Musculoskeletal Conditions are Often Myofascial-Related vs Non-specific Neck Pain

By James Fricton DDS, MS

Neck pain patients often find it challenging to understand their pain’s potential relationship to myofascial pain or musculoskeletal conditions.

The relationship can be simply stated as Myofascial Pain Syndrome (MPS) is a chronic pain condition that generates pain and tightness in the musculoskeletal system. However, there may also be an underlying joint or nerve pain. It may encompass pain in the muscles, the cervical joints, or both. This makes it difficult to differentiate which is the cause and thus, definitive treatment for neck pain can be confusing.

Our bodies are complex and wonderfully made with pain as the indicator of a problem. Even if the cause is not clear, these conditions are typically responsive to management when treatment is integrated with empowering the patient with self-management training.

This article will help both neck pain patients and clinicians take the mystery out of myofascial pain.

Over time, many people feel that their neck pain often follows some trauma, repetitive head movement, or muscle strain. Myopain conditions that encompass myofascial pain and fibromyalgia are widely recognized as the most common cause of chronic pain. This prompts more patient visits to health professionals than any other single pain condition.

Can neck pain be caused by myofascial pain syndrome?

Your taunt, achy neck, and painful knots may indicate having myofascial pain syndrome.

Myofascial pain syndrome (MPS) is a chronic condition that causes pain in the musculoskeletal system. This pain is often localized where there are muscle knots called trigger points in the muscle. Both local pain in overlying the knot and referred pain to distant areas can be related to trigger points in muscles. is usually related to trigger points in muscles. For example, you might only feel the pain and tenderness in your right shoulder and neck. However, the pain may also refer down the arm or up the back of the head causing headaches.^[1]

It’s a pain condition stemming from muscle and surrounding connecting tissue. Musculoskeletal pain is typically localized in a person with myofascial pain syndrome, whereas persons suffering from fibromyalgia find it more generalized.

Is neck pain a musculoskeletal disorder?

Neck pain is among one of the most prevalent musculoskeletal pain conditions. BMC Musculoskeletal Disorders reports an age-standardized prevalence rate of 27.0 per 1000 population in 2019. It also considers neck pain as a multifactorial disease. It may be accompanied by co-morbid conditions such as temporomandibular disorders, jaw pain, headaches, shoulder pain, and upper back pain. Additionally, it can be caused by many lifestyle factors such as whiplash, poor posture, repetitive strain, and stressors. ^[2]

MAny clinicians refer to neck conditions as “non-specific neck pain”. Being both a musculoskeletal disorder diagnosis and possibly a multifactorial disease, a clear diagnosis. An orofacial pain specialist identifies and manages all of the diagnoses causing pain in the head, neck, and jaw area including muscle, joint, neuralgic, or neurovascular conditions. So, what exactly qualifies as chronic neck pain?

“Chronic neck pain is defined as a persistent neck discomfort for at least 3 months due to chronic mechanical stresses such as a bad neck posture as well as degenerative changes”, according to Dr. Kamran Ezzati. He added the following comments in his March 9, 2021, National Institute of Health (NIH) article.

“Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome (MPS) is considered a common nonarticular musculoskeletal pain syndrome and an etiology for chronic neck pain.

 

Non-specific neck pain results from mechanical disorders‚ head and neck deformities, and myofascial disorders.” – Prevalence of Cervical Myofascial Pain Syndrome and its Correlation with the Severity of Pain and Disability in Patients with Chronic Non-specific Neck Pain

How is muscle health impacted in musculoskeletal neck pain patients?

Myofascial pain in the muscles is the most common condition causing neck pain and other pain conditions around the body including the back, jaw, shoulders, and hips. In this condition, the affected neck muscles may show symptoms of increased dull achy pain, stiffness, subjective weakness, and fatigue during movement, and a slight restriction in their range of motion.

Neck muscle pain is often triggered when placing repetitive strain by tensing or twisting your neck repeatedly throughout the day. For example, a study of jaw range of motion in patients with MFP and no joint abnormalities commonly found a lower range of motion (approximately 10%) compared to healthy people’s full range of motion. This restriction of neck movement may perpetuate existing trigger point pain and develop additional issues in the same muscle and connected muscles. This can cause multiple trigger points to form with overlapping areas of pain referral.

What often causes musculoskeletal neck pain?

Most often musculoskeletal neck pain is triggered by the following types of injury:

• Injury causing trauma to the head, jaw, or neck.
• Chronic muscle overuse.
• Repeated tense postures.
• Joint degeneration age-related disease.
• Nerve injury or compression.

Traumatic injuries from a sports-related concussion, a fall, a car accident, or stress-triggered teeth grinding can also result in muscle strain and sprain. Or the injury to your neck muscles may have occurred over time. For example, poor posture is a common cause of musculoskeletal neck pain.

Anything that puts additional strain on the muscles and ligaments in the neck over a period of time may lead to myofascial pain. For example, we get referrals from dentists where the patient has a history of dental treatment involving the maxillary sinus. Opening the mouth wide for a period of time can lead to myofascial pain of jaw, head, and neck.

The Relationship Between Myofascial Trigger Points and Neck Pain

The NIH study on The Importance of Myofascial Trigger Points in Chronic Neck Pain reports that Myofascial Trigger Points (MTPs) can be objectively detected with ultrasonography and demonstrates associated with the severity of pain and disability in individuals with chronic neck pain. Ultrasound can detect structural changes within the muscle and increased muscle knots associated with MTPs.

The study confirmed that trigger points can be documented with ultrasonography in patients with myofascial pain syndrome. Participants’ pain intensity was assessed using a 0-10 cm visual analog scale (VAS).

It found “a positive correlation between the VAS scores of the participants and the ultrasonographic detection of myofascial trigger points (MTP)s in the multifidus and middle trapezius muscles”.

An understanding of the trapezius muscles will help explain the etiology of myofascial trigger points in the neck.

What do trapezius muscles have to do with neck pain?

Myofascial pain in the trapezius muscles can cause neck and shoulder pain. You have a pair of large triangular muscles extending over the back of your neck and shoulders. They help you move your head up and down, raise and lower your shoulders, and maintain proper posture. You additionally use your trapezius muscles every day when rotating your head, as well as elevating and depressing your shoulders. It is a large muscle that starts at the base of your neck, runs across your shoulders, and extends down the middle of your back.

Challenges of Diagnosing Neck and Myofascial Pain

Head and neck myofascial pain are too often overlooked as a diagnosis since it commonly presents with signs and symptoms from other conditions. These symptoms may include tightness, fatigue, weakness, dizziness, or ringing in the ears. Myofascial pain signals and symptoms can also mimic many medical conditions. These include joint disorders such as arthritis, fibromyalgia, migraine headaches, neuralgias, temporal arteritis, TMD, and other pathology making it difficult to diagnose.

An individual can have both fibromyalgia and myofascial pain syndrome. This adds to the importance of consulting with a healthcare pain specialist who is qualified to diagnose the difference and apply the best treatments for each condition.

Bilateral jaw clicking may indicate a musculoskeletal or temporomandibular disorders (TMD) condition is present with a myofascial pain relationship. An examination will check for muscle tension, fatigue, and possible trigger points or knots in the masticatory jaw muscles.

Diagnostic Criteria for TMD when Chronic Overlapping Pain Conditions Exist

The National Institute of Health (NIH) 2020 study assessed a group of patients in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) project that compared the degree of overlap between pairs of chronic overlapping pain conditions (COPCs). The primary scientific aim of the study was to quantify the degree of overlap among the five COPCs.^[3]

The five COPCs are jaw pain, headache, low back pain, irritable bowel syndrome, and widespread body pain.

Overlap is reported more often between widespread body pain of fibromyalgia and either TMD or low back pain than between other COPC pairs. Musculoskeletal conditions exhibited some features that can be attributed to one clear functional syndrome. Patients with reported neck pain and tenderness upon palpation were found frequently in patients with all COPC musculoskeletal pain.

Patients became classified as a TMD case when all four of the following existed:

1. History of orofacial pain in examiner-verified locations of the masseter, temporalis, submandibular, or temporomandibular joint (TMJ) area(s) and/or history of headache in the verified location of the temporal region that had occurred on 5 or more of the 30 days preceding the examination.
2. Evoked pain in the same muscles and/or TMJ(s) following palpation of those structures or jaw maneuvers.
3. Reported familiarity of evoked pain, as judged by a positive response to the question “Was the pain you felt [during palpation or jaw maneuver] familiar to the pain [or temporal headache] that you reported during the last 30 days?”.
4. Pain that was modified by jaw function (commonly involving a pulled jaw muscle), as judged by a positive response to the question “During the last 30 days, was any of the pain modified by chewing hard food, opening the mouth, jaw habits such as clenching, or other jaw activities?”

This can guide clinicians while diagnosing jaw, head, and neck musculoskeletal conditions. It can assist in doing a better job than diagnosing non-specific neck pain with a specific diagnosis such as myofascial pain and fibromyalgia.

Are Myofascial Trigger Points the Same as Fibromyalgia Tender Points?

Myofascial pain trigger points are often confused with tender points of fibromyalgia. They are not the same even though “trigger points” and “tender points” are both localized areas of pain in the soft tissues. A trained pain specialist and other clinicians can distinguish the difference.

Tender points do not trigger referred pain or spreading pain, but trigger points do upon palpation. Fibromyalgia tender points tend to be symmetrical, meaning that they exist on both sides of the body. Trigger points often do not have a symmetrical pattern. This helps pain specialists do a better job of identifying what treatments work best when it’s been previously labeled as “non-specific neck pain”.

How to Distinguish Between Types of Myopain Disorders?

Additional distinct muscle disorder subtypes can also affect your muscular system. This is why you need a clinician that specializes in pain management. Certified pain therapists take a unique approach to atypical facial and neck pain. It means assessing all areas in your face, head, and neck for a comprehensive treatment plan.

Subtypes of Myopain Disorders:

• Myositis is about regional pain and diffuse tenderness. It is categorized as an acute pain condition with local or general muscle inflammation. Swelling in the connective tissue may overly the muscle.
• Muscle spasms are brief painful muscle contractions that render you with a limited range of motion. They involve a brief involuntary tone contraction of a muscle. These are the contractions that manage the resting tone of your muscles. A spasming muscle is acutely shortened, and quite painful causing a joint range of motion limitations.
• Muscle contracture refers to a limited range of motion that endures over a lengthier period of time. It is a chronic condition that is identified by continuous, extreme shortening of the muscle with a much-limited range of motion.
• Muscle splinting is when regional pain and localized tenderness parallel a joint problem.

A common treatment for myofascial pain is myofascial release. This can help with neck pain or tightness, headaches, and jaw pain that may be impacting your quality of life. Myofascial release isn’t the kind of thing that you can do casually. Like most muscle exercises, if you want lasting benefits, you need to follow through with your self-care neck and facial exercises every day.

This means that whether or not you’re experiencing pain at that time, stay the course. If one muscle area is more problematic, focus on this with exercises and massage for that particular day and bring it up during your next pain consultation.

What Does a Myofascial Neck Pain Treatment Plan Include?

Likely, a myofascial pain therapy plan will be created for you.

In most cases, neck pain treatment is successful with conservative methods. Physical therapy, analgesics, muscle relaxation, a modification of parafunctional behavior (such as teeth clenching and grinding), improving posture, and/or treating a bruxism and temporomandibular disorder with an oral appliance is usually effective.

Yoga, jaw and neck stretching exercises, postural therapy, and foam rolling are all common methods for keeping neck muscles moving well. It may be as simple as a myofascial trigger point therapy that uses your thumb or a tennis ball. Our pain specialists can help you learn how to directly target your unique tension and trigger points.

Myofascial release therapy is also helpful and includes a gentle, constant soft tissue massage. This releases tightness and pain in your myofascial tissues. Your pain provider will identify trigger points, or knots, in your neck and fascial tissues. Then, they’ll gently apply the right amount of pressure until the tension in your neck and face releases.

Management of Musculoskeletal Conditions to Reduce Neck Pain

Individual clinicians may have limited success in managing the “whole” patient without a team approach. At the Minnesota Head & Neck Pain Clinics, we address various aspects of a patient’s head, neck and face pain issues with a team of specialists. Our team approach is used in order to address all of the pain conditions and causes of the pain to enhance the overall success.

If success is delayed or the muscles are too tight, we also offer trigger point injections that many people find helpful. We also have health coaches ready to guide you in establishing a home treatment and exercise plan.

Call 763-577-2484 to request an in-person or telemedicine visit today: Schedule A Clinic Visit

About the Author

James Fricton DDS, MS is a leading pain specialist at the Minnesota Head and Neck Pain Clinic, a clinical research scientist whose clinical and research interests have focused on relieving and preventing chronic head and neck pain. He is also Chair of the Specialty Committee for the AAOP, and a University of Minnesota Professor Emeritus

References

[1] https://www.asahq.org/madeforthismoment/pain-management/types-of-pain/myofascial-pain-syndrome/

[2] https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04957-4

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10073941/