I had a client come to me recently with the diagnosis of Myofascial Pain Syndrome. Yet, his biggest challenge was weakness, not pain. I could see the confusion and frustration he was experiencing because his condition did not make sense. The causes and remedies for myofascial pain or weakness are not at all intuitive. Don’t blame yourself if you are suffering from weakness or pain that makes no sense. I’ll try to explain what is going on from a massage perspective, but know that if you are experiencing mystery pain or weakness, your first job is to see your doctor because of course you cannot know if the cause is myofascial dysfunction or some bigger and more concerning issue that needs medical help.

Here is our roadmap. We will discover what your body is doing when it creates trigger points. This will involve some anatomy and discussion of the makeup of fascia, the substance in your body that creates trigger points. We’ll talk about why you might get trigger points and finish up with what to do about it. Please know that everything we discuss will relate to the body’s need for balance. Balance in this arena involves balance of the muscles, front/back, side/side, upper/lower. It also relates to balance in posture, balance in lifestyle and balance in all of the external and internal environmental factors that create health.

Let’s start at the beginning. The term “myofascial” relates to “myo,” aka, muscle and “fascia,” aka, connective tissue. People understand muscle, but fascia or connective tissue is just so much noise. For those of you who have cut up a chicken, you know fascia. It is the stuff between the skin and the muscle that is super sticky. If you could look at live fascia under a microscope, you would see a jelly-like web of supersaturated living tissue. In its healthy form, it is a jelly and cushion between your skin and your muscles. When you bump into something, it absorbs the force of that bump and disperses it across the web of fascia. The fascia is like a skin underneath your skin and therefore has a large area to disperse forces that your body experiences. Inside this fascia lay many, many nerve endings, more than your muscles contain.

What happens when your body experiences something more traumatic than a mere bump? Your fascia is your friend in that moment. It not only disperses as much force as possible, but it holds things together. It goes from jelly-like to leather-like. It uses its spiderweb form to glue the skin, fat and muscle together, as if it was sewn together. Under a microscope, the web looks delicate. This is deceptive. The tensile (resistance to being pulled apart) strength of fascia is enormous. It grips. It holds. It keeps everything together. In a healthy state, it stops gripping when the area is healed. You might ask yourself, then, why is it still gripping, and causing you pain? The answer is in the trauma you are experiencing.

In our day to day world, most people are not experiencing the traumas of days gone by. They don’t have vikings raiding their villages, they don’t have horses kicking them, they aren’t dealing with the falls that come from traveling across rough terrain. Today’s common stresses to the body come from the lack of balanced posture and the demands of repetitive movements. If you think that your muscles were meant to hold you upright, you would be wrong. Your bones are meant to hold you up. Your bones hold you up because the weight of your body is balanced on your bones. If you lose that balance, then what takes up the slack? Your fascia and your muscles. Because the tensile strength of fascia is much stronger than the tensile strength of muscle, it is the job of the fascia to bear the brunt of the forces that come from your muscles holding you up against gravity. In that case, what happens to both the muscle and the fascia?To answer that question, let’s look at any person, place or thing that gets overworked.

What do you feel like when you are overworked? First, you feel an energy depletion. Second, you might use up all your resources or ability to get outside help. Third, you “forget” what it feels like to be in a normal, healthy situation. Let’s take those ideas and apply them to your muscles and fascia. 

When your muscles are overworked through lack of balanced posture or repetitive or constant motions (think of holding your phone for long periods of time), the muscles lose their energy. It takes the body’s energy, ATP, to contract a muscle. It also takes the body’s energy to release the contraction, so it can stretch. If you are continually asking the muscle to contract, the body responds by feeding the muscle with the biochemicals that make the muscle contract. This uses up energy and also because the muscle is “bunched up,” it puts pressure on the tissues around the contracted muscle. 

Try this for yourself. Tense up or contract your bicep muscle, the one in your upper arm. Use the hand of your other arm to touch and squeeze that contracted bicep muscle. You can feel the pressure that your tensed bicep puts on the rest of your upper arm. It might help you understand how the flow of blood or lymphatic fluid or even messages from your nerves might get squeezed out, if the contraction continues. When you ask your muscles, not your bones, to hold you up or when you do repetitive or static motions, the muscles respond just like your contracted, bunched up bicep muscle did. This uses up the available energy and squeezes out the flow of chemicals and energy that will allow the muscle to relax. This is not absolute, of course. But as a general rule, the more a muscle is constantly contracted, the more it is cut off from the resources that will allow it to relax. 

This is made worse by the function of the fascia in the area. Remember, it binds together tissues that are experiencing stress. So, the fascia begins to “sew” the stressed out, overworked muscle to the skin and other layers of fascia, especially in the spots where the stresses are most extreme. Remember when I said that the fascia becomes like leather when stressed? To a massage therapist, a trigger point feels like a thick, leather-like structure. Remember also that the fascia is doing this to keep the muscle and tendon from tearing under the strain of overuse. As helpful as this is, the leather-like trigger point adds to the restriction of blood flow. It is blood flow that brings the healing, relaxing chemicals to the overstressed muscles. What is the typical outcome of all of this? Pain. Pain localized to the area of overworked muscles, or mysteriously, pain in other muscles that are stressed out due to the web of fascia.

Remember how I explained that your fascia is like a skin underneath your skin and how fascia disperses the impacts of forces experienced by the body? You might imagine that the force of overworked muscles in one part of the body gets transferred to other areas. Now, I must add another layer of complexity here. Fascia is not as continuous as I described above. Instead, it is a system of sheets or planes that weave together like a quilt whose pieces overlap and are sewn together with slightly elastic thread. When you are looking at the force transmission along fascial sheets, think about the sheet of fascia and the areas where one fascial sheet connects to another. This is just as complex as many other operations of the human body. Luckily, you can simply do an internet search to see the referred pain patterns relating to any muscle in the body. You don’t need to know how all of these structures interplay with one another. 

The bottom line is that stresses in one part of the body can result in stress and pain in completely different areas. This referred stress and pain causes the muscles in that area to contract. This is called muscle guarding. Have you noticed this? When you get a cut or bruise, the muscles in the area tighten up to protect or guard. It’s just how the nervous system works. Since the referred pain doesn’t go away, the muscle never gets to relax. That causes trigger points in the area of referred pain. 

In many cases, the result is pain. In some cases, the result is weakness. That is because the weak muscle has no power. The lack of power is not necessarily due to the lack of energy. It might also be due to nerves that are so squeezed that they cannot send proper messages to the muscles or adaptation of the nervous system to the “new normal” of tight muscles. The weakness might also be due to the lack of available muscle fibers to do the work of the muscle. Muscles are interesting. They are made up of individual muscle fibers. These muscle fibers are either completely contracted or completely relaxed. The power of the muscle is a measure of the number of muscle fibers that are available to contract. If most of the muscle fibers are contracted to participate in muscle guarding, the muscle will be weak. If weak muscles are overused, they will react like any other overused muscle and restrict even more. It results in a scary, confusing, frustrating outcome of pain and/or weakness that is very difficult to diagnose and unwind.

To fix this, my opinion is that we should aim for balance. You might ask yourself, “How am I out of balance?” You might look at your posture. You might look at your overuse or repetitive use of your body. You might ask yourself, do I allow my muscles to go through their full range of motion? You might look at your nutrition. Do you take in the nutrients that allow your muscles and fascia to function properly? This includes water. Do you have the strength to do what you ask of your body? Do you have the rest that allows your body to repair itself? 

If your body is in trouble, if you have chronic pain or weakness, you need help from professional people. You need your doctor. You probably need a physical therapist. You would benefit from a massage therapist who is trained in myofascial release. You need to reach out to those who can educate you about your body and what you can do for your own self care. I recommend Clair Davies’ book, “The Trigger Point Therapy Workbook.”

Aim for balance, my friend. Your healing is your creation. I’ve seen many, many people get better from pain or weakness. Those who get better approach their situation with a growth mindset. They are willing to try things that might or might not work. If that approach isn’t working, they pivot and try something else. They approach their situation with curiosity and the understanding that they are learning more. If you want a silver bullet, a single answer for your dilemma, you might be suffering from a fixed mindset. If you are looking for someone or something to fix you, you might be overlooking your path to balance and health. For many of you, your choices created the lack of balance you are experiencing. Only you can take the steps to regain balance. This is not blame. You cannot know what you don’t know. Now that you know better, you can do better.  And you can be supported and helped by professionals. However, they cannot change the way you are using your body. I believe that your body is your first and best friend. I also believe that you can give your body the inputs it needs to thrive. Best of luck in your journey. You can do it!