Myofascial Pain & SI Joint Dysfunction

Question 1

What is myofascial pain syndrome?

Answer 1

Myofascial Pain Syndrome

• Myalgic condition characterized by local and referred pain that originates in a myofascial trigger point
• Most common cause of chronic and persistent regional pain
• May be the primary cause of pain in 30-85% of pts. complaining of MSK pain
• Predominantly females 3:1
• The traditional emphasis for back pain is on discogenic changes, however most pts. that wait to see a spine surgeon do not need surgery
  
  • These pts may need treatment for myofascial etiologies of back pain

Question 2

What are the 5 common muscles in the back that lead to back pain and are identified by their respective trigger points?

Answer 2

1. Gluteus Medius
2. Gluteus Maximus
3. Gluteus Minimus
4. Piriformis
5. Quadratus Lumborum

Additionally:

• Iliopsoas
• Pelvic floor

Question 3

How do you differentiate between low back pain vs. pelvic girdle pain?

Answer 3

LBP: 12th rib to gluteal fold

Pelvic girdle: Iliac crest to gluteal fold

Question 4

What important functional test is used to diagnosis pelvic girdle pain?

Answer 4

The Active Straight Leg Raise

Effort Scoring Scale:

0 - not difficult at all

1 - minimally difficult

2 - somewhat difficult

3 - fairly difficult

4 - very difficult

5 - unable to do

Question 5

What is the treatment for myofascial LBP?

Answer 5

Treatment

1. Posture
   
   • Ergonomics; computer, work, car, recreationally
2. Foam roller: supine-ly x 5 min/day
3. Breathing exercises
4. Trigger point management (conservative)
   
   • Shepherd’s hook/Theracane/Tennis balls/The stick
5. Stretches for affected muscles: quadratus lumborum, gluteus medius, minimus, maximus, piriformis, iliopsoas, pelvic floor
6. Strengthening: core, balance, one leg standing
7. Trigger point injections
8. Intramuscular Stimulation
9. Dry needling