Our clinic believes that you should treat myofascial pain as you would any other type of muscle pain:

First: You must have the right diagnosis. Is it really myofascial pain?

Second: You must identify the correct cause or causes of the myofascial pain. If you do not identify the cause of your pain you will never get better.

Third: After the correct diagnosis is made and the cause is identified, then the treatment begins. Below is a list of what causes myofascial trigger points to become active and another list of what makes trigger points better.

These are similar to the causes of trigger point activation anywhere, but there are some causes which are specific to the head and neck.

• Activities... may be as simple as running a vacuum cleaner.

• Trauma... Recent or in the past (examples include a car wreck, a severe fall, surgery which causes you to open your mouth wide for long periods of time). (During any surgery in which you have a general anesthetic, it is necessary to open your mouth very wide to insert the breathing tube. Dental procedures can also force your mouth to stay open for long periods of time. It is not that the anesthesiologist or the dentist did anything wrong, it is just a possible consequence of the procedure.

• Nutrition... too much sugar or caffeine, not a balanced diet, not enough water, fast food.

• Stress... When we are stressed we have a tendency to tighten our muscles especially the jaw muscles.

  Think of a straight line going through the head of the picture and down the center of the body like the spine. The head is not centered through the center of the body. Thus the neck and back muscles must strain to hold the head forward over the body. Here the head is centered through the body. This allows the muscles to relax because they do not have to hold the head in this forward position.

• Malocclusion or a "bad bite." For more information, watch our video.

• Posture... see the forward-head and correct head positions in the pictures shown at right.

• Sleep disorder... Sleeping problems such as difficulty in falling asleep or awakening during the night 1 or more times. This does not mean that you have to awaken in pain; just the fact that you wake up for any reason. This causes a great disturbance in your sleep stages which in turn causes trigger points to become active.

• Cold air blowing on your face or neck.

• Habits... chewing on a straw or toothpick or chewing gum.

• Sitting, or standing, in one position too long, such as riding in a car or spending too much time on the computer.

• Repetitive motion... many times carpel tunnel is not a problem with the nerves and tendons in the wrist, but referred pain from the muscles in the forearm.

• Sleeping too long... Just as not getting enough good sleep is bad, lying in bed in the morning can activate trigger points.

• Addressing the causes of the trigger points.

  This may sound over simplified, but you are not going to quiet the trigger points until you correct the causes.

  For example, if your headaches are caused by a bad bite or awakening too many times during the night, you have to correct the bite and take something for sleep.

• Physical Therapy - In physical therapy the goal will be to achieve the full range of motion of a muscle, or group of muscles, without pain, and then in a non-harmful and non-painful way, strengthen these muscles.

• Massage Therapy - The purpose of massage therapy is to resupply the muscles with blood flow and to stretch the muscles to their full working length and then to work out the taut bands of muscles which are in reality the trigger points.

This list of causes and treatments is meant to give you a general idea about your pain. We are only trying to give you some insight as to what your problem may be, not to try to treat you over the internet.

For more information on self help in managing triggerpoints please see www.triggerpointbook.com.