Myofasciitis, also known as “low back muscle injury”, “low back fibrositis”, “low back fascial pain syndrome”, etc., refers to the aseptic inflammatory reaction of muscles and fascia. The acute onset of myofasciitis can be triggered when the body is stimulated by wind and cold, fatigue, trauma or improper sleep position, etc. Acute or chronic injury or strain to the muscles, ligaments and joint capsule of the shoulder, neck and lumbar region is the basic cause of this disease. Due to the lack of thorough treatment in the acute stage and the transition to chronic; or due to repeated strain, wind and cold and other adverse stimuli, the patient may repeatedly experience continuous or intermittent chronic muscle pain, soreness and weakness.
Pathophysiology
Muscles and ligaments are the power base of various activities of the body, and their end devices are the bones to which the muscles are attached, and they are the power transmission hubs that drive the bones and joints, and they are also the parts where stresses are concentrated and intersected, so they are very easy to be injured. Repeated injury to the local muscle, when the injury healed can leave scars or adhesions, scar tissue can reduce the number of local blood vessels or small diameter, the occurrence of local microcirculation blood flow regulation ability to reduce the muscle blood supply and anaerobic work ability to lose. The local ischemia of the muscles causes pain due to stimulation of the peripheral nerves, and the patient cannot tolerate prolonged physical activity or even sedentary activities. For example, long-term incorrect posture or psychological depression can cause physiological contracture at the level of local muscle segments, long-term repeated muscle spasm causes muscle ischemia, sterile exudation, scar formation, local myofascia often undergoes postural load and extreme tension, fatigue causes postural injury, repeated exertion causes micro-tearing muscle damage, and pain-causing substances appear around the microvascular reaction zone of myofascia.
Rheumatoid myositis, ankylosing spondylitis or viral myositis cause peripheral nerve compression due to muscle swelling, which may form nociceptive sensitive points or painful muscle sclerosis for a long time and experience a complex intertwined reaction process of long-term local irritation, inflammation, healing, hyperplasia or scarring, with painful local tissues and calcification of inflammatory exudate deposits and development of myoclonus. Hypoxia or lack of energy metabolism may be secondary to a decrease in local blood flow and is an important mechanism of CMPS painfulness that can cause muscle dysfunction and tissue destruction, therefore any means of improving microcirculation to the muscles and nerves even local massage or walking can provide some relief from the painful symptoms of CMPS.
Pathological features of painful nodules.
(i) a bundle of muscle fibers in a muscle surrounded by a sterile inflammatory myofibrils that are stiffer.
(ii) A lesioned dermal nerve.
(iii) Hyperplastic inflamed fatty connective tissue that is closely attached to the deep fascia.
(iv) The site where the motor nerve enters the muscle. Painful nodules mostly occur in the supraspinal ligaments, interspinal ligaments, posterior laminae, supraspinatus, intertransversus, occipital ring fascia, levator scapulae, trapezius, rhomboid, psoas, sacrospinous, and so on.
Causes of morbidity
Chronic strain injury is one of the most common causes, the muscle and fascia are damaged and fibrotic changes occur, so that the soft tissue is in a state of high tension, resulting in small tearing injuries, and finally, the fibrous tissue increases and contracts, squeezing the local capillaries and peripheral nerves to cause pain. The wet and cold climate is another important pathogenic factor, which can cause muscle vasoconstriction, ischemia, edema, and local fibrous plasma exudation, eventually forming fibrillitis. Chronic infections, depression, sleep disorders, hypothyroidism, and hyperuricemia are also frequent complications of myofasciitis.
The following predisposing factors are common.
1. Some patients have a history of trauma of varying degrees. The injury to the muscles and fascia is not treated in time or is not treated thoroughly, leaving a hidden problem that is prolonged and causes the disease.
2, many patients do not have an obvious history of acute trauma, but because of prolonged sitting class less activity; or because of poor work posture, long-term in a single specific posture; or because of work tension, continuous weight bearing, overwork, etc., prolonged day and cause the disease.
3, feel the wind, cold and damp evil, meridian obstruction, poor blood flow, affecting the nutrition and metabolism of the muscles and fascia, prolonged for a long time and cause the disease.
4, the patient is weak, immune function is not strong; or lumbosacral spine congenital mutation (deformity); or degenerative disease of the spine (osteophytes) induced.
Disease classification
Posterior cervical myofascial syndrome: also known as chronic cervical muscle spasm, easily confused with cervical spondylosis. The main cause of the disease is to maintain a posture for a long time, especially for long-term ambulation, low work types, easy to suffer from this disease, generally limited to the posterior neck discomfort. The main symptoms: pain, stiffness, soreness, heaviness, pressure, and inactivity in the back of the neck, usually without neurological symptoms, which are aggravated in the morning and reduced after activities. Severe disease may be accompanied by headache and involvement of the back of the shoulder, manifesting as soreness and numbness, etc.
Neck and shoulder myofasciitis: also known as neck and shoulder myofascial pain syndrome, refers to aseptic inflammation of soft tissues such as the fascia, muscles, tendons and ligaments in the back of the neck and shoulder, causing pain, stiffness, limited movement and weakness in the back of the neck and shoulder. It is mainly related to minor trauma, exertion and cold. The main symptoms: neck, shoulder and back pain, muscle stiffness, or a feeling of heavy pressure, numbness, can be radiated to the head and upper extremities and between the back and scapula; morning or weather changes and after cold, the symptoms are aggravated, after activity, the pain is reduced, often recurrent; may appear the neck popping sensation; physical examination can be found local muscle tension, pressure pain, pressure pain points are often located in the spinous process and spinous process, often involving the trapezius muscle, rhomboid muscle and scapular muscle The pressure pain is limited and does not radiate.
The patient’s back pain is severe in the acute phase, with a burning sensation, the symptoms increase when the back is active, the local pressure pain is more significant (mostly at the starting and ending points of the lesion muscle), some patients have an increased body temperature, blood tests can see an increase in white blood cells. After an acute attack, the symptoms may subside completely in a few patients, but most of them may remain painful or reoccur months or years later. Chronic cases are characterized by lumbar pain, muscle stiffness, and a feeling of heaviness, often aggravated by changes in weather (such as rainy days), at night, or in humid areas. The lumbar pressure pain is widespread, and the lumbar function activity can be normal, but the lumbar pain is obvious when moving.
Third, plantar fasciitis: plantar fasciitis is a chronic injury caused by sports, the most common cause is often walking for a long time (including hiking and fitness, hiking and other activities). Walking for long periods of time can easily cause chronic injury to the bottom of the foot, resulting in plantar fasciitis; in addition, the heel of the shoe is too hard to cause pressure on the heel, can also cause plantar fasciitis; often wear high heels will also aggravate the damage to the bottom of the foot. The main symptoms: plantar fasciitis is mostly a single foot attack, in addition to heel pain, some patients feel pain in the arch or forefoot. This is due to the fact that the plantar tendons have not had a chance to be stretched all night and are suddenly stretched when getting up from bed, so the pain is immediate.
Clinical manifestations
(1) Localized muscle pain: chronic persistent soreness, swelling or dull pain, pain with tightness or heavy pressure, can occur in the waist, back, sacrum, buttocks, legs, knees, soles, neck, shoulders, elbows or wrists, etc.
(2) Ischemic pain: pain can be induced by local cold or general fatigue or cold weather, waking up with pain during late night sleep, stiffness and pain in the morning, relieved after activity but often aggravated after long working hours or in the evening, and pain can also be aggravated when inactive for a long time or overly active or even in bad mood.
(3) Fixed pressure point: During physical examination, the patient is found to have tension, spasm, bulge, contracture or stiffness in one side or local muscle. The location of the pressure point is often fixed near the starting point of the muscle or at the intersection of two groups of muscles in different directions, and painful hard nodes or painful muscle cords may be felt deep in the pressure point.
(4) There may be a history of local or adjacent injury, and the incidence is more common in women than in men.
Dangers of the disease
Fasciitis, if left untreated, can aggravate lumbar disc herniation, lumbar spinal stenosis, and lumbar spondylolisthesis, adding more pain and making treatment more difficult. In addition, patients often have difficulty concentrating on their studies and work because of back pain, and many even suffer from anxiety, depression and other psychological problems as a result. And as time goes on and the condition progresses, fasciitis can lead to problems with the entire spine.