focus of hyper-irritability, which when compressed are locally tender. Trigger points can also refer pain from one area of the body to another. For example, trigger points located in muscles of the neck can cause pain in the head, contributing to headaches.

Trigger points can initiate and maintain a vicious cycle of pain and immobility that frequently gets worse over time. Neuromuscular therapy techniques systematically release trigger points.

Nerve entrapment/compression – Nerve “entrapment” is pressure on nerves caused by myofascial binding from chronically contracted muscles and/or injury. For example, the piriformis muscle deep in the hip can clamp down on the sciatic nerve causing symptoms similar to sciatica. Another example would be tight muscles of the neck or shoulder impinging on the brachial plexus – a network of nerves formed from roots in the cervical spine (neck) — causing symptoms in the arm, wrist, or hand. Neuromuscular therapy works to reduce muscular contractions that irritate nerves and to lessen intrajoint pressure.

Nerve “compression” is nerve impingement by a bone or cartilaginous “disk” between the vertebrae; for example, when sciatica is caused by the herniation of a vertebral disk that presses on lumbar nerve roots. Please note: MRI and x-ray images may reveal this “problem”, yet it may not be the cause of pain. Many joints showing degeneration under imaging remain pain free. Among other sources, the New England Journal of Medicine reports that 64% of people with no history of back pain had evidence of abnormal disks: 52% had a bulge of some kind, while 28% had some kind of herniation.

The pain may well be caused by soft tissue impairment and we should always look for the simplest solution first. Medical massage delivers the least risk of side effects and complications as a non-invasive, cost-effective therapy for the musculoskeletal system.

Postural and Biomechanical Dysfunction – A postural distortion occurs when the body deviates from its anatomically correct position. We are beautifully designed to “hang” in gravity with minimal effort and to thrive on efficient movement. When this elegant balance is thrown off by improper use, patterns of strain develop and we struggle with inefficient biomechanical “efforting.”

Consider not only times when we are standing, sitting or working at the computer, but also times when we are asleep. Faulty sleeping positions, like lying on our stomachs, can intensify swayback.

An example of a postural dysfunction would be when the head, which weighs around 12 lbs., is habitually carried forward of the ideal plumb line; the resulting effort in the muscles of the neck and between the shoulder blades is increased 2 to 3 times.

A biomechanical dysfunction is the habitual pattern of faulty body movement. An example of this condition would be walking with the leg constantly rotated outward, placing excess strain on the hip and on the inside of the knee. Another common biomechanical dysfunction is the shoulders rolling forward and down which can impede the lungs’ ability to draw a full breath. Neuromuscular therapy works to restore alignment and to develop a fuller range of efficient movement.

Nutrition – Learning what foods your body needs to be healthy is a worthy pursuit. In this era of endless and often conflicting dietary advice, it takes some time and effort to find out what may be your body’s unique needs.

In a myofascial pain syndrome, consider the following:

• Does the body receive enough quality proteins to rebuild and restore itself or is it struggling with nutritional deficiencies?
• Are you taking in too many neuro-stimulants, i.e. sugar, colas, coffee, white flour pastries, nicotine, empty carbohydrates, preservative-laced junk food, etc.?
• Are prescription drugs leeching essential nutrients from your system or deranging the good flora and fauna of your digestive tract?
• Are you taking your meals in a non-stressful manner that promotes good digestion? Eating even a balanced diet of healthy food in a stressful or rushed environment disrupts the entire process. (Note to readers: if you figure out how this can be successfully accomplished, please notify the author. Thank you and good luck!)

Emotional Well Being – Stress!! OK, let’s all take a deep breath and reflect for a moment on this: stress in and of itself is not a bad thing. After all, “life” itself is defined in part as “the ability to respond to a stimulus.” This “stimulus” can be a positive influence and motivator.

Think of it as fuel; what counts is how well we burn it (resolve it.) If we have a negative emotional response to unresolved stress, it can produce anxiety and long-term consequences. If it contributes to the disruption of sleeping patterns, all other symptoms can be intensified.

Persistent unresolved stress and emotional turmoil can leave us more vulnerable to pain and disease by increasing our blood pressure and raising our levels of stress hormones like cortisol. Chronic elevations of stress hormones can erode the body’s strength and resiliency and is a predictor for the early onset of hypertension, heart disease, and stroke.

Massage therapy is now being researched in formal clinical trials. The Touch Research Institute at the University of Miami and the National Institutes of Health are reporting that with regular massage therapy, patients have shown lowered incidence of anxiety, depression, and hostility along with decreases in blood pressure and cortisol levels.

Emotions and unresolved long-term stress may affect health in ways that science may struggle to define. The research conventions of the modern era demand results that can be precisely quantified. But the complexity of variables that impact our well-being may not easily be reduced to a narrow study of a constituent part. How emotional response impacts health may be difficult to scientifically measure.

However, common sense tells us that people who are under stress or who are disturbed may lose interest in self-care, smoke and drink more, eat poorly, fall off their exercise programs, and either don’t receive adequate care or ignore medical advice.

I personally feel that how we perceive our physical, social, and spiritual world and our ability to identify and deal with stressors will affect the degree to which “stress” impacts our health. Let’s put the undeniable power of the mind-body connection to work for us rather than against us.

It may be that stress is as natural, indeed as essential, as gravity. Quoting Helen Keller:

“Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.”

EXERCISE — In a myofascial pain syndrome, it may be best to consult a trained fitness instructor or physical therapist. Please note: engaging in strengthening exercises when the musculature is chronically tight or bound-up will risk more pain and injury. Asking the already foreshortened muscles to contract even more under weight bearing or resistance training risks tearing soft tissue fibers (strains and tendonitis).

When rehabilitating an injury, I feel that this premature return to strengthening exercise is why physical therapy programs are sometimes of limited benefit and why it would be an ideal time to schedule a series of appointments with your massage therapist. Exercise is critical for a full recovery, but it is safest when undertaken after the therapeutic release of muscle tension. Strengthen, yes… but lengthen first!

Exercise for flexibility, strength and endurance. Let these three components, developed in this order, form the basis of your exercise program. With a good stretching program to develop a pain-free and effortless range of movement, you can then safely and effectively move into strengthening exercises. When the body has good muscle tone (flexibility and strength), one is well positioned to develop endurance (aerobic capacity).

Also, consider that in your all-important stretching program, stretching should NOT be done as a warming up activity. This may sound contrary to what you’ve heard, but stretching is best done after limbering up with a modest aerobic work-out, such as walking or jogging easily in place, when extra heat and circulation are distributed throughout the muscles. When the muscles are warmed up, you can safely and effectively maximize the elongation of fibers and lessen potential damage to ligaments and tendons.

Even when you have a stretching and massage program in place, be careful to exercise beneath your pain threshold to minimize the risk of re-injury. Many young athletes and performers have been forced into early retirement from thinking “No pain, no gain” and ignoring their body’s pain message.

It’s clear that a sedentary lifestyle stagnates the body’s fluid circulation, decreases strength, and dampens energy, making us more vulnerable to pain and injury. The body thrives on a regular, properly performed, consistent practice of conditioning. Even a modest program of activity will improve your state of overall health. It doesn’t have to be elaborate. Consider dedicating 30 minutes for a brisk walk every day.

“ Only action gives life strength.
Only moderation gives it charm.” – Anon.

Honorable Mention: What might be overlooked in a myofascial pain syndrome.

• Are you getting enough sleep at night? The body needs this “down time” to rebuild and restore itself, but many studies show that a big percentage of us are fatigued due to sleep deprivation.
• Are you experiencing side effects of muscle or joint pain from prescription drugs? It’s not uncommon. In addition to your doctor, consider your pharmacist as a good source for information. If they should prove unhelpful – shop around.
• Do you get outdoors for enough fresh air and natural light? We haven’t evolved over the millennia to thrive on dead air and artificial light.
• Does your office set-up support good ergonomics to avoid repetitive strain injuries? Ergonomics information is readily available, but it is most important to frequently pause your work so you can move, breaking up a static posture.
• Does your furniture properly support your home activities? Saggy couches and mattresses can be a set-up for pain. Good postures for reading and watching TV are habits worth developing.
• Are you getting enough oxygen into your system with good breath mechanics? Many of us are habitually shallow breathers, depriving us of a key element in our vitality. Try some Hatha Yoga or other breathing exercises.
• Try to avoid or limit: crossed legs, wallet in your hip pocket, noise pollution, cold drafts, standing/walking on concrete, blown-out sneakers or high heel shoes, and heavy shoulder straps.
• And of course, never run with scissors or dive into murky water, especially at the same time.