Causes of Myofascial Pain

Written by Leon Mao
Physiotherapist, University of Melbourne
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on May 31, 2022

Man being assessed for myofascial pain by a physiotherapist

What is Myofascial Pain?

Myofascial pain is a term that describes symptoms related to the myofascia. Tender focal points can develop in the underlying tissue, known as trigger points. These areas are sensitive to compression, and pain from these points can radiate to the surrounding areas. Whilst most people experience general muscle aches or pain at some point, myofascial pain can become a chronic clinical condition, known as myofascial pain syndrome.[2],[3]

The myofascia is the thin connective tissue that surrounds the muscles in the body. The myofascia is flexible and helps the muscles move and function properly. It is made up of contractile muscle and connective tissue.[1]

Myofascial release is a type of manual therapy technique used by qualified health professionals to relieve myofascial pain. In most cases, symptoms respond well to myofascial release.[4] However, myofascial release should not be used in some situations, such as open wounds or fractures.

What are the symptoms of myofascial pain?

Common symptoms of myofascial pain may include:

  • Deep or superficial muscular pain

  • Trigger points

  • Stiffness

  • Sensitivity to stretch

  • Pain on compression of affected area

  • Reduced range of motion.

What are the causes of myofascial pain?

There are several different mechanisms that could lead to myofascial pain.

These may include:

  • Repetitive muscle activation, particularly without adequate rest or recovery

  • Muscle overload or overuse

  • New activities, especially for unconditioned muscles

  • Direct force

  • Stress

  • Poor posture

  • Sitting for a long time in awkward positions

  • Nutritional deficiencies

  • Serious lack of exercise or movement

  • Any injury to the musculoskeletal system or intervertebral discs

  • Generalised fatigue

  • Lack of sleep

  • Hormonal changes (menopause)

  • Intense cooling of muscle (such as when sleeping in front of an air conditioner)

  • Emotional problem (depression, anxiety)

  • Other pain or inflammation conditions

  • Obesity

  • Smoking

Myofascial pain may also be caused by underlying medical issues. It is therefore important to speak to a doctor for differential diagnosis before any treatment begins.

Treating myofascial pain

The treatment for myofascial pain depends on the cause and severity of the symptoms. In some cases, myofascial pain may resolve on its own with time. In other cases, specific therapeutic techniques can be used to relieve the symptoms, such as myofascial release.

Myofascial release

Myofascial release is a manual therapy technique. A light pressure is applied to sensitive or stiff areas to alleviate symptoms and restore movement. It is often used by health professionals, such as physiotherapists, massage therapists, or medical practitioners and is an effective form of decreasing pain and improving function.[4]

The myofascia is a network of tissue that is connected and interrelated. A tight area of the muscular system may cause pain in another area of the body. Therefore, the specific area of the body that is causing the pain may not be easily located. Myofascial release techniques are therefore sometimes applied over a broad area rather than a local point. These areas may be near the source of the pain, or in a different part of the body.

Contraindications of myofascial release

Myofascial release is used to reduce symptoms and restore movement, and carries minimal risk. However, there are several contraindications (situations where myofascial release is not appropriate or indicated). In very rare cases, improper techniques or application can result in allergic reactions, bleeding, heavy bruising, or even weakness or numbness.

Myofascial release is not appropriate for situations including:

  • Burns or open wounds

  • Fractures or bone issues

  • Internal bleeding

  • Infection

  • Blood clots, such as deep vein thrombosis

  • Anywhere there is risk to the underlying tissue.

It is important to consult qualified health professionals who can assess for these conditions and use myofascial release techniques appropriately.

Outcomes of myofascial release

The outcome of myofascial release depends on the cause of the pain and the treating health professional. Often, myofascial can be beneficial to reduce symptoms and restore ease of movement in the affected area. However, myofascial release techniques can differ from therapist to therapist, so outcomes may be different.

It is important to consult a doctor if there are any concerns or unexplained symptoms. A health professional can discuss the risks and benefits of different treatments.

Alternative treatment options

Beyond myofascial release, there are several other treatment options available to assist in the treatment of myofascial pain.

Dry needling

Dry needling is an emerging and quick treatment to inactivate myofascial trigger points. Your doctor will insert a needle directly into the trigger point, move it around, and poke it in and out.

It can be painful, but it effectively decreases pain from disabling a trigger point. Some clinicians, like physiotherapists or acupuncturists, use acupuncture needles. These are smaller and less painful than hypodermic needles.

Trigger point injections

Trigger point injections are saline or local anesthetic, or sometimes corticosteroids injected into the tissue. The effects may seem similar to a dry needling treatment, but the procedure may cause minor discomfort.

Ultrasound therapy

Ultrasound machines transmit sound waves into the tissue through a sound-conducting gel applied to the skin. The sound waves then heat up and relax muscles, improve blood flow, and remove scar tissue. Although the pain-relieving effects are minimal, this reduces stiffness and increases mobility before stretching.

Massage therapy

Generally, massage therapy improves blood flow and warms up the muscles, reducing stiffness and easing pain. A massage therapist may use their thumb to put pressure on your trigger points, aggravate the discomfort and then release the muscle tension.

There are several types of massage treatments that can relax myofascial trigger points. These include:

  • Passive rhythmic release

  • Active rhythmic release

  • Shiatsu (acupressure)

  • Trigger point pressure release

Home Remedies

You can take several steps at home to reduce pain and improve your quality of life:

  • Choose a better chair at work, and improve your posture

  • Try adjusting the height of your computer so that it falls in your natural eye line.

  • Try a new mattress, or change your sleeping position.

  • Practice yoga, Pilates, or another stretching technique.

  • Wear a back brace when doing heavy lifting.

  • Use a personal massager or vibrating device.

  • Start an exercise program and get your muscles moving every day.

  • Set a mental health professional and reduce your stress level.

  • Use an ice pack immediately after any muscle injury.

  • Use moist heat to treat muscle inflammation.

  • Take a hot bath.

  • Use a traction device.

  • Practice mindfulness to manage pain

Myofascial pain syndrome vs. fibromyalgia

Fibromyalgia is a disorder of widespread muscular pain felt throughout the body. It is associated with multiple, widespread tender points without referred pain.

In comparison, myofascial pain is localised in regional groups of muscles, like the lower back, neck, or jaw. Furthermore, it has trigger points in a taut ropey band of the muscles, producing localised pain, and they trigger referred pain.

Key messages

The myofascia is a complex network of tissue that has an important role in the body. In some cases, myofascial pain can develop. Myofascial release can be an effective therapeutic tool to alleviate symptoms and restore function when used appropriately.

Myofascial release is not suitable for everyone. A health professional can discuss the risks and benefits, depending on the situation.

Written by Leon Mao
Physiotherapist, University of Melbourne
Published on May 31, 2022
Medically reviewed by Dr Gina Arena
Research Fellow, University of Western Australia
Reviewed on May 31, 2022
Medical reviewers
Last medically reviewed on May 31, 2022 has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
  • 1.

    Bordoni B & Sugumar K. Myofascial pain [Internet]. Treasure Island (FL): StatPearls Publishing. [Updated 2022 Dec 2; cited 2022 May 20]
  • 2.

    Evan Rivers W, Garrigues D, Graciosa J & Harden JN. Signs and symptoms of myofascial pain: An international survey of pain management providers and proposed preliminary set of diagnostic criteria. Pain Med 2015 [cited 2022 May 20]; 16 (9):1794–1805.
  • 3.

    Koukoulithras I, Plexousakis M, Kolokotsios S, et al. A biopsychosocial model-based clinical approach in myofascial pain syndrome: A narrative review. Cureus 2021 [cited 2022 May 20]; 13(4): e14737.
  • 4.

    Ajimsha MS, Al-Mudahka NR &, Al-Madzhar JA. Effectiveness of myofascial release: systematic review of randomized controlled trials. J Bodyw Mov Ther 2015 [cited 2022 May 20];19(1):102-12.
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