Feeling like you are walking
around in a heavy wet suit? Muscles
just don't move the way you want
them to and tire out easily? A new
study looking at relieving the knotted,
ropy muscles found in all
fibromyalgia (FM) patients offers an
explanation.
Even when these firm knots aren't
being touched, they hurt. Naturally,
many patients reach for soothing gels
and topical roll-ons in search of relief,
but do any of them really help? Five
of the most common were tested in
patients with neck and shoulder pain
to give you an idea of which ones are
worth a try.
Muscles Work in Pairs
For every muscle that contracts,
there is an opposite muscle that
relaxes. Muscles, or sometimes
muscle groups, work in pairs to give
you more coordinated movement. The
nerves that branch out from your
spinal cord tell one muscle in a pair to
contract, while electrical signals to the
opposite muscle should cease—
forcing it to simultaneously relax.
A Denmark team headed up by
Hong-You Ge, M.D., Ph.D., found
when one muscle had a myofascial
trigger point (MTP), or what you feel
as a rope-like knot, the opposite
muscle doesn't completely relax. He
only looked at what are considered
"latent" or baby-sized MTPs known to
interfere with muscle function, but
they don't actually cause nonstop pain
like the active MTPs found in F M
patients.
Ge and others have already shown
that most of the 18 tender points are
actually pain-generating, active
MTPs. Not surprisingly, MTPs tend
to be concentrated in the muscles that
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get the most use, which happens to be
in the neck, shoulders, forearms, back,
and hips. When the contracting
muscle harbors an MTP, Ge found the
opposite muscle still gets a partial
signal, preventing it from fully
relaxing. Even when muscles in a pair
are supposed to be resting, they are
both "buzzing" with too much electrical activity. This is why studying
MTPs is so essential for a better
understanding of physical function in
people with F M .
"Muscles harboring latent MTPs
may result in delayed and incomplete
muscle relaxation following exercise,
disordered fine movement control,
unbalanced muscle activation, and
sustained muscle overload," states Ge.
In other words, if you feel wired with
tension and your muscles are tuckered
out before noon, this study offers
proof.
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Effective Topicals
Topical analgesics, such as painrelieving gels or roll-ons applied to
the skin over MTPs are also being
studied. The effectiveness of three
gels and two roll-ons were tested
against a placebo gel in a trial by
Daniel Avrahami, D.C., of Toronto,
Canada.
Moist heat, such as a hot bath (see
page 10) can help relax sore muscles,
reducing the painful impact of MTPs,
but this form of therapy is not always
convenient. Massages can be great for
rubbing out the tension of tight
muscles, but weekly visits to a masseuse can add up. Oral medications
may help in this area, such as muscle
relaxants, but they can leave you
feeling a bit loopy. So the next best
medicine may be a topical that absorbs through the skin, hopefully deep
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Spring 2012.
enough to reduce muscle pain.
Every drugstore has dozens of
topicals, and many others are sold
online or distributed by healthcare
providers. Although Avrahami's study
was small (only 20 pain patients per
group), it's a start.
A l l subjects had one M T P treated
in either their neck or shoulder area.
Their pressure pain threshold was
measured before a topical was rubbed
into the area (everyone wore nose
plugs and no one knew which topical
was applied). A n increase in pressure
pain thresholds, signifying an objective improvement in pain, was the
greatest for Professional Therapy
Muscle Care roll-on, followed by
Bengay Ultra Strength Muscle Pain
ointment. Biofreeze, Icy Hot Extra
Strength cream, and Motion Medicine
did no better than the placebo gel.
Professional Therapy Muscle Care
roll-on contains Eucalyptus oil,
thought to improve the penetration of
its active ingredients, which may be
why it worked the best. It also contains glucosamine sulfate, chondroitin
sulfate, dimethyl sulfoxide and
Boswellia extract, believed to
improve circulation and reduce
inflammation. This roll-on is $17 for
3 oz. and Bengay is $7 for 4 oz.
These two over-the-counter products
can be a solution for reducing MTP
pain, but patients should use multiple
approaches for best results (i.e., heat,
massage, and other physical or handson therapies).
GND
1.
2.
3.
4.
Ibarra J M . et al. J Pain 12:1282-8. 2011.
Ge HY. et al. J Pain 11:644-51. 2010.
Ge HY, et al. Arthritis Res Ther 13:R48, Mar
22, 2011.
Avrahami D , et al. Chiropr Man Ther 20:7,
Mar 21, 2012.