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Pain from tight knots in muscle — trigger points — which frequently hurt somewhere other than where they are. That displacement is why the condition is so often chased in the wrong place.
Myofascial pain syndrome is persistent muscle pain arising from trigger points — small, tight, exquisitely tender knots within a taut band of muscle. Pressing one reproduces the pain, and often produces a visible twitch in the muscle.
It typically develops where a muscle has been contracted repeatedly: lifting at work, a day at a keyboard, or sustained tension held without noticing. Almost everyone has had muscle tension ache; what distinguishes this is that it persists or worsens rather than settling.
This is the part that confuses people, and it is the reason the condition gets mistreated.
A trigger point frequently causes referred pain — pain felt at a distance from the knot itself. A trigger point in the shoulder can produce pain down the arm. One in the neck can produce a headache. One in the hip can produce pain down the leg that is easily mistaken for sciatica.
So people get investigated where it hurts. Scans of the painful area come back normal, because the problem is in a muscle some distance away that nobody pressed. The examination finds this; imaging generally does not.
The name describes the two tissues involved: myo for muscle, fascial for the fascia — the sheet of connective tissue wrapping and linking muscle, shown in the inset. Pain arising in that muscle-and-fascia unit is myofascial pain.
Because fascia is continuous rather than divided into separate parcels, a problem in one place can be felt along the sheet somewhere else. That continuity is part of why the pain travels.
The pattern each trigger point produces is fairly consistent from person to person, which is what makes the examination useful. Someone who knows the maps can work backwards from where you feel the pain to the muscle likely causing it.
The two are regularly confused, and most people with muscle pain and fatigue have one or the other. The distinction matters because they are managed differently.
| Myofascial pain | Fibromyalgia | |
|---|---|---|
| Distribution | Localised to one region or muscle group | Widespread, across the body |
| The tender spots | Discrete trigger points in taut bands | Diffuse tenderness at many sites |
| Referred pain | Characteristic | Not typical |
| Twitch on pressure | Often present | Absent |
| Main treatment aim | Deactivating the trigger points | Managing a system-wide pain state |
They can also coexist, which is one reason a careful examination is worth more than a label.
Not all trigger points behave the same way, and knowing which is which explains why pain moves around and why treating one spot sometimes is not enough.
A tender nodule in a taut band that is currently causing pain. Produces referred pain and a twitch when pressed. This is usually what brought you in.
Present but not currently painful. Can sit dormant for years and become active under stress, fatigue or injury.
A point that becomes active because a nearby muscle is being overloaded, often while compensating for the first problem.
A point that becomes active simply because it sits within the referral zone of another. Treat the original and these often settle too.
Rarely one thing. Usually several, accumulating:
By examination. There is no blood test and no scan that shows a trigger point — which is exactly why people arrive having been told nothing is wrong.
The examination locates the taut band, finds the tender nodule within it, and confirms that pressing it reproduces your pain, including the referred pain elsewhere. That reproduction is the diagnostic step.
Imaging is used for a different purpose: excluding the things that can mimic this. Nerve compression in the neck or lower back can refer pain into a limb in much the same pattern, and it needs ruling out rather than assuming.
Treatment has two jobs: settling the current pain, and removing whatever keeps recreating it. Doing only the first is why it comes back.
Stretching the affected muscle, strengthening what surrounds it so no single muscle is overworked, and correcting the posture or work setup that caused it. Exercise is the one element common to every effective treatment plan for this condition.
Heat relaxes the muscle and helps the stretching work. Sustained pressure on the trigger point, and massage along the muscle, can release the band — useful alongside the rest rather than on its own.
Pain relief has a part to play, and some medications used at low dose for nerve pain also help here and improve sleep, which matters more than it sounds — poor sleep lowers the threshold at which the muscle complains.
Where a specific point is clearly driving the pain and has not responded to the above, injecting local anaesthetic directly into it deactivates it. The relief is often immediate, and it commonly makes stretching possible where pain had prevented it.
This is part of Dr Tung's practice, alongside neuromodulation and pulsed radiofrequency for pain that has not settled with anything else.
A good deal of myofascial pain resolves with physiotherapy and a change to whatever caused it, and that is the right first step. Two situations make a specialist assessment worth having.
Because trigger points do not appear on imaging. A normal scan is expected and does not mean nothing is wrong. Scans are done here to exclude other causes, not to find this one.
That is referred pain, and it is characteristic of trigger points. It is also the reason people get investigated in the wrong area — the painful spot is often not where the problem is.
No. Myofascial pain is localised to a region with discrete trigger points; fibromyalgia is widespread with diffuse tenderness. They can coexist, which is why examination matters more than the label.
They deactivate the point and often give immediate relief, but they do not address what caused it. Without changing the posture, loading or habit behind it, the trigger point tends to return — which is why injection and physiotherapy work better together.
It can be, and the patterns overlap. Pain referred from a trigger point and pain from a compressed nerve in the neck or back can look similar — which is a reason to have both assessed rather than one assumed.
No. You can book directly. It helps to note where the pain starts, where it travels to, what makes it worse, and what you have already tried.
Neuropathic pain · Tension headache · Neck pain · Rhomboid pain · Lower back pain · Shockwave therapy · Neuromodulation
If scans have shown nothing and the pain keeps returning, an examination that looks for trigger points is what has been missing.
