Posted by MERM on 6/15/2008, 12:42 pm, in reply to "Myofasical Pain and Fibromyalgia "
Superficial fascia is attached to the underside of your skin.
Capillary channels and lymph vessels run through this layer and so do many nerves, so constriction in this fascia can constrict them.
The subcutaneous fat is attached to it as well.
If your superficial fascia is healthy, your skin can move fluidly over the surface of your muscles.
In FMS and CMP, it is often stuck.
The body can store excess fluid and metabolites in superficial fascia.
The metabolites are the breakdown products of metabolism and other biochemical reactions in your body. This is the area of fascia that often is the easiest to palpate.
Palpation is the art and skill of being able to touch meaningfully, interpreting what the skin and fascia are willing to tell about your state of health.
It takes training and experience to palpate. It is more difficult if excess fluid has accumulated in this area due to dysfunction.
This type of swelling is often noticed by the patient but frequently missed by the physician because it is diffuse and may be body-wide.
Deep fascia is tougher and denser material.
Your body uses it to separate large areas such as the abdominal cavity.
Deep fascia covers some portions like huge sheets, protecting them and giving them shape, and separating muscles and organs.
The bag-like covering around your heart, the lining of your chest cavity, and the area between your external genital and your anus are specialized forms of deep fascia.
There is a third layer of fascia, called sub serous fascia. This loose tissue covers your internal organs and holds the rich network of blood and lymph vessels that keep them moist.
Even your cells have a type of cytoskeleton connected to the fascia network, which is what gives your cells shape and allows them to function.
Myofascia is fascia that is related to muscle tissue. Healthy myofascia allows for compression and tension, as well as relaxation.
The dural tube is another fascial connection. This tube surrounds and protects your spinal cord and contains the cerebrospinal fluid. It is connected to the membranes surrounding your brain. Together, they hold and protect your craniosacral system.
Once you understand the pervasive nature of fascia, you can see how fascial dysfunction can cause all sorts of problems.
In the myofascia there is a material called ground substance. The ground substance transfers nutrients from where they are broken down into usable materials to where they will be used and removes waste products from these areas of use.
The ground substance can change from a loose gelatin consistency to gel-foam or even like stiff Styrofoam, hardening and losing elasticity if subjected to biochemical or mechanical trauma. The myofascia tightens with it.
Ground substance also maintains the distance between connective tissue fibers.
This prevents microadhesions from forming and keeps your tissues supple and elastic.
When the critical distance is not maintained, the fibers become cross-linked by newly synthesized collagen, which are also part of the fascia. Collagen crosslinks are arranged haphazardly, unlike healthy linkages, and are hard to break up.
Sheets of fibrous myofascial adhesion can form anywhere along nerves and block normal healthy function.
Myofascial Trigger Points
Trigger Points (TrPs) are extremely sore points occurring in ropy bands throughout the body. You can feel them as painful lumps of hardened fascia, like nodules or like hardened peas. TRIGGER POINTS ARE NOT PART OF FIBROMYALGIA!
The bands are often easiest to feel along the arms and legs if you stretch your muscle about 2/3 of the way out.
If your muscles are tight so that you can't feel the lumps, or even the tight bands, that doesn’t mean that the TrPs aren’t there.
That’s why it’s important to know the pain patterns so you can find the TrPs and work on them.
Many common TrPs have referred pain or other symptom patterns that are carefully documented.
The first time I opened the Trigger Point Manuals ("Myofascial Pain and Dysfunction: The Trigger Point Manual Vol I & II" by Janet Travell, M.D., and David Simons M.D.) I was dumbfounded.
After being told for so long by medical experts that the pain patterns I described did not and could not exist, seeing them illustrated in a medical text brought a flood of emotions. I felt so relieved I cried. Then, as the truth started to hit home, I started to get angry.
Why didn't these "experts" have knowledge of Travell and Simons' work? Why hadn't I learned about these texts in medical school!
Most localized pains commonly attributed to FMS are actually from myofascial TrPs.
TrPs seem to form throughout life as a response to many things that happen to our bodies — overuse, repetitive motion trauma, bruises, strains, joint problems, etc.
Pain creates a neuromuscular response, and the muscle around the pain site tightens, "guarding" the hurt area.
When muscles are in a state of sustained tension, they are working, even if you're not.
A working muscle needs more nutrition and oxygen, and produces more waste, than a muscle at rest. This creates an area in the myofascia starved for food and oxygen and loaded with toxic waste — a TrP. Dr. Janet Travell, in her autobiography, "Office Hours Day and Night" explains how dizziness, ringing of the ears, loss of balance and other symptoms can all be caused by TrPs in the side of the neck, in the muscle group called the sternocleidomastoid (SCM) complex.
Receptors in the SCM complex transmit nerve impulses to inform the brain of the position of the head and body in the surrounding space. With TrPs, the receptors lie.
What they tell the brain is not what the eyes tell the brain. When head movement changes the SCM message — when you turn or look up from changing kitty litter, you get dizzy. This, coupled with poor balance, can make it seem as if the walls are tilting.
Proprioceptors are receptors that tell your body and brain where parts of your body are in relation to the world around you and to each other. Proprioceptor dysfunction is associated with TrPs.
When we take corners while driving, we get the impression that we're "banking" the turn at a steep angle, as if we're on a motorcycle. Cold drafts alone can bring on TrPs. Be careful how you move in bed. When you turn, roll with your head flat and use your arms to help.
Don't lift your head and "lead with it" as you roll. That puts a great strain on the neck area and electrically "loads" the SCM TrPs, just as climbing steps or walking uphill "loads" the muscles of the thighs.
This means that the electrical potential of the muscles is changed. A common symptom of SCM TrPs is a "drunken" walk. Every TrP has perpetuating factors, and identifying these and controlling them will help you control the symptoms.
An active TrP not only hurts when it is pressed, like an FMS tender point, but it "triggers" a referred pain pattern locally or elsewhere in the body. This pain pattern is usually similar from patient to patient. These TrPs often produce other symptoms, also usually in the referred pain zone. Such a TrP hurts whenever you use the involved muscle.
When the point becomes very active, symptoms occur even when the muscle is at rest. A "latent" TrP doesn't hurt at all, unless you press it.
You might not even know it's there. It weakens and prevents full lengthening of the affected muscle. If you press on the TrP, it refers pain in its characteristic pattern. Latent TrPs may be activated by overstretching, overuse or chilling the muscle. People who get little exercise have a greater chance of developing latent points. This is important, because some people feel that by restricting their range of motion, they are getting rid of their TrPs. Nothing can be further from the truth.
Physical stress isn't the only thing that can cause TrPs. Tension TrPs can occur. These are not psychological results of tension but are physiological biological affects of long-term emotional abuse or mental trauma. If you are constantly holding your muscles tight in a "fight-or-flight" stress response, this changes your body patterns. TrPs can be caused by a surgical incision, as is often the case with abdominal surgery.
TrPs may form as a result of other medical conditions. A case of arthritis may be otherwise well managed, for example, but the accompanying TrPs are overlooked.
The pain load of that patient could be substantially lessened if the secondary TrPs were treated successfully.
Where muscles and tendons, bones and ligaments, come together, there are areas of attachment. Cellular membranes in these areas can become extremely convoluted, which increases the surface area and changes the angle of force.
This increases the potential for adhesions and causes tissue there to become more easily torn (Simons, Travell and Simons, 1999). In these areas, Attachment TrPs (ATrPs) can develop.
When you have TrPs, muscle strength becomes unreliable. Your grip can fail. TrPs cause muscle weakness and dysfunction before they cause pain.
You may have also noticed that if one part of your body rests over another, the compressed part goes numb.
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