Myofascial pain syndrome: facial, cervical, thoracic, lumbar spine

Anyone who has at least once encountered small seals in the muscles that bring unbearable pain when you press them, of course, knows what the myofascial syndrome is, and will not advise anyone to encounter this in his life. Although the diagnosis may have sounded quite different. For example, myofascitis, myogelosis or myofibrositis, pelvic floor muscle syndrome or muscle rheumatism, etc., etc.

However, the above-named names, applicable to the same pathology, do not quite accurately reflect the essence of the problem. After all, the tension and pain in the muscles in the myofascial pain syndrome are not related to structural changes in the muscles, but to their dysfunction. Therefore, it would be more correct to call this pathological condition a painful muscular-fascial dysfunction.

[1]

Epidemiology

Statistical studies of chronic pain in the human body give us a clear picture of the prevalence of muscle pain, which is characteristic of the myofascial syndrome. So chronic pains of different localization on the planet suffer from different data from 7 and a half to 45% of the population.

About 64-65% of patients complain of muscular pains in the back, neck, arms and legs, considered the most common after headaches. But two-thirds of this number are patients directly with myofascial syndrome.

The greatest prevalence of muscle pain is in old age, but old people complain of muscle pain less often, in the foreground they have pain and limited mobility in the joints.

In addition, it is believed that the susceptibility to pain in women is slightly higher than in men (especially in young and adulthood), so they often come to doctors with this problem and note a higher compared with men's intensity of pain. Moreover, the birth pains and discomfort during menstruation are not taken into account.

[2], [3], [4], [5],

Causes of the myofascial syndrome

Despite the fact that the pain is felt in the muscles, the pathology is actually of a neurological nature. After all, the cause of muscle spasm is the signal coming from the central nervous system.

When the body is healthy, the muscles receive a correct chain of signals, which contribute to the regular reduction and relaxation of muscle fibers. But some health pathologies can become a hindrance to the normal passage of the signal, and the muscles can be delayed for a long time in one of the positions.

A prolonged relaxed state of the muscles prevents their motor function, but muscle spasms can cause a strong pain syndrome, which is called myofascial (MFES).

The following diseases can become the causes of myofascial syndrome development:

• Osteocondritis of the spine. The localization of pain in this case depends on the location of the vertebral column, on which degenerative-dystrophic changes are observed. So cervical osteochondrosis provokes a painful syndrome in the neck, neck, collarbone, shoulder girdle, arms. But pathological changes in the spinal column in the sternum and lower back cause pain similar to renal colic, angina attacks or painful manifestations of the acute stage of pancreatitis.
• Dystrophic or inflammatory changes in the joints with the localization of muscle pains in the same area as the damaged joint.
• Diseases of organs located inside the thoracic or abdominal cavity: heart, kidneys, liver, ovaries, etc. In this case, there is a reflex mechanism to protect the affected organ, and therefore the muscles in the vicinity are in a stressed state. Plus, the pain associated with the underlying pathology, force a person to take a forced position, in which it becomes a little easier. This again causes overstrain of certain muscle groups.
• Congenital and formed during life defects in the formation of the skeleton. The difference in the length of the left and right legs more than 1 cm, scoliosis, flat feet, asymmetry of pelvic bones and other pathology of the musculoskeletal system can cause strong tension of the individual muscles, especially when walking.
• Various inflammatory diseases with edematous syndrome, as a result of which there is a squeezing of the nerves passing nearby, as a result of which the conduction of nerve impulses worsens.
• Intoxication of the body, which was caused by a prolonged course of taking certain groups of drugs (cardiac glycosides and antiarrhythmics, calcium antagonists and β-blockers used to treat cardiovascular pathologies, anesthetics such as lidocaine and novocaine).
• Pathologies of the neuromuscular system (myopathy, myotonia, etc.).
• Rheumatic pathologies characterized by systemic inflammation of the connective tissue (fascia): lupus erythematosus, erythematous dermatitis, rheumatoid arthritis, polyarthritis, etc.

Risk factors

Risk factors for the development of the MSAC are:

• incorrect posture,
• inconvenient clothing accessories that promote the transmission of nerves and muscle tissue,
• excess weight,
• sedentary lifestyle,
• "Sedentary" work, a long stay in a static pose at the computer,
• nervous overstrain, susceptibility to stress, impressionability,
• stably heavy physical labor,
• Professional sports (especially against the background of taking drugs that stimulate the growth of muscle mass),
• infectious diseases,
• tumor processes,
• dystrophic processes associated with aging,
• injuries of soft tissues,
• hypothermia, frequent stay in a draft (especially physical work in adverse weather conditions),
• forced long-term restriction of motor activity, as a consequence of injuries or surgeries.

[6], [7], [8], [9]

Pathogenesis

Our body is a complex mechanism, the motor activity of which is provided by the musculoskeletal system, which includes bones, tendons, muscles, fasciae (connective tissue surrounding the muscle). The movements of the hands, legs, body, facial expressions, breathing, talking - all this is possible only thanks to the muscles.

Any movement is based on the ability of muscles to contract. And this is not chaotic contractions, but systematized with the help of the central nervous system. The impulse for the work of the muscle is obtained from the brain.

If everything is in order in the body, the neuromuscular system works without failures. But under the influence of the above factors, the transmission of nerve impulses can be disturbed, either complete relaxation of the muscles (paralysis) or overstrain (prolonged spasm) of the muscles, accompanied by severe pain. It is against the background of excessive muscle strain and there is a myofascial syndrome.

In the thickness of the muscle, subject to the negative effect of provoking factors, a small seal develops in the vicinity of the motor nerve, which is characterized by an increased tone even when the rest of the muscle is relaxed. Such a seal can be one or more, formed in the region of one muscle or in a specific part of the body. These seals are called trigger points, which, in the case of myofascial syndrome, are associated with pain sensations.

The mechanism of formation of such seals of muscle tissue has not been thoroughly studied. Nevertheless, scientists have clearly determined that seals are nothing more than spasmodic tissue, structural changes in which (such as inflammatory processes or proliferation of connective tissue) can appear only at a certain stage of the pathology, not being the true causes of muscle spasms and pain.

[10], [11], [12], [13], [14],

Features of trigger points in myofascial syndrome

The appearance of dense nodules of muscle tissue is a distinctive feature of myogelosis, in which development of myofascial syndrome is noted. Nodules, or trigger points, can hardly be seen with an external examination, but they are perfectly recognized by palpation, prominently on the background of the rest of the muscle tissue, even if it is in a stressed state.

Some nodules are located closer to the skin, other places of localization choose deep layers of muscles (such trigger points can be felt only in the relaxed state of the muscle).

In addition, trigger points in myofascial syndrome can be either active, accompanied by severe pain and with pressure, and at rest, and passive (latent). Latent points are characterized by pain sensations of lower intensity, appearing only when pressure is applied to the nodule or when the muscle is strained.

No matter how strange it may sound, but despite the pronounced painful sensations, active trigger points are not always easy to detect. The thing is that they have reflected pains, radiating to different parts of the body along the muscle, in which the point that is the source of pain is located. The poured pain does not allow to determine the exact location of the trigger point, so sometimes it is necessary to probe the entire muscle.

With pressure on the active point, doctors often face the so-called "jump effect", when the patient from the very strong pain just jumps in place. Sometimes the pain is so strong that a person can lose consciousness.

And still there is some benefit from these points. They prevent excessive stretching of the already injured muscle and limit its contractile function until the consequences of the influence of negative factors are eliminated.

For more numerous latent points, such intense pains are not inherent. Nevertheless, passive points under the influence of unfavorable factors tend to become active with the symptomatology characteristic of this group of triggers.

[15], [16], [17], [18],

Symptoms of the myofascial syndrome

The first signs of the myofascial syndrome of any localization are pains of varying intensity, amplified by the strain of the affected muscle or pressure on the trigger point. In which place to expect pain depends on the location of the trigger points, as well as the size of the affected muscle. Because the pain is not always localized, the reflected pain can be felt along the entire length of this muscle.

Myofascial pain syndrome (MFES), depending on the location of the muscle with motor dysfunction can be divided into several types. In this case, localized and reflected pain, depending on the type of MSF, may be accompanied by other unpleasant symptoms.

Head and face

Myofascial pain syndrome in the face is a pathology with a rather wide symptomatology. In addition to dull, diffuse pain, it is characterized by multiple symptoms that cause patients to contact different doctors: lor, neurologist, dentist.

Patients can complain about difficulties with opening the mouth, clicking in the temporomandibular joint, rapid fatigue of the muscles when chewing food, pain when swallowing. The pain itself can spread to the area of the gums, teeth, pharynx, palate, ears.

Less often, in the diagnosis of myofascial syndrome, patients complain of symptoms such as more frequent blinking, nervous tics in different parts of the face, stuffiness of one or both ears, occasionally accompanied by noise or ringing in them.

Sometimes there is also an increased sensitivity of the teeth. It is this problem that is known for myofascial syndrome in dentistry. However, the rest of the symptomatology does not just talk about the neurological nature of the pathology, but also that the main reason is still in the muscle dysfunction.

With this pathology, trigger points can be found in the area of masticatory muscles, pterygoal processes of the sphenoid bone on both sides of the nose, in the temporomandibular joint region, and also in the upper part of the trapezius muscle (radiating pain in the temporal region).

Neck and shoulders

Cervical myofascial syndrome also begins with pains that can be localized either in the neck or occiput, or spread to the areas of the head, face, and forearms. In the next stage they are joined by vegetovascular disorders: dizziness, visual and hearing impairments, ringing in the ears, fainting. Could also appear "causeless" runny nose and intensify salivation.

In spite of the fact that in most cases trigger points with cervical myofascial syndrome are located mainly along the cervical spine and upper part of the shoulder girdle, single stress centers can also be found in the region:

• staircases,
• oblique and belt muscles of the head (burning pain in the nape and eyes, vegetative disorders), 
• the middle section of the sternocleidomastoid muscle (pain on one side of the face, accompanied by lacrimation, increased salivation, rhinitis),
• in the zone of scapula or clavicle,
• upper sections of the trapezius muscle (pulsating pain in the temples),
• thoracic and subclavian muscles.

About half of patients with this pathology suffer from various sleep disorders, psychoemotional disorders, and a decrease in work capacity. About 30% developed panic attacks.

Rib cage

The appearance of severe pain in the chest area is most often associated with heart disease, and in particular with myocardial infarction. However, diagnostic studies do not always confirm this. The cause of pain in the chest can be the formation of seals in the muscles of the front of the chest, and then we are talking about a kind of myofascial breast syndrome called the anterior chest wall syndrome. It is characterized by dull aching pains more often on the left side of the sternum, which increase with bends of the trunk, lifting weights, dilating hands to the sides, coughing.

Despite the fact that with such a localization of trigger points, the symptomatology is mainly limited only by pains in the chest, the appearance of painful foci may be the result of some diseases of the chest cavity organs or even the back, which in itself is an occasion to undergo examination in a medical institution.

Another type of thoracic myofascial syndrome is the syndrome of the small pectoral muscle with localization of trigger points in its thickness. It is characterized by pain in the subclavian area, which can be irradiated to the shoulder or left arm. The pains are often accompanied by the appearance of goosebumps and the temporary loss of sensitivity of the limb.

Back

Myofascial syndrome in the muscles of the back develops against the background of the appearance of painful nodules in the muscle, which runs along the thoracic spine, in the broadest muscle, in the rhomboid and subacute muscles. The place of pain localization in this case is the area between or under the shoulder blades, as well as over the shoulders.

The pain in this case is acute and occur suddenly, especially with overstrain or hypothermia of the muscles.

Myofascial syndrome of the lumbar region is characterized by pain in the lower region of the back, which can spread to the groin or sciatic nerve. The cause of back pain can be and disc hernias, and ostiomyelitis, and diseases of the digestive system, and even cancer that has released its metastases in this area. But most often it all comes down to overstrain of the muscles with a lot of physical exertion (for example, lifting weights) or to the displacement of the vertebrae in the lumbar spine.

If the time is not taken to cure the main diseases, trigger points are formed in the lumbar region, which provokes a painful pain syndrome.

[19], [20]

Pelvic region and thigh

Symptoms of myofascial pelvic syndrome are more like symptoms of pathologies of the intestine or urogenital area. Sometimes complaints are reduced to the fact that the patient begins to feel as if he has a foreign body in his intestine. There are painful sensations when walking or when a person does not change the sitting position of the body for a long time. Localization of unpleasant sensations is predominantly the area of the lower back or lower abdomen.

Many patients report frequent urination. Women can also indicate discomfort in the internal genital area and anus.

All this symptomatology makes people turn to a gynecologist, urologist, andrologist who put the appropriate diagnoses: cystitis, prostatitis, urethritis, andeksit, etc. Long-term examinations and treatment according to the above diagnoses remain unsuccessful, while doctors can not find out the true cause of discomfort and pain in the pelvic area.

And everything turns out to be much simpler, and pains in the pelvic region provokes a spasm of muscles that hold such organs as the bladder, rectum, uterus and women, etc., in the small pelvis. Depending on which muscle is affected (m.piriformis, m.levator ani, m.obturatorius int, or superficial muscles), the pain may be localized in different parts of the pelvis and delivered to the hip.

Thus, in the pear-shaped muscle syndrome, pain in the buttocks and hamstrings is accompanied by discomfort during walking and having sex, pain during defecation and unpleasant aching pains in the rectum and perineum, arising at the slightest strain of perineal muscles.

The syndrome of the internal obturator muscle and muscle in the anus, sometimes called myofascial urethral syndrome, is characterized by pain in the vagina, anus or urethra, frequent painful urination, difficulties in defecation, discomfort in the lower abdomen, especially during sitting.

Myofascial syndrome in children

Strong muscular pains in childhood seem to be something out of the ordinary, however, this problem is much more urgent than it may seem at first glance. Yes, chronic pathologies in children with myofascial syndrome are unlikely to be detected. But in this case, the emphasis is not on them, but on the birth trauma of the spine and in particular of the cervical spine.

Slightly less than a third of children born have spinal and spinal injuries associated with the period of the child's appearance in the world, i.е. Passage of the fetus through the birth canal. More than 85% of these children receive various injuries to the cervical spine. About 70% of infants with various injuries of the spine are diagnosed with myofascial syndrome.

In older children and adolescents, myofascial pains occur most often either as a result of hypothermia of the muscles, followed by their spasms and the formation of trigger points, or as a result of incorrect posture (scoliosis and other similar pathologies). Often, muscular pains provoke children's inherent mobility and inadequate care for their health. As a result, we have pain syndrome associated with neck, spine and hip injuries or muscle overcooling, when a child after active games with intense perspiration is for some time in a draft or in a poorly heated room.

Cervical myofascial syndrome in children is most often manifested by headaches, pain in the eyes, dizziness, loss of balance. Damages of the shoulder girdle and spine are manifested by pains in the back and upper limbs, and injuries of the hip and knee joint - pain under the knee, in the shin area, in the anterior and outer thigh area, in the groin.

Complications and consequences

Muscle pain, despite all the unpleasant sensations, many patients do not seem a dangerous condition. The view that getting rid of its cause, one can solve all problems in one fell swoop, is gaining increasing popularity, and a person prefers not to bring the treatment to the end or at all to him not to resort.

Sometimes this attitude to the problem, especially at the beginning of the disease, gives good results. There is no reason - no pain. But in neglected cases, when there is already a pronounced myofascial syndrome with the characteristic muscular densification of the muscles and the fibrotic changes that occur in them, its consequences can hardly be called safe.

Complications of myofascial syndrome can be considered not only structural changes in the muscles that contribute to the chronic process. The very fact that the muscle tension for a long time leads to the accumulation of lactic acid in them, which prevents the normal metabolism in the tissues of the body and causes their oxygen starvation, can not but alarm.

Severe cases of myofascial syndrome with the gradual formation of several trigger points, in the end, can lead not only to psychoemotional abnormalities associated with sleep disorders and constant pain, or disability. Numerous cases of compression of the nerves and vessels affected by the muscles are frequent, which increases the pain syndrome and leads to circulatory disorders with consequences resulting from this situation.

[21], [22], [23]

Diagnostics of the myofascial syndrome

Complaints of muscle pain can be associated with various causes. And only after understanding the reason can you assign the appropriate treatment situation. And since myofascial pain syndrome is a symptom of many serious diseases, it is a matter of honor for a doctor to diagnose these diseases.

Diagnosis begins, as usual, with examination of the patient and collection of anamnesis. Perhaps the patient at the time of the onset of pain already knew about the presence of certain diseases, which the doctor can tell. Having information about chronic pathologies in the patient's body, the doctor can preliminarily determine the possible cause of the onset of pain and start from it in further studies.

When examining the patient, the doctor pays special attention to the palpation of the sore spot. To determine trigger points, the muscle in the area of pain localization is stretched along the length and palpated. Under the fingers there is a cord in the form of a tight cord. Trigger points or seals should be searched just along this "cord". Pressing on a muscle nodule during palpation causes severe pain, from which patients jumped or screamed. This indicates that the trigger point is found correctly.

In search of strings and trigger points the doctor can deeply examine the muscle, moving the fingertips across the fibers or rolling the muscle between the fingers. During palpation and communication with the patient, you need to pay attention to the following:

• Is there a connection between the appearance of pain and physical exertion or hypothermia of the muscle?
• Is there atrophy or other changes in the muscles indicating, for example, the inflammatory nature of the pathology?
• Does the nasal compaction feel for muscles or does it have only a general muscle tension?
• The pain has a certain localization or gives to other places?
• Pressure or puncture of muscle nodules contributes to the appearance of reflected pain?
• Is there a symptom of a jump?
• Does the intensity of pain decrease after a massage or the effect of heat?
• Do the symptoms pass after the blockade of the muscles?

Among other things, the doctor pays attention to how the patient tolerates pain, how it relates to his condition, whether there are any sleep disorders, whether there are signs of depression.

To exclude the factor of inflammation, blood and urine tests are performed. They will also help to prescribe safe treatment. The analysis of urine will make it possible to differentiate myofascial pain in the lower back and kidney colic.

To instrumental diagnosis, doctors resort to cases where there is a suspicion of heart pathology, in which pains similar to myofascial pain occur. The doctor can prescribe electro- or echocardiography, coronary or hygraphy, ECG monitoring during the day by Holter, etc. Methods.

As already mentioned, pain in myofascial syndrome can be of two types: localized and reflected. It is the presence of the latter that precisely explains the difficulties in the diagnosis of pathology.

Indicative in this regard is the right-sided myofascial syndrome with pain under the scapula. A strong pain syndrome in this area can occur for various reasons. It can be a jamming of the nerve roots, an attack of acute pancreatitis or cholecystitis, cholelithiasis or biliary dyskinesia, renal colic, pyelonephritis, malignant processes in the liver, pancreas, kidneys on the right side.

[24]

Differential diagnosis

The task of differential diagnosis is precisely to discover or exclude the relationship of pathologies, which are possible causes of pain in a certain area, and myofascial pain. It is very important to find out the true cause of such pains, to simultaneously treat both the cause and the effect. Only in this way will the treatment yield the expected results.

After the patient is examined by the district therapist, he can be referred to a neurologist, cardiologist, gastroenterologist, traumatologist. The final diagnosis is made already on the basis of the results of the survey of these specialists. At the same time, an effective treatment of the pain syndrome and the pathologies found during the diagnosis, capable of provoking muscle pain, are prescribed.

Treatment of the myofascial syndrome

Myofascial syndrome is often caused by a peculiar duet: the cause of muscle pain (usually a kind of pathology of health) and a provoking factor (emotional stress, hypothermia, etc.). It is necessary to struggle both with that, and with another, so the approach to treatment of myofascial pain syndrome should be complex.

Sometimes you can fix the situation without taking medication. This is possible if the cause of muscle pain is incorrect posture, hard physical work, playing sports, working at a computer, etc. The doctor gives such a patient recommendations regarding the working regime, correction of posture, strengthening of the back muscles, etc.

If the cause of the MSFE is a serious illness, in parallel with the removal of the pain syndrome, a comprehensive therapy of the existing pathology of health is conducted.

The pain syndrome is removed with the help of drug therapy and alternative therapies. As a drug treatment the following types of drugs are used:

• for the removal of pain: drugs with anti-inflammatory and analgesic effect, such as "Diclofenac", "Nimesil", "Ibuprofen", "Voltaren emulgel", etc., and, as a form for oral administration, and for topical administration,
• for the removal of muscle tension and pain: drugs from the group of central muscle relaxants ("Belofen", "Tizanidin", "Midokalm", Sirdalud "," Flexin "),
• to stabilize the psychoemotional state of patients: nootropic and hamkergic drugs (Pikamilon, Piriditol, Noofen, etc. 1-2 tablets 3 times a day), sedative and vegetotrophic drugs, antidepressants,
• restorative means and means for improving trophism of muscle tissue: vitamins and vitamin-mineral complexes with an emphasis on preparations containing vitamins of group B and magnesium,
• for blockade: most often budgetary anesthetics "Novocaine" or "Lidocaine".

In addition to drug therapy in myofascial syndrome, various alternative methods and physiotherapy are used. The latter is especially important in myofascial face syndrome. In this case, electrostimulation and thermomagnetotherapy, as well as cryoanalgesia, provide good results.

A major role in the therapy of myofascial pain is given to massage, with which it is possible to relieve muscle tension and improve blood circulation at the site of the lesion, which will enable drugs to flow unhindered to the scene. Particularly indicative in this regard are the methods of manual therapy, which act as a diagnostic and therapeutic procedure. It is important only that it is conducted by a professional with knowledge of his business.

Helps to remove hypertonic muscle and related pain and reflexology techniques, such as acupressure and acupuncture. The introduction of drugs that reduce its activity (pharmacopuncture) and the stretching of the diseased muscle (osteopathy) with the same purpose, also give good results in the muscular nodule with the MFBS.

When acute pain subsides, you can resort to a can of massage, spending it every three days (about 6-8 procedures). After massage on the affected area, apply a warming cleanser or ointments that relieve pain and inflammation (for example, butadionic or indomethacin), cover the skin with special compress paper and cloth.

In some medical institutions, patients may be offered to undergo a course of treatment with leeches. And if myofascial pains are associated with physical stress, abnormal posture, overstrain of muscles due to prolonged static position, and if changes in the diseased muscle adversely affect other muscle groups, exposing them to unnecessary stress, a set of exercises for different muscle groups myofascial syndrome of this species.

In advanced cases, when no myofascial pain can be removed by any of the above methods, doctors can resort to surgical treatment, which consists in relieving the nerve root from compression by a strained muscle (microvascular decompression).

Alternative treatment

Speaking about the people's treatment of myofascial syndrome, one must understand that it helps to relieve painful symptoms only for a while: spasms and pains in the muscles, but it does not fundamentally solve the problem. Without the use of muscle relaxants and various methods of physical impact on trigger points, a stable result can not be achieved.

But with the impossibility of drug therapy or in addition to it, the following recipes, based on the positive effect of heat, will help alleviate the pain syndrome:

1. Paraffin wraps. Molten paraffin is applied to the site of pain localization. On top, another layer of paraffin is applied, after which the sore spot is covered with a film and the heat is wrapped for half an hour.
2. Therapy 3 in 1:
   • Dry heat. Warmed up to a hot state (so that a person can safely endure), the salt of coarse grinding is applied to a sore spot and covered with a blanket. We remove when it cools down.
   • Iodic grid. After the salt has been removed, iodine draws a mesh on the skin.
   • Healing adhesive. Over the iodine mesh, glue the pepper patch. After the end of the procedure we send the patient to bed until morning.
3. The English salt (it is magnesium sulfate or magnesia). It can be purchased at a pharmacy and used to relieve spasm and muscle pain by dissolving in water for bathing. Reduces pain and warm water itself, but magnesium also helps relax the muscles, thanks to the content of magnesium, a natural muscle relaxant. To take a bath you need 1 or 2 cups of English salt. The procedure takes only 15 minutes.

But not only does heat help with myofascial pain. The therapeutic effect is also provided by a massage with essential oils, which can be performed at home. An ordinary relaxing massage with mint, magnolia vine and marjoram, taken in equal proportions, will help to relieve muscle spasms. And with painful sensations, the essential oils of such plants as chamomile, basil, immortelle, lavender are good. It is better to use a mixture of different oils, adding them to the base oil (preferably coconut oil).

Treatment with herbs for myofascial pains is carried out with the help of the horsetail, from which a medicinal ointment is made, mixing crushed grass and butter in a ratio of 1: 2, or infusion of the flowers of the medicinal sweet potato.

[25], [26], [27], [28], [29], [30]

Homeopathy

Since the main symptoms of the myofascial syndrome are spasms of the muscle tissue leading to the appearance of trigger points, and the accompanying pains, the main direction of homeopathic treatment is precisely the removal of spasms and cupping of myofascial pain.

The most popular antispasmodic in homeopathy is the drug "Spaskuprel". Take it three times a day, one tablet, dissolving it in your mouth. To relieve the pain syndrome with muscle spasm, you can take the drug 4 times for an hour, until the pain subsides.

With hardening in the muscle and pain that go away under the influence of heat, the homeopathic preparation "Rus toxicodendron" in 12 dilutions is also useful.

With pain in the waist, the "Brionia" preparation works well at 12 dilutions, and with pains in the neck and between the shoulder blades, the homeopathic doctor can offer "Helidonium" drops.

Preparations "Brionia" and "Beladonna" are also effective in the headache of tension, which also refers to the category of reflected myofascial pain.

Indicative for the removal of symptoms of myofascial pain syndrome is treatment with the help of homeopathic subcutaneous or intramuscular Guna-injections. For muscular pain for injection, GUNA®-MUSCLE preparations are used in conjunction with GUNA®-NECK, GUNA®-LUMBAR, GUNA®-HIP other.

Prevention

The effectiveness and duration of treatment for myofascial syndrome depends not only on the severity of the process, but also on the patient's desire to get rid of the pain that pains him. Taking medications and physiotherapy, massage and manual practices will give a tangible and sustainable result if the patient adheres to the skills that he is taught in rehabilitative studies. These are new motor stereotypes, and the ability to own one's body with the control of the condition of the muscular system, and the possibilities of strengthening the muscular corset, and correct posture.

And for those who do not want to face such an unpleasant disease, we recommend taking the following preventive measures:

• avoid supercooling of the muscles and the effect on the heated muscles of drafts,
• Limit physical activity, avoiding muscle strain,
• provide conditions for a good rest,
• when performing work that requires a long-term retention of the static position, take small breaks with charging for tired muscles,
• time to treat illnesses, not allowing their transition to a chronic condition.

Adhering to these recommendations, one can never know what a myofascial syndrome is with its painful pains.

[31], [32], [33], [34]

Forecast

The prognosis for myofascial pain is mostly positive, but this, of course, is not a reason to start the situation and complicate their treatment.

[35], [36]