Dr. Martin G Owen BHK (Exercise Science) MD CCFP
Imagine hanging from a tree over the open mouth of a crocodile. Despite your desire to keep on living, eventually the pain in your arms will become so severe that you will fall to the delight of the awaiting predator.
Severe muscle pain
I often relate this story or a similar one to validate the severity of pain experienced by my patients. You see, they often find it hard to believe that pain from their muscles alone could be so excruciating. For those who have been unfortunate enough to have had multiple types of pain, muscle pain has been compared to kidney stones, broken bones and heart attacks in severity (2).
Let’s put the problem in perspective
Low back pain is the fifth most common reason for all physician visits in the United States. Approximately one quarter of U.S. adults reported having low back pain lasting at least 1 whole day in the past 3 months, and 7.6% reported at least one episode of severe acute low back pain within a 1-year period (1).
So we know it hurts and we know it’s common, but what is the cause? It can be as simple as reaching the wrong way to pick something off the floor, or as traumatic as suffering multiple injuries in a car accident. Whatever the cause, when muscular pain becomes chronic the problem is a much more difficult and lengthy process to undo than it was to create.
The familiar component is those common knots that we all get in our muscles from time to time. But why do they become the source of chronic pain? Researchers noticed the knots and took some painstaking steps to describe them. First, they have a defined area of band-like hardness in the muscle, with a very local area of tenderness. Second, during the physical exam, applying pressure to the specific point will cause both local and distant pain. That’s the knot. What makes it chronic is mostly the inability of an inflamed muscle to relax, leading to a state of constant tension and pain. Changes in the spinal cord are also responsible for some of the many side effects of chronic muscular pain, including: weakness, spasms, imbalance and excessive sweating, to name just a few (2).
How can you get better?
Fortunately, during the painful process of discovering these specific sources of discomfort in the muscles, researchers found that massage or injection of that spot relieved the pain (1). Myofascial Trigger Point injection, as the procedure has come to be known, is still used as a tool for the assessment and treatment of chronic pain. The main advantage of using these simple, in-office injections, is their ability to provide information about the source of a patient’s pain within minutes of performing them. For instance, in a patient with low back pain and a tender quadratus lumborum muscle, for whom the pain before injection was 8/10 and only 2/10 afterwards, we can conclude that 75% of their pain was from the muscle alone.
So next time you have an injury lasting longer than 3 months, talk to your doctor about chronic muscular pain and myofascial trigger point injection.
- Roger Chou, Amir Qaseem, Vincenza Snow, Donald Casey, J. Thomas Cross, Jr, Paul Shekelle, Douglas K. Owens, Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007 Oct;147 (7):478-491.
- David G. Simons & Janet G. Travell. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol 1 (2nd Ed.). Lippincott, Williams, & Wilkins. 1999.
American Academy of Family Physicians: http://www.aafp.org/afp/2002/0215/p653.html
Dr. Martin G Owen is a proud husband, father of 6, and family physician in Alberta, Canada. He completed his medical training at Queens’ University and his residency at the University of Calgary where he was fortunate to have some excellent mentors in chronic pain.