Myofascial Pain Syndrome Support Group
Myofascial Pain Syndrome (or MPS) is a term used to describe one of the conditions characterized by chronic pain. It is associated with and caused by "trigger points" (TrPs), sensitive and painful areas between the muscle and fascia. The symptoms can range from referred pain through myofascial trigger points to specific pains in other areas of the body. It may be related...
Hi all, please bear with me while I tell my story. I hope you might have some insights for me.
I used to be very active-I ran, kickboxed, walked everywhere, cycling, you name it. At the beginning of May my hamstring felt tweaked after running, so I decided to rest it and took a few days off. During that rest period my calves tightened up, and they haven't let up since. It feels like they need to be stretched, but stretching doesn't help. They are constantly tight, all day, every day, since May. Sometimes I get pain-like a stabbing pain, as if someone is in there with tweezers pinching my muscles. Sometimes it aches. I get weird sensations, like muscle twitches or bubbles or something. It is present as rest, while sitting, standing, walking. I cannot do anything high impact like running anymore, since walking is too much most days.
So far I've had an ultrasound to rule out DVT, and a clean xray and MRI on both legs. My blood work was normal except for low Vit D (now taking a vitamin) and slightly elevated TSH, so I'm seeing an endocrinologist at the end of September. I've been to physical therapy who prescribed the usual stretching and strengthening, which didn't provide relief. I've seen two orthopedic docs, both of whom don't know what to do. They don't think it's compartment syndrome because of my symptoms at rest, and there was no obvious injury in the scans. I was referred to a chiropractor who did seven sessions with me of ART. I now have been referred to a vascular surgeon to look closer at that. Doc says if that finds nothing, then it's on to a nerve study, and then pressure testing, even though he's really not enthusiastic about it.
I take Mobic for inflammation that helps keep a lid on it, but doesn't by any means make me pain free. Flexaril did nothing for me. I have a Vicodin PRN that I avoid as much as possible. I ice, I use heat, I elevate. The most relief I get is from compression, via ace bandages during day to day, and compression sleeves when exercising. I take epsom salt baths. And I sit. Which kills me, because I was so active and I love to exercise. I've gained weight since this all began.
I'm here because my doc mentioned myofascial pain syndrome as a possibility I guess he'll consider it further after all the testing. Do I sound like I might fit? I can't locate specific sources of pain (the trigger points) but there are days when I foam roll that I feel knots, and days when I don't. Lord knows the chiropractor sure found some tender spots. Please help!
I used to be very active-I ran, kickboxed, walked everywhere, cycling, you name it. At the beginning of May my hamstring felt tweaked after running, so I decided to rest it and took a few days off. During that rest period my calves tightened up, and they haven't let up since. It feels like they need to be stretched, but stretching doesn't help. They are constantly tight, all day, every day, since May. Sometimes I get pain-like a stabbing pain, as if someone is in there with tweezers pinching my muscles. Sometimes it aches. I get weird sensations, like muscle twitches or bubbles or something. It is present as rest, while sitting, standing, walking. I cannot do anything high impact like running anymore, since walking is too much most days.
So far I've had an ultrasound to rule out DVT, and a clean xray and MRI on both legs. My blood work was normal except for low Vit D (now taking a vitamin) and slightly elevated TSH, so I'm seeing an endocrinologist at the end of September. I've been to physical therapy who prescribed the usual stretching and strengthening, which didn't provide relief. I've seen two orthopedic docs, both of whom don't know what to do. They don't think it's compartment syndrome because of my symptoms at rest, and there was no obvious injury in the scans. I was referred to a chiropractor who did seven sessions with me of ART. I now have been referred to a vascular surgeon to look closer at that. Doc says if that finds nothing, then it's on to a nerve study, and then pressure testing, even though he's really not enthusiastic about it.
I take Mobic for inflammation that helps keep a lid on it, but doesn't by any means make me pain free. Flexaril did nothing for me. I have a Vicodin PRN that I avoid as much as possible. I ice, I use heat, I elevate. The most relief I get is from compression, via ace bandages during day to day, and compression sleeves when exercising. I take epsom salt baths. And I sit. Which kills me, because I was so active and I love to exercise. I've gained weight since this all began.
I'm here because my doc mentioned myofascial pain syndrome as a possibility I guess he'll consider it further after all the testing. Do I sound like I might fit? I can't locate specific sources of pain (the trigger points) but there are days when I foam roll that I feel knots, and days when I don't. Lord knows the chiropractor sure found some tender spots. Please help!
Yes, you be you'll have trigger points in your legs causing problems - they pop up whenever something 'odd' happens to your muscles like you've described.
And yes, you've already got some good knowledge of basic self trigger point work which is excellent, with a bit more you may be able to significantly reduce your pain and muscle tightness and learn how gym work is still possible despite having trigger points (very carefully and only under scientific knowledge!).
Expert information is called for...
1. www.painscience.com gives you the 'science based' lowdown on trigger points, self treatment, other treatments and 'how to go to the gym with trigger points'!
2. http://www.amazon.com/Healing-through-Trigger-Point-Therapy/dp/1583946098/ref=pd_sim_14_4?ie=UTF8&refRID=0BS14MDPCPJSFT3B37YC gives you detailed information about which trigger points in which muscles give you which symptoms (or vice versa) ...one major point they make is that they give really good diagrams of each muscle but don't give a 'point' or 'dot' where the trigger point is because each muscle is likely to have multiple trigger points all along the muscle or else the trigger point can be much larger than a single 'dot' implies. It's an important point (and helps explain why you're struggling to feel the trigger points in amongst the overall muscle spasms).
3. My own personal recommendation is to mix pure comfrey oil with weleda massage oil (or base massage oil) and rub generally over the painful and problematic areas, paying special attention to any weird bumps / lumps / stringy feeling areas. I've found comfrey oil to really help 'melt' the spasms and shrink the trigger points (sadly it doesn't stop them coming back, but can really help as an overall approach). www.painscience.com has the science of it!
Whatever's going on remember that your muscles are in a delicate state and it would be very easy to cause even more trigger points to pop up like wildfire so steer as far clear as possible from any further strength and stamina training. www.painscience.com calls it 'frying pan to fire' syndrome.
Heat and lots and lots of it is most likely to help relieve the aching. Ice - not so much.
Pain pills. It sounds like you need a low level of analgesia to help build a 'blanket' to bring the overall 'noise' down on the pain. Only use pills to help you get treatment and whilst going through diagnosis. The best place to start is something you take regularly, ibuprofen is the best place to start (take 4/500mg three times a day with food) and give it a few days to kick in and something 'simple' like that can actually be more effective than the other stuff at this stage.
They key is to have regular pain pills, to build up that blanket of analgesia. This is much better to control the pain that taking nothing and then only taking something when the pain gets too bad - you can bet you then have to take at least double what you would have needed...it's called chasing the pain.
Good luck
When you say no further strength or stamina training, do you mean while actively feeling pain?
I ask because like I mentioned, I was a runner, very active, and to think of never performing high-impact activity again is like telling an artist that they cannot use their hands anymore.
I do take Mobic, which is a prescription NSIAD like Ibuprofen. It helps to a point, but I still feel pain in spite of taking this every day. My doctor mentioned taking Cymbalta, but I don't think he wanted to prescribe it until I go through the last couple of tests and he knows for sure this isn't something neurological or vascular. I do have Obsessive compulsive disorder and have taken my fair share of antidepressants over the years including Effexor, which is in the same class as Cymbalta (SNRI) so I know I'd probably be ok with minimal side effects, and it'd probably help my anxiety as well. But like I said, I haven't gotten that prescription yet.
I just want to learn as much as I can in case this is the diagnosis I end up with, and start doing things now to ease my pain so I can re-engage in my life!
Once you get on top of the trigger points it's a case of being careful about 'taking your tp's to the gym'. There's a post a few back discussing this exact topic. It's not that you 'can't', just that you have to change the 'how' to get the results and avoid further problems.
You're still a runner, still very active, still like high-impact activity, but you're injured...just in a very odd way that's not the 'standard' sort of injury. You need to rest the muscles in the first instance, gather information (please do check out www.painscience.com as there's a key section all about high impact exercise and going to the gym). How long to rest? How long is a piece of string? Basically you need to rest as long as your body needs you to. Confusing? Always.
Your muscles would now also benefit from adding in a different type of exercise, specifically remedial (so 1:1 designed for your situation) pilates or yoga. We've seen a number of people get back almost full activity through tp-therapy (someone else-highly trained- doing the tp-massage) and either pilates or yoga.
If your taking mobic I see the problem. NSIAD's don't give that much pain relief for trigger point pain because (at this stage / level) it's not really an inflammatory process. I would suggest adding in regular co-codamol (I'm in the UK, not sure what you can get over the counter) -something with weak codeine in, or ask your doctor for sl stronger regular codeine 30-60mg three / four times a day. Failing that to go straight for tramadol (highly effective for muscle pain).
You're doing all the right things to get in control of any trigger points causing or adding to any problems. As bad as it is right now you can make a significant recovery and get back to exercising and being in control of it not vice versa; information is your key weapon. That and patience with yourself and your body to get through this stage.
I swam yesterday, and then sat in the whirlpool at the gym with my legs on the jets. Felt great. Tightened up a bit over the day but yoga and night helped out too.
Excellent news about the swimming, whirlpool, yoga and sleep! All of these will help calm your flare up down, bring the pain down, especially if you add in the 'sarno' method that has been so successful for myofascialpain.
Once your flare is really calm and you feel almost back to normal...that's the time to listen to Paul Ingraham and www.painscience.com about how to do gym work with trigger points if you really feel you have to.
Just make sure that you don't go straight back to the high intensity gym work that will set off all your trigger points again and then some.
Good luck
I'm curious, have you given yourself any time off from exercising since this started?
I'd like to throw out a few medicine thoughts. First, the hot tub felt good to you. Generally, inflammation does not respond positively to heat. I know it gets my nerves jumping (I have a few ailments). This leads me to question whether the Mobic is necessary. I would try to gauge that. I'm a believer in medicine where medicine is necessary but I'm extremely cautious.
Second, as you know Cymbalta and Effexor are in the same AD class. Cymbalta has been shown (ie studied) to be effective at relieving some people's pain. Effexor does the same although it has less norepinephrine and more serotonin. In Cymbalta, the chemicals are more equal. What does that mean in terms of pain relief? I don't know. My doctors have given me conflicting information. Cymbalta is supposedly more stimulating. The good news is that if you can't tolerate the Cymbalta, you can fall back on the Effexor.
As hard as it is, try not to get worried while getting to the bottom of your pain. It sounds like your doctor doesn't intend on leaving any stone uncovered. You might develop some trigger points, even if you don't have full blown myofascial syndrome, simply because the muscles compensate for injury. This is a workable situation. As you take a little break from your work out routine, remember about muscle memory, and know that you'll get back to your fitness level quickly.
Good luck! Give us an update or drop in to ask questions. The board has been slow but someone caring and knowledgeable will respond.
http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Treatment/dp/1608824942/ref=dp_ob_title_bk
Go to the chapter on the lower leg and see if any of the pain areas sketched out on the drawings match where you have pain. Vigorously massage, say with the end of a wooden spoon, the trigger points associated with them and see if you get any relief. If you do, you have myofascial pain.
I have been on the Cymbalta for a week now, and I know it's too soon to feel a difference, so it's probably placebo effect but I don't care, I've had a better week. I went camping with my husband and our friends and was able to walk some distances, although running was still off the table. So answer a question, yes, I have taken a significant amount of time off from exercise, I've spent most of the summer very sedentary and I started swimming because I couldn't take it anymore. So far the swimming is going well, so I'm hopeful. I see a vascular surgeon in two weeks to rule out any issues there. But in the mean time, I am going to keep swimming, stretching, and eating healthy in hopes of getting rid of some of this weight I put on from all this inactivity. And I will keep reading and educating myself.