Year : 2021 | Volume
: 11 | Issue : 4 | Page : 176--180
Finding the possible link between physical activities, dietary nutrients and health on myofascial pain syndrome
Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
Dr. Andrew Lalchhuanawma
C-47, Ramhlun Venglai, Aizawl - 796 001, Mizoram
Myofascial Pain Syndrome (MPS) is a general term indicating a widespread muscular pain that arises from the musculoskeletal system and showing the characteristics of trigger points. MPS is the primary cause of disability, and a common complaint among the working-class and the middle-aged population. It has been estimated to affect 25 million persons in the US alone, and three-fourths of the general population at some point in their lifetime. The various causative factors associated with this chronic muscular pain disorder are yet indecisive and still ambiguous. Up till now, the primary notion for the development of MPS occurs through mechanical trauma; either indirectly through chronic repetitive stress disorder as a result of overloading of muscle, or directly as a result of external force such as muscle contusion. Among other probable causes, lack of physical activities and dietary nutrient-associated conditions on health may too, be responsible for the development of MPS. Although there is a dearth of evidence and information to suggest the integrated role of physical activities and dietary nutrients on MPS; this study suggests the possible link between sedentary lifestyle-physical inactivity and nutritional deficiencies, and MPS. Food and nutrition, coupled with physical activity richly serve as the foundation for optimizing the overall health status. Eating the right food and staying physically active helps maintain a healthy body, reduces the overall risks of developing MPS and other associated chronic diseases such as cardiovascular diseases, hypertension, stroke and diabetes.
|How to cite this article:|
Lalchhuanawma A. Finding the possible link between physical activities, dietary nutrients and health on myofascial pain syndrome.Curr Med Res Pract 2021;11:176-180
|How to cite this URL:|
Lalchhuanawma A. Finding the possible link between physical activities, dietary nutrients and health on myofascial pain syndrome. Curr Med Res Pract [serial online] 2021 [cited 2021 Oct 22 ];11:176-180
Available from: http://www.cmrpjournal.org/text.asp?2021/11/4/176/324250
Myofascial Pain Syndrome (MPS) is a general term indicating a widespread muscular pain that arises from the musculoskeletal system and showing the distinctive characteristics known as trigger points., Myofascia refers to the skeletal muscle and the surrounding connective tissue sheath. The muscles and the skeletons that maintain the structural framework of the human body constitute the musculoskeletal system. MPS is characterised by a palpable nodule in a taut band of skeletal muscle fibre called myofascial trigger points. This soft tissue disorder is the primary cause of disability, and a common complaint among the working-class population, adults and the middle-aged in particular. It has been estimated to affect roughly 25 million persons in the US alone, and three-fourths of its general population at some point in their lifetime.,
MPS is a chronic, painful condition that arises from chronic overuse or repetitive syndrome. Muscle overuse (chronic repetitive stress) and muscle overload (sustained muscle contraction) are believed to be the most common causes of MPS. The various causative factors associated with this chronic muscular pain disorder are yet indecisive and still ambiguous. Up till now, the primary notion for the development of MPS occurs through mechanical trauma; either indirectly through chronic repetitive stress disorder as a result of overloading of muscle, or directly as a result of external force such as muscle contusion.,,, The clinical presentation of MPS includes hypersensitivity and irritability, muscle spasm, limited range of movement and muscle weakness. Sustained muscle contraction, spasm or shortening of muscle fibre occurs as a consequence of localised energy crisis a deficit of adenosine-triphosphate, which in turn, may predispose to myofascial trigger points.,,
There is a dearth of evidence and information to suggest the integrated role of physical activity and dietary nutrients on MPS. The possible underlying mechanisms that may predispose to the development of MPS include the following: When there is an injury to a muscle or soft tissue as a result of several predisposing factors like traumas, mechanical stressors, lifestyles or nutritional deficiencies, energy crisis occurs which gives rise to local ischemia and hypoxia at the affected muscle.,, Disturbances in the ionic concentration of Ca+ channel cause an enormous release of acetylcholine at the motor endplates. The increased biochemical activity at the motor endplates enables the release of pro-inflammatory mediators. Substance P and histamines are indirectly responsible for the onset of muscle pain and tenderness by promoting inflammation and vasodilation.,
Among other probable causes, lack of physical activities and dietary nutrients-associated conditions on health may too, may also be responsible for the development of MPS. This study suggests the possible link between sedentary lifestyles-physical inactivity and nutritional deficiencies and health with MPS. Numerous studies have shown relationships between physical inactivity (sedentary lifestyle) and nutritional deficiency (certain vitamins and minerals) with chronic myofascial pain.,,,,, According to the WHO (2018), insufficient physical activity, and an unhealthy diet play a pivotal role in non-communicable diseases and other chronic conditions such as hypertension, stroke, type-2 diabetes and cancer. An individual with a sedentary lifestyle consisting of physical inactivity, poor nutrition, tobacco use and consumption of alcohol all increase the risk of morbidity and mortality from non-communicable diseases.
Role of Physical Activities and Health on Myofascial Pain Syndrome
Physical activity, according to the World Health Organization (WHO) is defined as any bodily movement produced by skeletal muscles that require energy expenditure. Physical inactivity or lack of physical activity is one of the leading risk factors for global mortality, which is accountable for 6% of deaths worldwide. Besides, physical inactivity is the key risk factor for developing chronic diseases such as diabetes, hypertension, coronary heart disease, stroke, breast and colon cancer. According to the American Heart Association, there is a direct correlation between physical inactivity and cardiovascular mortality. In addition, physical activity improves the mineralization of bone and the overall functional health by maintaining a healthy weight.
Physical activity involves an exercise in addition to other recreational activities that require the use of energy for producing skeletal muscle contraction. Exercise is a sub-category of physical activity, it is planned, structured, repetitive and purposeful to improve or maintain physical fitness. Research shows that a physically active individual increases the longevity of life by up to 40% than those who are less physically active. Physically inactive individuals are at risk for developing obesity and obesity-associated co-morbidities, for instance, chronic diseases like cardiovascular disorders and diabetes in particular, which have earlier been discussed. Physical inactivity, due to the consequence of physical pain is another causative factor for individuals to gain weight. A person is physically active by doing at least a moderate-intensity physical activity.
The WHO (2020) recommended moderate and vigorous-intensity aerobic physical activities, for healthy adults aged between 18 and 64 years. Moderate-intensity includes brisk/leisurely walking, slow swimming/bicycling or dancing and gardening. Vigorous-intensity includes jogging, fast walking/bicycling and strenuous dancing/gardening. At least 150 min of moderate-intensity and a minimum of 75 min of vigorous-intensity aerobic physical activities throughout the week are recommended. The intensity of moderate and vigorous physical activities could further be increased up to 300 and 150 min per week respectively for supplementary health benefits., A physically active individual ensures a healthy relationship between the basic components of the musculoskeletal system to ease the activities of daily living. Research shows that at least a moderate-intensity aerobic physical activity delayed the loss of bone density, of the degenerative process involved in aging.
The musculoskeletal system of the human body is comprised of the bones, joints, bursae, ligaments, tendons and skeletal muscles. These essential components provide the structural framework, enable bodily movement in space, and provide postural stability. The interdependency of all these structures of the musculoskeletal system provides the basis for proper functioning and control of motion. The movement of the skeletal muscle is controlled by the central nervous system in response to various stimuli. Dysfunction in any components of the musculoskeletal system is reflected in the muscle tone and contraction, muscle balance, coordination and performance. Changes in the quality of the muscular system result in altered joint mechanics leading to pain and dysfunction. Muscle imbalance occurs as a result of altered relationships between dynamic muscles and postural muscles.,
Skeletal muscles of the human body can be generally grouped into two; dynamic and postural muscles. Dynamic muscles are activated with bodily movements, or when the body is in dynamic motion like walking, running, jumping, and are relatively inhibited when the body is in a static posture like sitting, standing, sleeping. Rhomboids and gluteus medius are examples of dynamic muscles. Whereas, postural muscles like scalene and quadratus lumboram are activated when the body is in a static posture, and are relatively inhibited when the body is in dynamic motion.,
An individual with a sedentary lifestyle spends most of the time in a static posture, rather than in dynamic posture. As a consequence of physical inactivity, dynamic muscles are relatively inhibited and become increasingly slack, whereas postural muscles are relatively tense and become tauter. The shortening of skeletal muscle fibres concerning changes in visco-elastic properties results in an increased muscle tone. Taut bands are formed within the muscle fibres and the adjacent fascia, necessary precursors for the development of myofascial trigger points. A chronic imbalance progressively develops between dynamic and postural muscles. Sedentary lifestyles or lack of physical activities increased the risks for MPS.,
Role of Dietary Nutrients and Health on Myofascial Pain Syndrome
One of the benefits of a healthy diet and physical activity is the reduction of risks of obesity. Obesity is a major risk factor for several serious medical conditions, and the co-morbidities of obesity include several non-communicable diseases such as cardiovascular diseases, type-2 diabetes and stroke. The daily intake of at least 400 g of fruits and vegetables reduces the risks of non-communicable diseases. In the adult population, the risks for non-communicable diseases can be significantly lowered and controlled. An unhealthy weight gain can be prevented by reducing the number of total fats and saturated fats intake to 30% and 10% respectively from the total energy intake.,
Intake of salt greater than the recommended 5 g/day increased the risks for hypertension and vascular disease. An estimated 1.7 million annual deaths could be prevented by reducing the daily average salt consumption. Potassium insufficiency contributed to hypertension, which could be increased by consuming derived fruits and vegetables. An unhealthy weight gain could be prevented by limiting the excess intake of free sugars (10% of total energy intake or 50 g daily for healthy individuals consuming 2000 calories), which contribute to obesity.,
Obesity plays a significant role in the development of myofascial pain and accounts for more than half of the total population among obese individuals. Studies have shown a significant correlation between obesity and physical pain. In contrary to obesity causing musculoskeletal conditions, physical pain in conjunction with physical inactivity leads to obesity. Obesity increases the risks of dysfunction in the structural components of the musculoskeletal system. The subsequent change in the structural and mechanical kinesiology of the body contributes to osteoarthritis, low back pain and myofascial pain. Vitamin D insufficiency is found to be more prevalent among the obese and female population.,
In a study conducted by Simons, the possible causative factors of MPS concerning nutritional deficiencies were determined. He further emphasised the importance of these nutrients and concluded that half of his patients require vitamin resolution. The water-soluble vitamins like B-complex vitamins (Vitamin B6 and B12, folic acid), Vitamin C, and minerals (iron, potassium, calcium, magnesium) are nutrients to be considered in patients with myofascial pain., The linkage between Vitamin B6 or pyridoxine and MPS can be attributable to its role in energy metabolism and normal brain function. Vitamin B6 is essential for the normal functioning of the nervous system, formation of red blood cells and helps maintain sodium-potassium balance., Vitamin B12 or cobalamin is essential for the production of red blood cells and functions of the brain cells by promoting neurotransmitters that assist in intellectual learning and memory. Lack of Vitamin B12 could lead to muscle pain susceptible to form myofascial trigger points, generalised muscle fatigue, and weakness., Folic acid in conjunction with cobalamin is required for the synthesis of nucleic acids-deoxyribonucleic acid and ribonucleic acid. It plays a key role in the energy proliferation of red blood cells, functions of the nervous system, and the brain. Deficiency of folic acid can cause myalgia or muscle pain susceptible to form myofascial trigger points, generalised muscle weakness, fatigue and irritability.,
Vitamin C or ascorbic acid is essential for the synthesis of neurotransmitters and prevents post-exercise muscle soreness. Insufficiency of Vitamin C could cause muscle weakness and fatigue, joint and muscle pain., Inadequacy of Vitamin D has been linked with musculoskeletal pain, poor bone mineralization may lead to achiness of the joints and muscles. Iron plays a vital role in the oxygenation and proliferation of red blood cells-haemoglobin and myoglobin. The deficiency of iron decreases the oxygen transport to the muscles, affects the energy production which results in muscle fatigue and weakness susceptible to cause myofascial pain. The role of sodium in the sodium-potassium pump is highly recognised as it relates to the response of muscle contraction, and its deficiency can cause spasm and weakness of the muscle. Potassium deficiency may lead to generalised muscle weakness and fatigue. Calcium is essential for the growth and contraction of muscles, and its deficiency can lead to achiness of the joints and muscles. Deficiency of magnesium can also be associated with chronic muscle pain, myalgia and fatigue.,,,,
Food and nutrition, along with physical activity are the basis for optimizing the overall health status, thus, richly served as the basic foundation of our lives. Food rich in nutrients optimizes the overall health condition and reduced the risks of serious health illnesses and chronic diseases. Nutrition is the science of food that lays the foundation for healthy living. A balanced diet maintains a healthy body or controls body weight by eating the right food rich in nutrients. Both nutrition and physical activity play a crucial role in the management and control of body weight. The level of caloric food intake should not exceed that of the number of calories burnt, subsequently an individual gains weight when it is sustained for a long period.
For maintaining a healthy body weight, eating the right foods coupled with physical activity are the outstanding domain for weight management. It has been observed that a physically active individual increases the longevity of life as compared to an inactive person. Physical activity not only decreases the morbidity but also reduced the risks of premature mortality in individuals with chronic diseases. Physical activity prevents serious illnesses and chronic diseases such as high blood pressure, high cholesterol and diabetes. Regular physical activity maintains the structural integrity and provides interdependency of all the structures and components of the musculoskeletal system.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
|1||Hong CZ, Hsueh TC. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil 1996;77:1161-6.|
|2||Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth 1997;22:89-101.|
|3||Simons DG, Travell JD, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual. The Upper Half of the Body. 2nd ed., Vol. 1. Baltimore MD: Williams and Wilkins; 1999.|
|4||Cole TM, Edgerton VR. Musculoskeletal Disorders. (Report of the Task Force on Medical Rehabilitation Research, 28-29, June 1990). Bethesda: National Institutes of Health; 1990. p. 61-70.|
|5||Imamura ST, Fischer AA, Imamura M, Teixeira MJ, Lin TY, Kaziyama HS, et al. Pain management using myofascial approach when other treatment failed. Phys Med Rehabil Clin N Am 1997;8:179-96.|
|6||Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010;11:32.|
|7||Barros-Neto JA, Souza-Machado A, Kraychete DC, Jesus RP, Cortes ML, Lima MS, et al. Selenium and zinc status in chronic myofascial pain: Serum and Erythrocyte concentrations and food intake. PLoS One 2016;11:e0164302.|
|8||Rachlin ES. Myofascial Pain and Fibromyalgia: Trigger Point Management. St. Louis: Mosby Inc; 1994. p. 145-57.|
|9||Gerwin RD. Perpetuating factors. In: Simons DG, Travell JG, Simons LS, editors. Myofascial Pain and Dysfunction: The Trigger Point Manual Upper Half of Body. 2nd ed. Baltimore: Williams and Wilkins; 1999. p. 178-228.|
|10||Simons DG. Clinical and etiological update of myofascial pain from trigger points. J Musculoskel Pain 1996;4:93-121.|
|11||Shah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 2005;99:1977-84.|
|12||Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther 2008;12:371-84.|
|13||Travell JG, Simons DG. The lower extremities. In: Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed., Vol. 2. Philadelphia: Lippincott Williams and Wilkins; 1992.|
|14||Yap EC. Myofascial pain – An overview. Ann Acad Med Singap 2007;36:43-8.|
|15||Cyrus IA. Nutrition and Myofascial Pain Management. Available from: http://eastasianmed.com/pdf/Nutrition_MyofascialPain.pdf. [Accessed 30 July 2021].|
|16||Lalchhuanawma A. Myofascial Pain Syndrome: Physical Activity, Nutrition and Health. American Journal of Sports Science and Medicine 2019;7(1):20-2.|
|17||World Health Organization. Physical Activity; 2018. Available from: http://www.who.int/news-room/fact-sheets. [Accessed 30 July 2021].|
|18||Centers for Disease Control and Prevention. Physical Activity and Health; 2018. Available from: https://www.cdc.gov/physical activity/ basics/pa-health/index.htm. [Accessed 30 July 2021].|
|19||American Heart Association. Recommendations for Physical Activity in Adults; 2017. Available from: http://www.heart.org/HEARTORG/ HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults. [Accessed 30 July 2021].|
|20||Pereira-Santos M, Costa PR, Assis AM, Santos CA, Santos DB. Obesity and vitamin D deficiency: A systematic review and meta-analysis. Obes Rev 2015;16:341-9|
|21||Okifuji A, Bradford DH. The association between chronic pain and obesity. J Pain Res 2015;8:400-8.|
|22||Janda V. Muscle Function Testing. London: Butterworths; 1983.|
|23||World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series, No. 916. Geneva: World Health Organization; 2003. Available from: https://www.who.int/diet-physical-activity/ publications/trs916/en/. [Last accessed on 2021 Jul 30].|
|24||Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD. Effect of reducing total fat intake on body weight: Systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 2012;345:e7666.|
|25||Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med 2014;371:624-34.|
|26||World Health Organization. Sugar Intake for Children and Adults. Guideline. Geneva: World Health Organization; 2015. Available form: https://www.who.int/publications/i/item/9789241549028. [Last accessed on 2021 Jul 30].|
|27||The American Academy of Manual Medicine. Myofascial Trigger Point Perpetuating Factor: Nutritional Deficiencies. Available from: http://www.webmanmed.com/triggerpt.html#tppf. [Last accessed on 2021 Jul 30].|