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Myofascial Dysfunction (MFD) - The Nature of the Disease
Nobody is really sure what causes MFD. When a person performs exercise greater than they are conditioned for, or if they are injured (for example, in an automobile accident), tiny fibers of muscle are torn. This leads to an inflammatory response on the part of the body, where white blood cells come to clean up the torn tissue, stimulate blood flow, etc. Pain is part of this reaction, because it is important not to continue using the muscle while we are healing - if we use it, we could tear more fibers. Unfortunately, we have a reflex that causes painful muscle to tighten up, which has the tendency to further injure the area.
Despite this fact, most people who stiffen up get better in a few days with rest, ice and/or heat, and some ibuprofen (e.g., Advil) or acetaminophen (e.g., Tylenol). Some people, however, don't get better. In fact, they may find themselves getting worse. What started off as a sore shoulder could spread to include the neck, back, arm, and even the entire body. These are people with MFD.
It appears that the basic problem in MFD is irritability in the pain-sensing cells of the spinal cord. When an injury occurs, long nerve fibers carry the pain sensation to cell bodies in the spinal cord, which process the information and send it on to the brain. These cell bodies have the ability to communicate with each other as well. When a person has MFD, this cell-to-cell communication in the spinal cord causes adjacent pain cells to become activated and feel pain themselves. As a result, the muscles associated with them become tight, irritated, and more painful. This further stimulates their nerve cells, which then communicate to the cells next to them, and so on. As a result, the effect spreads, causing more and more areas of the body to become involved.
Why do some people get MFD and not others?
While we are still learning about the causes MFD, and there are obviously many factors that remain to be identified, a number of things are known to be involved. It appears that many people have some sort of predisposing factor (technically called "perpetuating factors") that increases their tendency to get MFD and can interfere with their response to therapy. These can include other medical diseases, posture, repetitive overuse or injury, and psychological stresses. A fairly complete list is detailed below:
Postural Stresses
Lying down watching TV or reading
Prolonged immobility
Bent-forward slouching position
Slouch sitting position
Sitting w/o lumbar or back support
Sitting w/o feet touching the floor
Mechanical Stresses
Skeletal asymmetry
Joint dysfunction
Short upper arms
Muscle constriction
Misfitting furniture
Occupational Stresses
Too few breaks
Too little movement
Cross eye/hand dominance
Work station ergonomics
Physical demands
Dislike job
Family/Social Stresses
Loss of income
Medical expenses
Diminished capacity to care for home/children
Strained relationships
Decreased physical activity
Sleep Stresses
Sleeping on stomach
Sleeping w/ head extended
Sleeping w/ arms overhead
Pillow too high or low
Jaw clenching
Poor sleep from emotional factors
Poor sleep from pain
Psychological Stresses
Loss of independence
Loss of control
Depression
Irritability
Anxiety/fear
Post-traumatic stress disorder
Nutritional Stresses
Skipping meals
High carbohydrate diet
Suboptimal levels of vitamins/minerals
Food sensitivities
Caffeine, nicotine, alcohol
Medical Stresses
Low thyroid
Low blood sugar
Candida hypersensitivity syndrome
Chronic infections
Allergies
Chronic fatigue syndrome
Arthritis
Rheumatologic disease (rheumatoid arthritis, lupus, sarcoidosis, etc.)
Chronic illness from virtually any cause
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