Myofascial pain syndrome: trigger points, symptoms, causes and treatment

Myofascial pain syndrome (MPS) is a pain condition in which muscles and the fascia surrounding them are the source of pain. Its hallmark is the trigger point: a small, tender, taut area within a muscle. A narrative review of the condition describes trigger points as hyper-contracted areas of muscle that are easily felt by a health professional and are hypersensitive.

A trigger point may hurt locally, but it can also send pain to another area, known as referred pain. The review says this referred pain follows muscle-specific patterns that do not follow a dermatome or nerve root distribution, which is one reason the source of pain can seem puzzling to the person who has it.

The review notes that the exact mechanism of MPS is not known. It also says there is a lack of agreed criteria for defining it, which is one reason estimates of how common it is vary widely. A consensus paper describes myofascial trigger point pain as primarily a nociceptive pain condition that can also be present in people who have neuropathic or nociplastic pain.

Neither source is UK-specific, and the NHS website does not have a dedicated page on myofascial pain syndrome, so this guide relies on published reviews. The advice to see a GP and the NHS access routes described below are UK-specific.

The review describes pain that is often a deep ache confined to a region, most commonly in the head, neck, shoulder and lower back. It lists the following features that may be found.

• A tender, taut band or knot in a muscle that reproduces the pain when pressed.

• Referred pain to another area in a pattern specific to the muscle.

• Limited range of movement, stiffness or muscle spasm.

• Muscle weakness without wasting.

• Pain during maximal muscle contraction, and sometimes numbness or other unusual sensations.

• A "jump sign": a startled response, such as wincing or crying out, to pressure on a trigger point that seems out of proportion to the pressure applied.

The review says treatment should combine hands-on and exercise-based approaches with attention to the biological, psychological and social factors that keep pain going. It describes the following options.

The review says trigger points are most often activated by mechanical factors such as poor posture, abnormal alignment of joints and overuse, as well as muscle damage, repetitive movements and prolonged sitting or standing. It also lists nutritional deficiencies, metabolic conditions including hypothyroidism, sleep deprivation, chronic infections and rheumatic disorders such as rheumatoid arthritis and osteoarthritis as factors that have been observed to activate trigger points.

Psychological and social factors matter too. The review says stress, anxiety, depression and behavioural factors can contribute to the persistence of trigger points and chronic pain, and it cites a cohort study linking insomnia with a higher risk of developing MPS. It also reports that women are more vulnerable to the activation of trigger points than men, and that chronic muscle pain is more likely in older people and manual workers.

The review describes acute activation of trigger points as usually subsiding within one week, while chronic MPS, which is what most people seeking help have, is more complex to manage.

MPS is diagnosed clinically. The review says the history should be taken in detail, often including a past injury or chronic muscle overload, and a careful examination should be carried out. Feeling for taut bands and applying deep pressure to find trigger points that reproduce the pain pattern is described as one of the best ways to make a definite diagnosis.

Tests such as scans or blood tests are not needed to diagnose trigger points, but may be used to look for other explanations for the pain. The NHS back pain advice is a useful guide to when other causes need ruling out: it says to see a GP if back pain has not improved after a few weeks of home treatment, if it is worse at night or does not improve with rest, if you have lost weight without trying, or if there is a lump or change in the shape of the back.

The NHS says to call 999 or go to A&E if back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, or bladder or bowel changes, and to seek urgent advice if you feel unwell, hot or shivery, or if the pain is severe, sudden or worsening quickly.

A GP is the usual first step. The NHS says that in many areas you can refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy without a GP referral. Physiotherapists are the main professionals who assess muscles and teach stretching, strengthening and posture advice. Some people choose to see a physiotherapist privately for quicker access; the Chartered Society of Physiotherapy keeps a register of qualified practitioners.

Treatments such as dry needling and injections are offered in some NHS pain and musculoskeletal services and in the private sector, and availability varies by area. If pain is widespread and comes with fatigue, poor sleep and "fibro-fog", ask your GP whether fibromyalgia needs to be considered, since the NHS lists these among its symptoms and recommends exercise, talking therapies and sometimes antidepressants for it.