Reframing myofascial pain syndrome: pathological disorder or adaptive protective response?

Abstract

Myofascial pain syndrome (MPS) is one of the most common causes of chronic pain. It is characterized by trigger points (TrPs) that are located within palpable taut bands (TBs) in muscles and their fascial structures. Traditionally, this clinical condition has been regarded as a dysfunction of the musculoskeletal system, commonly associated with mechanical overload, such as acute strain, repetitive movements, and/or abnormal posture holding. However, the intrinsic mechanisms underlying its development remain a subject of debate. This review proposes a paradigm shift: to consider MPS as a physiological protective response rather than a pathological disorder. From this perspective, the TrP-TB complex may represent a dual contributor to structural and functional protection. On the one hand, it might limit potentially harmful movements through local and segmental sensitization mechanisms. On the other hand, it could enhance joint stability by increasing the tension of the muscle fibers that form the TB and its intramuscular connective tissue, potentially augmenting proprioceptive input. This new perspective offers a revised conceptual framework in which phenomena traditionally interpreted as purposeless manifestations of painful dysfunction may instead be understood as defensive and/or compensatory responses. Such a perspective both broadens understanding of MPS and may encourage the development of treatment protocols that go beyond classical techniques, which focus mainly on inactivating TrPs and managing pain. This new perspective suggests incorporating strategies to modulate load, perform functional training, and address both peripheral and central sensitization within a comprehensive, multilevel framework. Ultimately, this perspective may help achieve more durable and sustainable therapeutic outcomes, possibly contributing to a reduction in the prevalence of pain-related disability associated with MPS.