ConditionBones, joints & muscles
Myofascial Pain Syndrome
Myofascial pain syndrome is a common cause of persistent muscle pain in which tight, tender knots called trigger points develop in a muscle and its surrounding tissue (fascia). Pressing a trigger point causes local pain and often pain in a predictable distant area, called referred pain. It most often affects the neck, shoulders, upper back, lower back and jaw, and is linked to overuse, poor posture, injury and stress. Stretching, physical therapy and trigger point treatments usually help.
Also called: Myofascial pain, trigger point pain, MPS, muscle knots
At a glance
- What it is
- Regional muscle pain from hyperirritable trigger points in muscle and fascia.
- Key feature
- Pressing a trigger point reproduces your pain and may send it to another area.
- Common sites
- Neck, upper shoulders (trapezius), shoulder blade, lower back, buttock, jaw.
- Causes
- Repetitive strain, poor posture, injury, inactivity, stress and poor sleep.
- Diagnosis
- Physical examination; tests only to rule out other causes.
- Treatment
- Stretching, physical therapy, heat, massage, dry needling, trigger point injections, posture and stress management.
When to get help
Call 911 or go to the ER
- Chest, jaw or arm pain with shortness of breath, sweating or nausea (possible heart attack): call 911 or your local emergency number
See a doctor within a day or two
- Muscle pain with fever, weakness, dark urine, or a red, hot, swollen area
- New weakness, numbness or loss of bladder or bowel control with back or neck pain
Book a routine appointment
- Muscle pain in one area lasting more than 2 to 4 weeks despite rest and stretching
- Morning stiffness of the shoulders and hips in someone over 50 (possible polymyalgia rheumatica)
- Widespread pain with fatigue and poor sleep
- Jaw pain, clicking or headaches with clenching
Usually safe to manage at home
- Tight, tender muscle knots after desk work, exercise or stress that ease with heat, stretching and movement
What trigger points are
A trigger point is a small, tight, very tender spot within a taut band of muscle. Doctors describe two kinds:
- Active trigger points: cause pain at rest and reproduce your usual pain when pressed.
- Latent trigger points: are tender only when pressed but can cause stiffness and weakness.
Pressing or needling a trigger point may cause a brief twitch in the muscle (local twitch response). The exact cause of trigger points is debated; theories include sustained muscle contraction in small areas, reduced blood flow and nerve sensitization.
Common trigger point patterns
| Muscle | Where pain is felt |
|---|---|
| Upper trapezius (top of shoulder) | Side and back of neck, temple, behind the eye |
| Levator scapulae (side of neck) | Neck stiffness, top of shoulder blade |
| Infraspinatus (shoulder blade) | Front and side of shoulder, down the arm |
| Masseter (jaw) | Jaw, cheek, teeth, ear |
| Quadratus lumborum (lower back) | Lower back, hip, buttock |
| Gluteus medius (buttock) | Lower back, buttock, side of hip |
Symptoms
- deep, aching muscle pain in a specific area that persists or worsens
- a tender knot that hurts when pressed
- pain that spreads to a predictable distant area
- muscle stiffness and reduced range of movement
- muscle weakness without wasting
- headaches, especially tension-type headaches from neck and shoulder trigger points
- poor sleep because of pain
Causes and risk factors
- repetitive movements at work or in sports
- poor posture: long hours at a desk, looking down at phones, carrying heavy bags on one shoulder
- muscle injury or strain, see muscle strain
- inactivity or immobilization
- stress and anxiety, which increase muscle tension
- poor sleep
- contributing conditions: hypothyroidism, vitamin D deficiency, iron deficiency, joint problems and differences in leg length or spine curvature
Myofascial pain vs fibromyalgia
| Myofascial pain syndrome | Fibromyalgia | |
|---|---|---|
| Pain distribution | Regional (one or a few areas) | Widespread |
| Key finding | Trigger points with referred pain | Widespread tenderness |
| Other symptoms | Usually limited to the painful area | Fatigue, poor sleep, brain fog, mood changes |
| Response to local treatment | Often good | Limited; whole-body approaches needed |
The two can occur together, and long-standing myofascial pain can evolve into a more widespread chronic pain condition.
Diagnosis
A doctor or physical therapist feels the muscles for taut bands and tender points and checks whether pressing reproduces your pain and its referral pattern. There are no blood or imaging tests for trigger points. Tests may be used to rule out other causes, such as thyroid function, vitamin D, inflammatory markers, or imaging for joint or nerve problems.
Treatment
Self-care
- Stretching of the affected muscles several times a day.
- Heat: warm packs or showers relax tight muscles.
- Self-massage with a tennis ball or foam roller against a wall or the floor, applying sustained pressure to the knot for 30 to 90 seconds.
- Regular exercise: aerobic activity and strengthening.
- Posture and ergonomics: adjust screen height, chair and work setup; take breaks every 30 to 45 minutes.
- Stress management and good sleep habits.
- Pain relievers: acetaminophen (paracetamol) or NSAIDs such as ibuprofen for flare-ups. Follow the label dose and avoid NSAIDs if you have kidney problems or stomach ulcers.
Professional treatments
- Physical therapy: manual therapy, stretching, strengthening and posture retraining.
- Massage therapy and myofascial release.
- Dry needling: a thin needle inserted into the trigger point to release it.
- Trigger point injections: a local anesthetic, sometimes with a small amount of steroid, injected into the trigger point.
- Medicines: short courses of muscle relaxants, or low-dose amitriptyline or other nerve pain medicines for persistent pain and sleep problems.
- Treat contributing problems: thyroid disease, vitamin deficiencies, jaw clenching (TMJ disorder).
Outlook
Most people improve within weeks to a few months with stretching, physical therapy and addressing the causes. Recurrences are common if posture, workload and stress are not addressed. Long-standing cases benefit from a combined approach.
Frequently asked questions
What are trigger points?
Trigger points are tight, tender knots in a band of muscle. Pressing them causes local pain and often refers pain to another area, such as from the top of the shoulder to the temple. They are the hallmark of myofascial pain syndrome.
What is the difference between myofascial pain and fibromyalgia?
Myofascial pain syndrome is regional, centered on trigger points with predictable referred pain. Fibromyalgia causes widespread pain and tenderness with fatigue, poor sleep and thinking problems. They can occur together.
How do you get rid of trigger points?
Stretching, heat, self-massage with a ball, physical therapy and correcting posture help most people. For stubborn trigger points, dry needling or trigger point injections can release them. Addressing stress and sleep reduces recurrences.
Can myofascial pain cause headaches?
Yes. Trigger points in the neck, upper shoulder and jaw muscles commonly refer pain to the head, causing tension-type headaches, pain behind the eye or jaw and ear pain. Treating these trigger points often reduces headaches.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Family Physicians: Myofascial pain syndrome, diagnosis and treatment
- Mayo Clinic: Myofascial pain syndrome
- MedlinePlus: Muscle aches
- American Academy of Physical Medicine and Rehabilitation: Myofascial pain
- Cleveland Clinic: Myofascial pain syndrome