What is Chronic Myofascial Pain?

Chronic myofascial pain (CMP) is a disease that affects the chemical responses between nerve endings and muscle.

It is a chronic disorder in which sensory, motor, and autonomic symptoms are caused by myofascial trigger points (TrPs). This condition may develop in muscles that are overstressed, overused, or injured. Different from isolated incidental occurrences of trigger points (TrPs), which do not become a chronic problem. Chronic Myofascial Pain (CMP) develops when trigger points (TrPs) are apparent in several quadrants of the body and are chronic, meaning they have outlived their usefulness as a warning sign, pain and dysfunction results.

Chronic Myofascial Pain History

Theories as to the cause of trigger points and how they affect muscle tissue and the body has been documented by early investigators, but the real pioneer for the study of chronic myofascial pain, as we know it today, is Dr. Janet Travell, later joined by Dr. David Simons.

Dr. Travell noted that by applying pressure to a trigger point, she could establish and predict the presence of referred pain patterns that remain consistent between patients. After successfully treating President Kennedy for previous bouts with myofascial pain and long-standing back problems, she was appointed as the first woman, and first non-military White House physician. Dr. Travell died in August of 1997. She was in her 90's. To this day, she is considered an expert authority and the result of her dedicated work is referred to around the world. Information regarding the history of myofascial medicine and Travell and Simons work can be found at the Internet sites found in the links area of the website.

Sarcomere

A sarcomere is a tiny unit of muscle fiber. Many of them lined up end to end form myofibrils, and thousands of myofibrils make up the skeletal muscle. The sarcomere's job is to contract the muscle. Each one goes through three phases—resting, contracted, and stretched—and the impulse from one to the other is transmitted in a domino effect.

Have you ever seen a Chinese finger trap? You put a finger in each end (this is the relaxed phase, normal length) and pull the fingers away from each other. This movement imprisons your fingers as the trap stretches, lengthens, and tightens. A sarcomere functions similarly. The finger trap contracts and shortens when you push your fingers together, thus enabling you to remove your fingers.

This is the way a muscle should work: stretching to full length and contracting, or shortening, when the muscle is performing a job, putting all that energy into accomplishing the movement. Myofascial trigger points are an area of unnaturally shortened, thickened, sarcomeres in knotted, ineffective muscle fiber. These bound-up sarcomeres contract and stay that way. When this happens it weakens the rest of the myofibril (chain of sarcomeres) during a full-length stretch. This makes the muscle weak and unable to function properly.

Think of it this way: Imagine a large shooter marble in the middle of that Chinese finger trap, then put a finger in each end and try to stretch it as far as it would stretch if it didn’t have a marble in the middle. This demands increased force and puts stress on the part being stretched. Over time, this will weaken the finger trap, it will fray and break, and so will a muscle with untreated TrPs.

It is extremely important to treat that myofascial trigger point so the sarcomeres can lengthen and contract normally. This is why applying gentle, passive range of motion to the muscle while treating TrPs improves the outcome of the treatment. It will help the knotted up fiber to relax and lengthen.