Myofascial Pain Syndrome
Medically reviewed by Dr Ramani Arumugam, Consultant Rheumatologist ·
A knot in the shoulder that never quite lets go. A deep ache between the shoulder blades by the end of every working day. Pain that shoots up into the head when you press one spot in your neck. Myofascial pain syndrome, sometimes shortened to myofascial syndrome, is very common, and it is very treatable once it is recognised. My role is to confirm that this is what you have, make sure nothing else is hiding behind it, and treat the cause as well as the knot.
Myofascial pain syndrome: understanding the condition
This one-page summary brings together what trigger points are, where they appear, what causes them and how they are treated. Tap the image to open it full size if the print is small on your phone.
View the full-size infographicUnderstanding myofascial pain syndrome
Myofascial pain syndrome is a long-term muscle pain condition that stays in one area of the body. "Myo" means muscle, and "fascia" is the thin layer of tissue that wraps around it. The pain comes from trigger points: small, tight, tender spots inside a band of muscle. Pressing a trigger point hurts at that spot, and it can also send pain to another area. This is called referred pain. A trigger point in the neck, for example, can cause a headache.
Where it usually appears
- Neck and the top of the shoulders
- Between and around the shoulder blades
- Lower back
- Buttock and hip
- Jaw
Why it happens
Trigger points usually form in muscles that are overloaded or held in one position for too long.
- Long hours at a desk, laptop or phone with the head forward and shoulders rounded
- Repeated movements at work or in sport
- A muscle injury or strain
- Stress and poor sleep, which keep muscles tense
- A painful joint nearby that makes the surrounding muscles guard
How I reach the diagnosis
No blood test or scan shows myofascial pain. The diagnosis comes from your story and a careful examination. I press along the muscle to find the tight band and the tender spot, and I check whether pressing it brings on the pain you know. I look at your posture and how your neck, shoulders and back move.
Tests are used to rule out other causes of muscle pain. Depending on what I find, these may include blood tests for inflammation, thyroid function and muscle enzymes, and a musculoskeletal ultrasound of a nearby joint or tendon.
Myofascial pain syndrome and fibromyalgia
These two are often confused. Myofascial pain stays in one region and comes from trigger points in specific muscles. Fibromyalgia causes pain all over the body, together with deep tiredness, unrefreshing sleep and difficulty concentrating. A person can have both, and the treatment plan is different for each.
What treatment looks like
Treatment has two parts: release the trigger point, and remove what keeps it coming back.
- Physiotherapy and stretching. Gentle, sustained stretching and strengthening of the affected muscles. This is the core of treatment.
- Posture and workstation changes. Screen height, chair, phone habits and regular movement breaks.
- Heat and massage. Simple measures that relax the muscle.
- Trigger point treatment. Dry needling, or an injection of local anaesthetic into the trigger point, for spots that do not settle.
- Medicines. A short course of anti-inflammatory tablets, a lidocaine patch or a muscle relaxant. For long-standing pain, duloxetine is sometimes used.
- Other therapies. TENS, therapeutic ultrasound and acupuncture help some people.
- Sleep and stress. Both affect how tense the muscles stay, so I include them in the plan.
What you can do yourself
- Change position at least every 30 minutes when you work at a desk.
- Raise your screen to eye level and keep your phone up, not in your lap.
- Stretch the neck, shoulders and upper back every day, gently and without forcing.
- Use a warm shower or a heat pack on the tight area.
- Build general fitness with walking, swimming or cycling.
- Protect your sleep, and notice when stress makes your shoulders rise.
My work and daily activity impact calculator can help you see how much the pain is affecting your day.
What the future holds
Most people improve well, especially when the trigger points are treated and the cause is corrected. Myofascial pain does not damage the muscle or the joints. It can return if the posture, workload or stress that caused it stays the same, which is why the self-care part matters as much as the treatment.
Some of the information on this page is adapted from the American Society of Anesthesiologists: Myofascial Pain Syndrome. It is general education and does not replace an individual medical assessment.
What myofascial pain syndrome is
Myofascial pain syndrome is a common cause of long-lasting muscle pain in one region of the body, most often the neck, shoulders or back. The pain comes from trigger points, which are tight, tender spots in a muscle that hurt when pressed and can send pain to another area. Blood tests and scans are normal.
Symptoms to look out for
A deep, steady ache in one area, such as the neck, shoulder or lower back
A tender knot or tight band you can feel in the muscle
Pain that spreads to another area when the knot is pressed
Headaches that start from the neck or shoulders
Stiffness and reduced movement in the area
A feeling of weakness or heaviness in the muscle, without true loss of strength
Pain that is worse after long sitting, stress or poor sleep
Disturbed sleep because of the pain
Why this matters to a rheumatologist
Muscle pain in the neck, shoulders and back has many possible causes. Before I call it myofascial pain, I make sure it is not an inflammatory condition such as polymyalgia rheumatica, inflammatory arthritis or myositis, and not a thyroid problem or a joint or tendon problem nearby. Once those are excluded, you can treat the muscle with confidence instead of worrying about what might be missed.
Signs I would like you to seek care for
For emergency symptoms please seek urgent or emergency care first rather than waiting for a WhatsApp reply.
Muscle pain that has lasted more than a few weeks despite rest, stretching and simple painkillers
True weakness, such as difficulty climbing stairs or lifting your arms
Morning stiffness in the shoulders and hips lasting more than 45 minutes, especially over the age of 50
Fever, unexplained weight loss or night sweats
Numbness, tingling or weakness in an arm or leg
Joint swelling, redness or warmth
Chest pain, or pain in the jaw or arm with breathlessness, which needs emergency care
What a specialist review looks like
I take a full history, including your work, posture, sleep and stress. I examine the muscles for trigger points and check the joints nearby. I arrange tests only where they are needed to rule out other causes. Then I explain what is happening in plain language and build a plan with physiotherapy, changes to how you work and rest, and trigger point treatment or medicine where they will help.
Questions my patients often ask me
A trigger point is a small, tight, tender spot inside a band of muscle. It can feel like a knot. Pressing it causes pain at that spot and sometimes in another area.
Speak with me
If a muscle pain in your neck, shoulder or back keeps coming back and you are not sure why, WhatsApp my clinic. We can help you decide whether a rheumatology review is the right next step.
Other conditions I treat
This page is for general education only and does not replace medical advice. Please consult a qualified healthcare professional for diagnosis and treatment.