Working Healthy

Learn the Facts About Chronic Myofascial Pain

Our job demands we bend over a desk with our head tilted for hours at a time. This stressful posture coupled with our repetitive motions put us at risk of developing chronic myofacial pain. This painful disease can be tough to diagnose and difficult to treat; the good news is you can take steps now to prevent it.

How many times have you found yourself tilting your head to the side and pinching your shoulders, or rubbing the muscles along your neck and back trying to reach the trapezoids? Do you often tilt your head as far back as it will go to relieve the tension in your neck? As nail techs, we could kvetch for hours, swapping stories of pain radiating from the neck to the lower back. It’s a negative byproduct of a great profession.

But are we powerless to change it? Is our only defense a few pain pills and an ice pack? The answer is a resounding no, but the beginning of the solution is the admission of the problem. We need to get past the idea that we can crunch over a desk for eight to 10 hours a day and be exempt from muscular pain in the neck, shoulders, middle back, and lower back. Our job requires that we have poor posture while we work, and filing, shaping, and polishing nails requires repetitive motion. These two factors make us prime candidates for aches and pains — which could lead to something far more serious if ignored.

After we admit our posture at work causes sore muscles, the next step is to find a treatment that counteracts (and hopefully prevents) the problem before tight muscles become a chronic and painful condition. Diana Pengitore is keenly aware of what happens when sore muscles advance into acute pain. A former nail tech from Virginia Beach, Va., Pengitore had to put down her brush after 15 years in the industry because of her pain. “I felt like a vice grip got a hold of me,” she says. Her condition was diagnosed as chronic myofascial pain (CMP).

CMP Defined

>In simplest terms, chronic myofascial pain means muscle pain. “Myo” means “muscle,” so literally CMP is pain in the soft fascia tissue that surrounds the muscles. The pain is created by trigger points that form within the layers of the fascia. Many conditions, including stress and surgery, can cause trigger points, but nail techs are at risk because of at least two factors: repetitive motion and poor posture.

Trigger points feel like knots or bumps on the muscles; however, the feeling of pain will not necessarily be at the location of the trigger point. This is known as referred pain, and is often the cause of misdiagnosis.

A Google search reveals many schools of thought about the treatment of CMP. Traditional MDs often recommend a muscle relaxer or some form of pain medication. Physical therapists recommend stretches; chiropractors advise overall physical health, including regular adjustment, stretching exercises, and diet. So who’s right? The answer is as varied as the individual who presents symptoms. Treatment also depends on how advanced the condition has become. However, one thing is clear: CMP is a painful, debilitating condition, and nail techs must do all we can to prevent it.

Make Changes Now

If you get nothing else from this article, please hear this: You are at risk. As a former nail tech of 15 years, I’ve seen dozens of women with the grimace of agony on their faces from the pain in their necks, shoulders, and lower backs. At 18 or 19 years old, you may bounce back from a 10-hour day more easily than us veterans in our 30s, but it’ll catch up to you. Small but consistent changes now will pay off later.

Dr. Lauren Brady is a chiropractor who practices in Endicott, N.Y. She has treated patients with slight myofascial pain and patients with chronic and acute myofascial pain. “It’s a self-promoting disease,” she says. “You’re in the same position for hours at a time. After a long day of work, you’re too tired to go home and exercise. Then you sleep on your side.” Dr. Brady says it is essential to counteract CMP, and to do so techs must develop a habit of daily extension exercises. “You are bent forward all day, not only from work, but also from stress and tension.” And don’t we know it. From racing the clock to stay on schedule to dealing with clients who are late, overbooked, or angry, techs can experience tension a number of times over the course of the day.

Dr. Brady describes the reason techs are especially susceptible to CMP. “Picture the spine,” she says. “A healthy spine, even when seated, should maintain the shape of an ‘S.’ But, because your job demands a certain posture,” she continues, “you turn your back into a ‘C.’” Because our muscles are stretched and flexed in this awkward position for extended periods of time, they begin to spasm.

For most techs, the minute the client leaves to wash her hands, we roll our shoulders around, drop our heads back to release our neck, arch our backs to try to find relief. Then, just as quickly, the client returns and so does our smile as we crunch back over the desk to polish.

This is all wrong, says Dr. Brady. “While stretching like this may cause temporary relief, it’s not enough. You need to strengthen those muscles.” She recommends a number of strengthening exercises to her patients, some of which we’ve included here. Dr. Brady suggests her patients do the exercises at the beginning and the end of each day.

Exercising to strengthen the muscles is a huge factor in preventing CMP, but Dr. Brady warns that prevention doesn’t end there. “It’s a multi-pronged approach,” she says. That means regular strengthening exercises, but also regular adjustments — even diet — as needed. Some foods, such as white sugar and red meats, can be inflammatory, she says. As in all of life, we need to look at the big picture.

CMP is caused by a lack of oxygen to parts of the muscles. To prevent CMP, we need to do all we can to send oxygen to the muscles. That means extending our shoulders back to open up our chest and rib cage, holding our head up correctly to allow oxygen an unobstructed airway, and treating our bodies well through diet and regular exercise so that it can work the way it should.

And because at work we are prevented from keeping our shoulders extended and our eyes level with the horizon, we must be proactive to reduce the painful consequences.

Symptoms Can Be Overlooked

Unfortunately, the symptoms of CMP are so common and so broad that many cases go undiagnosed for years.

After doing manicures and pedicures for eight hours a day over many years, Pengitore began to have earaches, headaches, and neck pain. So, she did what most of us would do and went to a medical doctor. The doctor told her there was nothing wrong with her ear. For her sore back and neck pain, she consulted a chiropractor, applied hot towels to the painful area, and got massages. The pain continued and worsened.

Finally, she found a professional trained in myofascial pain. She was told her earache came from muscles in her shoulders that were weak and in spasm. She received an injection of Lidocaine in her shoulder and the pain went away that day. But it returned.

The best defense against this painful condition is to form habits that help prevent it. Often the condition is advanced by the time someone seeks treatment. Because the symptoms are so common, they are easy to overlook. Because nail techs are prone to this type of pain, you should be especially aware of lingering or recurring pain. Aches in the morning, allergies, irritability, stiffness, headaches, fatigue, and anxiety are all symptoms of CMP.

Getting the Right Treatment

It’s important to remember that the location of pain is not the site of the trigger points. That often leaves sufferers frustrated when dealing with traditional doctors who more than likely will prescribe medicine for the pain. “It’s not a problem that needs muscle relaxers,” warns Pengitore.

If you suspect you have CMP, be sure to choose a professional who is trained in its treatment, and who believes it to be something more than a “waste basket” diagnosis. In the past, this condition was referred to as myofascial pain syndrome. It was considered a syndrome because, although patients complained of symptoms, they showed no objective evidence of disease.

After years of study, myofascial pain syndrome became known as chronic myofascial pain because trigger points were determined to cause the pain. Make sure the professional you seek —whether a chiropractor, a massage therapist, a physical therapist, or an MD — recognizes CMP as a problem and is educated on the cause and treatment.

The treatment includes the recommendations for prevention: exercises that build strength and increased oxygen to your muscles through extension stretches and daily exercise. But once you know you have CMP, you’ll need to work on those trigger points. This can be done in the early stages by picking up a book on trigger points and learning ways to treat yourself. Diana Pengitore highly recommends The Trigger Point Therapy Workbook by Clair Davies. The website (www.triggerpointbook.com) is highly informative as well, but the book provides illustrations and instructions on self-treatment.

A physical therapist, chiropractor, or massage therapist trained in CMP can provide a stretching and strengthening routine, which you can do as part of your daily therapy. The added benefit of choosing professional treatment over self-treatment is that professionals will be able to feel where the trigger points have tightened the muscles, and they will be able to use their thumbs, or an instrument, to release the trigger point. “The goal of any treatment,” says Pengitore, “is to desensitize and eliminate trigger points and then to strengthen the muscles.”

If your pain persists, you may need to be more aggressive in your treatment. After years of misdiagnosed pain, the only way Pengitore found relief was from a process called needling. With this treatment, a professional penetrates the skin with a needle and hits the trigger point directly. Pengitore describes the process as painful, but has found it to be the only treatment that offers her relief. “If I didn’t have needling, I would probably be in a wheelchair,” says Pengitore.

Treatment for CMP is ongoing. Pengitore does slow stretches daily, including lumbar stretches. She also continues to get dry needling treatments. “Chronic myofascial pain took years to develop, and it will take years to undue,” says Pengitore. “This probably could have been prevented by better posture and daily exercises. We need to get the word out.”

Resources

  • The Trigger Point Therapy Workbook by Clair Davies
  • www.triggerpointbook.com
  • www.istop.org (The Institute for the Study and Treatment of Pain)
  • www.painpoints.com (Pain and Rehabilitation Medicine)

     

    Michelle Pratt is a freelance writer and licensed nail tech based in Johnson City, N.Y.

  • Keywords:   ergonomics     healthy working  

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