Muscle, bone, and pain conditions

Myofascial pain syndrome

• Chronic pain condition that affects muscles and the tissue that surrounds them. Characterized by trigger points in muscles that cause pain when pressed

  • Can be caused by sudden overload, overstretching, and increased repetition
  • Types of trigger points
    • Active trigger points are tender to palpation and can cause referred pain
    • Latent trigger points are taut bands that can be transitioned to active trigger points

• Symptoms

  • Deep, aching, or throbbing pain that can be localized or widespread.
  • Tender knots in the muscles that cause pain when pressed.
  • Pain that radiates to other areas of the body, such as from the neck to the head or shoulder.
  • Headaches
  • Sleep disturbances
  • Postural changes

• Diagnosis

  • Clinical presentation

• Medical management

  • Dry needling
  • Corticosteroid injections
  • Analgesic injections

• Physical therapy management

  • Soft tissue techniques to reduce pain and inflammation
  • Progressive resistance training
  • Modalities for managing pain and inflammation
  • Functional mobility training
  • Dry needling

Complex regional pain syndrome (CRPS)

• Chronic pain condition characterized by persistent, severe pain; presentation of symptoms is disproportionate to the initial injury, thought to be caused by an abnormal response of the sympathetic nervous system to an injury.

  • Results in dysfunction of the sympathetic nervous system
  • Can be caused by trauma or have an unknown etiology
  • Types of complex pain syndrome
    • CRPS I- tissue injury with no nerve involvement
    • CRPS II- tissue injury with known nerve involvement

• Symptoms

  • Intense, burning, or throbbing pain that is disproportionate to the initial injury
  • Pain that worsens with movement or touch
  • Pain that may spread to other areas of the body
  • Allodynia (pain from normally non-painful stimuli, such as light touch or temperature changes)
  • Hyperalgesia (increased sensitivity to pain)
  • Hypersensitivity to heat and cold
  • Numbness, tingling, or prickling sensation
  • Changes in skin color, temperature, or sweating
  • Swelling
  • Joint stiffness

• Diagnosis

  • Clinical presentation

• Medical management

  • Sympathetic nerve block
  • Spinal cord stimulation
  • Intrathecal drug pumps
  • Antiseizure medications
  • Antidepressants
  • Corticosteroid medications
  • Opioid medications

• Physical therapy management

  • Patient education on diagnosis and prevention of exacerbating activities
  • Desensitization activities for return to normal function
  • Modalities for pain relief, such as TENS, avoid heat and cold therapies.

Muscle strains

• Injury to the muscle or tendon, the fibrous tissue that connects muscles to bones, causing an inflammatory response

  • Typically due to overuse or overstretching caused by forceful movement

• Symptoms

  • Sudden, sharp, or throbbing pain that worsens with movement
  • Inflammation and fluid buildup in the affected area
  • Discoloration of the skin due to blood vessel damage
  • Difficulty or inability to use the injured muscle
  • Restricted movement in the affected area
  • Feeling tight or sore when the muscle is stretched or contracted
  • Involuntary muscle contractions that can cause sudden pain
  • Pain when the injured muscle is touched or pressed

• Diagnosis

  • Clinical presentation
  • MRI, possibly

• Medical management

  • Acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs)

• Physical therapy management

  • Same conservative approach as tendonosis/tendopathy: soft tissue techniques, progressive resistance training, modalities for pain and inflammation, and functional mobility training.

Grades

Grade 1 (Mild)

• What it is: Minor overstretching or microscopic tearing of muscle fibers with no appreciable structural damage.
• Symptoms: Mild soreness, tenderness, and slight stiffness.
• Function: Less than 5% loss of strength; strength and movement remain mostly intact.
• Healing time: A few weeks.

Grade 2 (Moderate)

• What it is: Partial tearing of the muscle or musculotendinous junction.
• Symptoms: Significant pain, moderate to severe swelling, and localized bruising (ecchymosis).
• Function: Moderate loss of function and strength (usually a 25% to 50% reduction).
• Healing time: Two weeks to a few months.

Grade 3 (Severe)

• What it is: A complete rupture of the muscle or tendon.
• Symptoms: Immediate, intense, sharp pain, severe swelling, and sometimes a visible gap or deformity in the muscle.
• Function: Complete loss of function, with strength loss typically greater than 50%.
• Healing time: Several months (often 4 to 6 months); frequently requires surgical repair and intensive rehabilitation

Myositis ossificans

• Abnormal calcification within the muscle belly

  • Can be caused by direct trauma- hematoma causes calcification
  • Frequently located in the quadriceps or biceps

• Symptoms

  • Persistent, localized pain that worsens with activity
  • A firm, palpable lump or mass in the injured muscle
  • Limited range of motion
  • Warmth
  • Redness

• Diagnosis

  • Clinical presentation
  • X-ray imaging
  • CT scan
  • MRI

• Medical management

  • Acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs)

• Physical therapy management

  • Same conservative approach as tendonosis/tendopathy: soft tissue techniques, progressive resistance training, modalities for pain and inflammation, and functional mobility training.

Paget’s disease

• Chronic bone disorder characterized by abnormal bone remodeling

  • May be linked to viral infections

• Symptoms

  • Deep, aching pain in the affected bones, often worse at night or with activity.
  • Bowing of the legs or arms
  • Enlargement of the skull or jaw
  • Thickening of the bones in the spine or pelvis
  • Numbness, tingling, or weakness in the arms or legs
  • Headaches
  • Hearing loss

• Diagnosis

  • Clinical presentation
  • X-ray
  • Lab tests
    • Serum alkaline phosphatase and urinary hydroxyproline

• Medical management

  • Acetaminophen
  • Calcitonin
  • Surgery for bone deformities or joint replacements

• Physical therapy management

  • Joint protection strategies
  • Improve joint biomechanics
  • Aerobic capacity/conditioning

Osteoporosis

• Bones become brittle and fragile from loss of tissue due to metabolic changes, resulting in bone mineral density loss

  • Affects women about four times more than men
    • Can be related to menopause (reduction in estrogen)
  • Common sites are the thoracic and lumbar spine, the proximal humerus, the proximal femur (hip), the pelvis, distal radius

• Symptoms

  • Bone fractures
  • Back pain
  • Loss of height
  • Brittle nails
  • Dental problems

• Diagnosis

  • Clinical presentation
  • CT scan
  • Dexa scan (bone density scan)
    • -1.0 or higher: Normal bone density
    • -1.0 to -2.5: Osteopenia (low bone mass)
    • -2.5 or lower: Osteoporosis (weak bones)

• Medical management

  • Calcium supplement
  • Vitamin D supplement
  • Estrogen - hormone replacement therapy
  • Calcitonin medication
  • Bisphosphonate medication

• Physical therapy management

  • Joint protection strategies
  • Improve joint biomechanics
  • Aerobic capacity/conditioning
  • Emphasize weight-bearing activities, such as walking, to help maintain bone density.
  • Aquatic therapy is not effective in maintaining bone density due to buoyancy.

Osteomyelitis

• Inflammation of the bone caused by infection

• Symptoms

  • Pain and tenderness in the affected bone
  • Swelling, redness, and warmth over the infected area
  • Drainage of pus from a wound or abscess
  • Limited range of motion in the affected joint
  • Fever and chills
  • Fatigue
  • Malaise
  • Loss of appetite
  • Weight loss

• Diagnosis

  • Clinical presentation
  • Bone biopsy
  • Lab tests

• Medical management

  • Antibiotics
  • Surgical debridement if necessary

• Physical therapy management

  • Joint protection strategies
  • Improve joint biomechanics

Somatic dysfunction

Somatic dysfunction is an impaired or altered function of the body’s framework, including muscles, joints, and fascia. It is commonly associated with pain, restricted movement, and abnormal tissue texture.

Diagnosed using the TART criteria:

Definitions

Tissue texture changes

Palpable differences in the texture of the skin, fascia, or muscle over the dysfunctional segment.

Asymmetry

Structural or positional asymmetry observed in the segment.

Restriction of motion

A decrease in active or passive range of motion at the segment.

Tenderness

Pain elicited on palpation of the segment.

Below is a description of somatic dysfunction within each segment type:

Cervical somatic dysfunction

• Location: Affects the neck (C1-C7).
• Common causes:
  • Poor posture, whiplash, prolonged screen time, stress-related muscle tension.
• Symptoms:
  • Neck pain, stiffness, headaches, dizziness, reduced range of motion, and possible radiating pain to the shoulders or arms.
• Treatment:
  • Soft tissue mobilization, cervical manipulation, stretching, and postural correction exercises.

Thoracic somatic dysfunction

• Location: Affects the mid-back (T1-T12).
• Common causes:
  • Poor posture, kyphotic spine patterns, prolonged sitting, rib dysfunction, and respiratory issues.
• Symptoms:
  • Mid-back stiffness, difficulty taking deep breaths, rib pain, referred pain to the chest or upper back, and limited spinal rotation.
• Treatment:
  • Thoracic mobilization, rib articulation techniques, breathing exercises, and spinal extension exercises.

Lumbar somatic dysfunction

• Location: Affects the lower back (L1-L5).
• Common causes:
  • Heavy lifting, poor body mechanics, prolonged sitting, muscle imbalances, disc pathology.
• Symptoms:
  • Lower back pain, stiffness, restricted forward bending, muscle spasms, pain radiating to the hips or legs, and possible sciatic nerve involvement.
• Treatment:
  • Lumbar manipulation, core strengthening, stretching, and movement retraining.