Muscular Pain ...Education, Prevention & Healing
This is an acute process that can go on for prolonged periods because many daily (acute) aggravating factors cause perpetuation. If you are not aware, you may have many minor aggravations over the course of a single day
Healthiness, whether in the whole individual or in specific organ systems (muscle is an organ system) depends upon a balance between healing processes and cellular deteriorative processes. When healing processes cannot keep up with deteriorative processes, then the balance shifts to a state of sub-optimal health in the involved muscles.
“Chronic Muscular Deterioration Cycles”
“Cyclogens” (factors that can initiate or perpetuate the cycle of muscular deterioration) are critical and you will have to become an expert at identifying what factors in your life (your behaviors, your activities, and your emotional and psychological status) tend to perpetuate your pain. You must become objective. Stop thinking about how much you hurt and what you can’t do, and start thinking about how it affects you and what you do to aggravate it. People who have myofascial pain (MFP) know well what it does to them, but what they are ignoring is what they do to increase their MFP. Understanding this concept is the most important aspect of the treatment process. You must change your way of thinking in order to switch the control factor: you control the pain instead of it controlling you.
Categories of muscular pain:
The most common causes of muscular pain include reinjury or strain, overuse, sleep disturbances, and emotional and psychological stress. All of these categories can be subdivided into many individual factors, and then individualized to that person’s activities, behaviors, and emotional and psychological status. Although the four categories of “cyclogens” are common in most people with MFP, most patients don’t want to admit that emotional and psychological issues are important. In our society there seems to be a stigma attached to these mental factors. It is not “macho” to have symptoms related to stress. In some cases, however, the most important perpetuators of MFP relate to stress (tension, anxiety, frustration, anger, depression and the list goes on). Stress reduction and relaxation are important aspects of comprehensive treatment. It is important for you to begin to realize the complexities of this syndrome and to understand the interaction of mind and body. This realization is imperative if you are to learn enough about this problem to gain control and gradually resolve it.
Several mechanisms contribute to muscular tension. We have already addressed how psychological and emotional problems can cause muscular tension patterns to develop. If you are one with “nervous stomach” tendencies, you may recognize your tension as an upset or “tight” stomach. It is important that you become aware of how nervous tension affects your muscular problems. Muscular tension can result in impaired blood flow, impaired healing, and it can facilitate deterioration. Muscular tension can also be caused by “splinting” or guarding” as the mind and body react to discomfort. Your mind and body produce this muscular tension consciously and subconsciously in order to protect the painful area from discomfort. You must be able to identify causes of stress and tension and to deal effectively with them, so that they do not continue to be factors perpetuating muscular deterioration.
Poor movement and posture patterns can develop because of chronic guarding behaviors: a limp is a good example. These dysfunctional motor patterns are abnormal and produce abnormal muscle use and tension patterns that can be important factors in your ongoing problems. With asymmetrical posture, some muscles elongate while others shorten in compensation for the abnormal position, also causing abnormal muscular stress and tension patterns. You must learn to recognize these abnormalities as maladaptive behaviors and start correcting them. It takes conscious effort; no one can do it but you. Postural issues are commonly overlooked but are significantly problematic. Lower back, upper back, and neck problems are particularly susceptible to the added stress of poor posture. First, you must become aware of your movement and postural abnormalities and realize their relationship to your pain. Then you can start to do what it takes to correct these problems. Practice, practice, practice good behaviors to make them habitual.
One interesting aspect of MFP is the definition of acute versus chronic. This has implications in treatment. The term acute indicates that it occurred or started recently, while chronic means that it has been present for a while…six months or longer. From this understanding, many with MFP have a chronic illness. However, I hope you have grasped the fact that this problem is an acute process that can go on for prolonged periods because many daily (acute) aggravating factors cause perpetuation. If you are not aware, you may have many minor aggravations over the course of a single day. Any one of these aggravations may be relatively unimportant, but their effects are cumulative, that is, they add to each other, resulting in significant muscle damage by the end of the day. Remember, already damaged muscle is very easily re-injured.
Any treatment program must take into account all aspects of the cycle if it is going to have optimum success. All “cyclogens” must be identified and systematically dealt with. Any “cyclogens” left unattended will continue to perpetuate the process, even with partial treatment, and may cause the treatment program to be unsuccessful.
The most important tool that you will have at your disposal in your fight to control and resolve MFP is what you know. In the end, only YOU can prevent cycling of MFP, and only YOU can control and resolve this non-life threatening, but miserable problem.
Rehabilitation must take into account, eliminate all causative factors, and facilitate healing in every way possible. There are several aspects to the treatment or rehabilitation program. None of these are difficult, but they must all be followed persistently and accurately if you are to be successful.
You should learn as much as you can about the many aspects of your problems. Explore by using the Internet, your libraries, bookstores, and credible health magazines. The investment of time and effort into your education will pay dividends. Without adequate knowledge, your likelihood of success is limited. Remember, you will never regret the education you get, but you may regret for many years the education that you don’t get.
Your muscles will not heal completely unless you determine what it is about you, your behavior patterns, your activities, your sleeping patterns, and your emotional and psychological status that gives you the tendency for this problem to persist. Your muscles would have healed themselves long ago if it were not for those “cyclogens” that you produce. If you make a mistake and aggravate your condition, treat the aggravation and learn from the mistake so that you rarely, if ever make it again. Mind yourself in all activities; put your brain in gear before putting your body in motion. Identify and eliminate all “cyclogens.” Become more aware of tension in your muscles and of factors or situations that tend to cause this tension. If inner psychological or emotional difficulties are feeding your problem, deal with them. Do some soul searching and introspection to get a handle on these issues, and seek professional help if necessary, knowing that nobody but YOU can really change your attitude and beliefs. You cannot ignore any “cyclogens” and expect to resolve your muscular problems because any remaining “cyclogens” will prevent complete healing.
You must accept the fact that you have chronic pain and do the best you can with it. Start setting goals for yourself, in terms of your rehabilitation program, work, recreation, social activities, hobby, or vocational interests. If your pain is getting to you, get angry at it to blow off your frustration and get back to your program. Your ultimate goal should be to get into the best physical condition that is possible and stay that way. Optimize your relaxation response by practicing relaxation techniques. Ask your family and close friends to reinforce only well behavior, not illness related behavior. They should pat you on the back for acting normal, not fuss over you because you are having discomfort or acting sick and disabled. Make a partnership with your doctor, use but do not abuse him or her. Be motivated and determined to persist in your own rehabilitation. If you quit no matter where along the path, you lose. The biggest difference between the successful people and those who fail in this world is planning, persistence, determination, and positive attitude.
If you follow these guidelines, you will be helping yourself. Feeling a sense of accomplishment increases self-esteem and self worth. There is nothing in the above information that you cannot understand and do if you are determined and persistent. Now, go do it for yourself! You will be grateful for the rest of your more enjoyable life.
There are numerous therapies that you can put into practice in the facilitation of muscular healing, several of which result in decreased muscle tension and increased blood flow, a key concept of healing. Health is proportional to blood flow.
COLD THERAPY: Use your large cold packs frequently and on a timed schedule. Use your cold packs when needed for exacerbations, such as with overdoing it. Use your cold packs for no less than 30 to 40 minutes when you do use them.
STRETCHING: Develop a regular stretching program and perform it frequently, for short duration, non-repetitively. Do stretching before and after exercise, immediately after getting up from sitting or lying, immediately after using your cold packs, and about every ten to fifteen minutes while awake. You will have to work at developing good habits. Unfortunately, bad habits are more easily developed.
EXERCISE: Your exercise program, in the long run, may be the most important aspect of successful rehabilitation. Until muscle healing occurs, however, you must approach exercise with caution so that it does not aggravate your condition. You have upper and lower limits of tolerance, and stretching these limits will work against you, causing the cycle of muscular deterioration to continue. At first, your exercise sessions should be short and frequent. Start with exercise sessions lasting from three to ten minutes about every hour or so. Gradually increase the duration and intensity of your sessions, and remember; more frequent, low intensity exercise is better tolerated and better for you than trying to progress too quickly. Walking is an excellent way to start your slowly progressive exercise program. Start any new activity or exercise with great caution, slowly, gradually increasing the activity, but never taking it to the point that it hurts you or increases your muscular pain.
REST AND RELAXATION: Rest and relaxation are important and helpful but only in moderation. Too much inactivity will be tolerated poorly and actually cause damage to already affected muscles. Inactivity can enhance the development of chronic tension patterns in painful muscles, reducing blood flow and causing more deterioration in the involved muscles.
ACTIVITY: Any activity you do, physical or mental, that is not injurious to you in any way and that does not aggravate your muscular condition probably has at least some therapeutic value. Keeping your mind and body focused on activity has important effects on control of discomfort and on your general sense of well-being. You must not allow your activities to cause recurrent aggravation. Daily structure is very beneficial and if you are not currently working at a regular, full-time job, you should start structuring your day around your rehabilitation program and your activities. Volunteer at a local hospital or senior citizen center. Get out of the house on a regular basis; do not let the television control the structure of your day. Find new hobbies, things you can enjoy and find self-satisfying. Do not just let the world go by, or it will…leaving you behind.
MEDICATIONS: Medications are often helpful in moderation, but can easily become a “crutch.” Anti-inflammatory medication such as aspirin or Ibuprofen (Advil, Nuprin) or your analgesic medication such as acetaminophen may be helpful. Initially, take the medications on a timed schedule, and reduce medication intake as your symptoms allow, as soon as possible. Ask your doctor if he or she thinks you would benefit from Flexeril or Elavil at bedtime to help normalize your sleeping pattern. These latter two medications can be very helpful if you suffer from the sleep deprivation that is commonly associated with MFP.
TREAT EXACERBATIONS IMMEDIATELY AND EFFECTIVELY: If you make a mistake and have an aggravation (increased symptoms), even if you do not think it was your fault, start treatment immediately, then think about it. Use cold pack therapy, short duration rest/relaxation, and a gradual return to stretching, exercise, and activity. Learn from your mistakes, but do not delay treatment.
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"Muscular Pain ...Education, Prevention & Healing"
Dr. Livingstone is the medical director of rehabilitation at Havasu Regional Medical Center in Lake Havasu City, Arizona. He is board certified in physiatry (P.M.&R.) having developed an interest in this field because of personal experience after a m...