Hello. I am Dr. Dongkyu Lee, an orthopedic specialist. If you have visited a hospital for muscle pain in areas like the shoulder or upper back and were told there is nothing structurally wrong, you may want to consider myofascial pain syndrome. Myofascial pain syndrome, also known as myofascial pain disorder, can occur in any muscle throughout the body, not just the shoulder. It primarily causes muscle pain in the shoulder and neck area rather than the scalp, and when symptoms worsen, it can cause stiffness along the neck muscles and a pulling sensation at the back of the head.
Myofascial pain syndrome develops when the fascia, a thin membrane surrounding the muscles, is subjected to large or small stresses, causing excessive muscle tension and, in severe cases, damage, resulting in abnormal calcium concentration regulation within muscle cells. When parts of the muscle are persistently contracted, metabolic byproducts increase, and the resulting compression of surrounding blood vessels leads to reduced blood flow. General muscle soreness occurs when lactic acid builds up from overuse, whereas myofascial pain syndrome occurs when muscles become stressed and tense or when the same posture is repeatedly maintained, causing muscles to contract repeatedly. This creates a taut band in the fascia surrounding the muscles, and trigger points within these taut bands become activated, causing pain. The typical cause is maintaining poor posture continuously or repetitive muscle movements that impair blood circulation, resulting in excessive muscle contraction and pain.
Beyond poor posture, other causes of shoulder muscle pain include chronic stress, lack of exercise, hypothyroidism, vitamin deficiency, and sustained muscle tension from sudden trauma like car accidents. The main symptom of myofascial pain syndrome is a deep, aching shoulder muscle pain. Cold or cloudy weather can worsen the pain due to barometric pressure changes. Like frozen shoulder, the shoulder may not lift well, and range of motion may become limited. As a condition triggered by muscle stress, muscles can easily knot up under even slight pressure, and muscle strength weakens. Tension in the neck and shoulder muscles that support the head can reduce concentration. In severe cases of myofascial pain syndrome, tears and nasal discharge may occur. Severe headaches, dizziness, tinnitus, and eye fatigue caused by excessive stress on neck muscles are all symptoms of myofascial pain syndrome. Myofascial pain syndrome diagnosis can be inferred from the patient's symptoms. In fact, even advanced imaging such as MRI, X-ray, CT, and ultrasound may not be able to identify myofascial pain syndrome. If symptoms like shoulder muscle pain develop, you should see a specialist to locate the painful area and receive treatment.
Treatment for myofascial pain syndrome varies depending on symptoms. If symptoms like shoulder muscle pain are mild, simply avoiding muscle stress through rest or massage to gently relax excessive muscle tension can easily improve symptoms. Anti-inflammatory painkillers or muscle relaxants may be prescribed, and basic physical therapy to relieve muscle fatigue is also beneficial. Physical therapy may involve applying warm compresses to trigger points or using laser or infrared devices to apply heat to the painful area, promoting muscle relaxation.
However, if symptoms are already severe, trigger point injection therapy may be performed, which involves injecting a mixture of saline, local anesthetic, and steroid into the painful area. For rapid and dramatic improvement, manual therapy by a specialized therapist may also be considered. Since the primary cause of myofascial pain syndrome is postural factors, even just addressing restricted blood circulation caused by sustained muscle contraction and excessive relaxation due to poor posture through manual therapy can significantly reduce pain. Ultimately, the key to treating myofascial pain syndrome is pain relief. And to prevent recurrence, providing guidance on maintaining proper posture is essential. Postural correction and exercise therapy that balances muscle contraction and relaxation through manual and rehabilitation exercises are extremely important. During treatment, it is also helpful to learn prevention methods for myofascial pain syndrome. Make stretching and exercise a part of daily life, and try to avoid excessive stress. If your work requires maintaining the same posture for long periods, take regular breaks to stretch your shoulder and neck muscles as a preventive measure.
Avoid postures that trigger myofascial pain syndrome. Identify and address the causes of stress on your body. The biggest cause of muscle tension is stress. When our body receives external stress, it naturally becomes excessively tense in an attempt to protect itself. Whether the stress is physical or mental, try to maintain a positive outlook and live in a way that minimizes stress on your body.
