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Bingölbali Ö, Taşkaya C, Alkan H, Altındağ Ö. The effectiveness of deep tissue massage on pain, trigger point, disability, range of motion and quality of life in individuals with myofascial pain syndrome. Somatosens Mot Res 2024; 41:11-17. [PMID: 36645811 DOI: 10.1080/08990220.2023.2165054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims to examine the effect of deep tissue massage (DTM) on the myofascial trigger point (MTrP) number, neck range of motion (ROM), pain, disability and quality of life in patients with Myofacial pain syndrome (MPS). METHODS The study involved patients with MPS between the ages of 20-57. The patients were randomly divided into two groups: the control group (n = 40) and the study group (n = 40). Transcutaneous Electrical Neuromuscular Stimulation (TENS), hotpack and ultrasound were applied to 40 patients in the control group. The study group was also administered DTM for 12 sessions in addition to TENS, hotpack and ultrasound applications. Neck pain and disability scale (NPDS) for a neck disability, universal goniometer for neck ROM, MTrP count using manual palpation, Short Form 36 (SF-36) for quality of life and severity of neck pain were evaluated using a visual analog scale (VAS). All patients were evaluated before and after treatment. RESULTS It was found that the DTM group has statistically more improvement than the control group for VAS, NPDS and SF-36. Moreover, although there was a significant improvement in favour of the study group for extension, lateral flexion, right rotation and left rotation in the neck ROM, there was no significant difference in flexion measurements between the study and control group. CONCLUSION In addition to the traditional rehabilitation program, DTM is effective on neck ROM, pain, disability and quality of life. Therefore, DTM treatment is a safe and inexpensive treatment method that can be applied in patients with MPS.
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Affiliation(s)
- Ömer Bingölbali
- Department of Health Care Services, Health Services Vocational School, Muş Alparslan University, Muş, Turkey
| | - Cengiz Taşkaya
- Department of Health Care Services, Health Services Vocational School, Muş Alparslan University, Muş, Turkey
| | - Halil Alkan
- Department of Physiotherapy and Rehabilitation, Muş Alparslan University, Muş, Turkey
| | - Özlem Altındağ
- Department of Physical Medicine and Rehabilitation Gaziantep, Gaziantep University, Gaziantep, Turkey
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Gross AR, Lee H, Ezzo J, Chacko N, Gelley G, Forget M, Morien A, Graham N, Santaguida PL, Rice M, Dixon C. Massage for neck pain. Cochrane Database Syst Rev 2024; 2:CD004871. [PMID: 38415786 PMCID: PMC10900303 DOI: 10.1002/14651858.cd004871.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Massage is widely used for neck pain, but its effectiveness remains unclear. OBJECTIVES To assess the benefits and harms of massage compared to placebo or sham, no treatment or exercise as an adjuvant to the same co-intervention for acute to chronic persisting neck pain in adults with or without radiculopathy, including whiplash-associated disorders and cervicogenic headache. SEARCH METHODS We searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Chiropractic Literature, trial registries) to 1 October 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any type of massage with sham or placebo, no treatment or wait-list, or massage as an adjuvant treatment, in adults with acute, subacute or chronic neck pain. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We transformed outcomes to standardise the direction of the effect (a smaller score is better). We used a partially contextualised approach relative to identified thresholds to report the effect size as slight-small, moderate or large-substantive. MAIN RESULTS We included 33 studies (1994 participants analysed). Selection (82%) and detection bias (94%) were common; multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding to the placebo was effective. Massage was compared with placebo (n = 10) or no treatment (n = 8), or assessed as an adjuvant to the same co-treatment (n = 15). The trials studied adults aged 18 to 70 years, 70% female, with mean pain severity of 51.8 (standard deviation (SD) 14.1) on a visual analogue scale (0 to 100). Neck pain was subacute-chronic and classified as non-specific neck pain (85%, including n = 1 whiplash), radiculopathy (6%) or cervicogenic headache (9%). Trials were conducted in outpatient settings in Asia (n = 11), America (n = 5), Africa (n = 1), Europe (n = 12) and the Middle East (n = 4). Trials received research funding (15%) from research institutes. We report the main results for the comparison of massage versus placebo. Low-certainty evidence indicates that massage probably results in little to no difference in pain, function-disability and health-related quality of life when compared against a placebo for subacute-chronic neck pain at up to 12 weeks follow-up. It may slightly improve participant-reported treatment success. Subgroup analysis by dose showed a clinically important difference favouring a high dose (≥ 8 sessions over four weeks for ≥ 30 minutes duration). There is very low-certainty evidence for total adverse events. Data on patient satisfaction and serious adverse events were not available. Pain was a mean of 20.55 points with placebo and improved by 3.43 points with massage (95% confidence interval (CI) 8.16 better to 1.29 worse) on a 0 to 100 scale, where a lower score indicates less pain (8 studies, 403 participants; I2 = 39%). We downgraded the evidence to low-certainty due to indirectness; most trials in the placebo comparison used suboptimal massage doses (only single sessions). Selection, performance and detection bias were evident as multiple trials had unclear allocation concealment, utilised a placebo that may not be credible and did not test whether blinding was effective, respectively. Function-disability was a mean of 30.90 points with placebo and improved by 9.69 points with massage (95% CI 17.57 better to 1.81 better) on the Neck Disability Index 0 to 100, where a lower score indicates better function (2 studies, 68 participants; I2 = 0%). We downgraded the evidence to low-certainty due to imprecision (the wide CI represents slight to moderate benefit that does not rule in or rule out a clinically important change) and risk of selection, performance and detection biases. Participant-reported treatment success was a mean of 3.1 points with placebo and improved by 0.80 points with massage (95% CI 1.39 better to 0.21 better) on a Global Improvement 1 to 7 scale, where a lower score indicates very much improved (1 study, 54 participants). We downgraded the evidence to low-certainty due to imprecision (single study with a wide CI that does not rule in or rule out a clinically important change) and risk of performance as well as detection bias. Health-related quality of life was a mean of 43.2 points with placebo and improved by 5.30 points with massage (95% CI 8.24 better to 2.36 better) on the SF-12 (physical) 0 to 100 scale, where 0 indicates the lowest level of health (1 study, 54 participants). We downgraded the evidence once for imprecision (a single small study) and risk of performance and detection bias. We are uncertain whether massage results in increased total adverse events, such as treatment soreness, sweating or low blood pressure (RR 0.99, 95% CI 0.08 to 11.55; 2 studies, 175 participants; I2 = 77%). We downgraded the evidence to very low-certainty due to unexplained inconsistency, risk of performance and detection bias, and imprecision (the CI was extremely wide and the total number of events was very small, i.e < 200 events). AUTHORS' CONCLUSIONS The contribution of massage to the management of neck pain remains uncertain given the predominance of low-certainty evidence in this field. For subacute and chronic neck pain (closest to 12 weeks follow-up), massage may result in a little or no difference in improving pain, function-disability, health-related quality of life and participant-reported treatment success when compared to a placebo. Inadequate reporting on adverse events precluded analysis. Focused planning for larger, adequately dosed, well-designed trials is needed.
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Affiliation(s)
- Anita R Gross
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Haejung Lee
- Department of Physical Therapy, Silla University, Busan, Korea, South
| | - Jeanette Ezzo
- Research Director, JME Enterprises, Baltimore, Maryland, USA
| | - Nejin Chacko
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Geoffrey Gelley
- Applied Health Sciences PhD Program, University of Manitoba, Winnipeg, MB, Canada
- Integrative Medicine, University of Manitoba, Winnipeg, Canada
| | - Mario Forget
- Canadian Forces Health Services Group | Groupe de services de santé des Forces Canadiennes, National Defense | Défense Nationale, Kingston, Canada
| | - Annie Morien
- Research Department, Florida School of Massage, Gainesville, FL, USA
| | - Nadine Graham
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Pasqualina L Santaguida
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Craig Dixon
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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Sadeghnia M, Shadmehr A, Mir SM, Hadian Rasanani MR, Jalaei S, Fereydounnia S. The immediate effects of deep transverse friction massage, high- power pain threshold ultrasound and whole body vibration on active myofascial trigger points. J Bodyw Mov Ther 2023; 36:165-170. [PMID: 37949555 DOI: 10.1016/j.jbmt.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 06/08/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The most important clinical problem in myofascial pain syndrome (MPS) is trigger points (TrPs). The aim of the present study was to investigate the comparison of immediate effect of deep transverse friction massage (DTFM), high-power pain threshold ultrasound (HPPTUS), and whole body vibration (WBV) on treatment of active myofascial trigger points (MTrPs). MATERIALS AND METHODS sixty six men with active TrPs of upper trapezius muscle were randomly divided into three equal groups: DTFM, HPPT US, and WBV. Pain intensity based on the Visual Analogue Scale (VAS), pressure pain threshold (PPT) and active contralateral lateral flexion range of motion (CLF ROM) of the neck were evaluated before and immediately after the interventions. RESULTS The VAS, PPT and the active CLF ROM were substantially improved after intervention in all groups (P < 0.01). When the three groups were compared regarding VAS, participants in the WBV group reported significantly more reduction in pain (P < 0.01). On comparing the interventions, there were no significant differences in PPT values (P > 0.05). The CLF ROM value in HPPTUS and WBV groups have significant increase in comparison to the DTFM group. CONCLUSION All three interventions can improve neck pain, PPT and ROM in participants with active TrPs in upper trapezius muscle, but due to the fact that the DTFM has more pressure on therapist fingers, and the HPPTUS technique requires proper interaction with the participants, WBV can be used as one of the effective intervention on active MTrPs of upper trapezius. CLINICAL TRIAL REGISTRATION NUMBER IRCT20200518047498N1.
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Affiliation(s)
- Mehrdad Sadeghnia
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shadmehr
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohsen Mir
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shohreh Jalaei
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Fereydounnia
- Physical Therapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Azhdari N, Kamali F, Vosooghi O, Petramfar P, Rahimijaberi A. The effect of manual therapies on tension-type headache in patients who do not respond to drug therapy: a randomized clinical trial. J Man Manip Ther 2023; 31:246-252. [PMID: 36052499 PMCID: PMC10324431 DOI: 10.1080/10669817.2022.2107446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUNDS Tension-Type Headache (TTH) is one of the most common types of headache. In patients with TTH, manual therapy can be used to treat myofascial pain. OBJECTIVES This study aimed to evaluate the effect of manual therapy on TTH in patients who did not respond to drug therapy. METHODS A total of 24 patients with TTH were randomly enrolled into this prospective trial. The participants were divided into an intervention and a control group. The intervention group received the common medication and manual therapy, while the control group only received the common medication. Headache pain intensity, frequency, and duration, tablet count, and Neck Disability Index (NDI) were measured in both groups before, after, and one week after the intervention. RESULTS There were significant differences between the two groups (treatment, control) regarding pain intensity (3.04, 6.75, P = 0.0001; effect size (ES) = 1.85), headache frequency (2.33, 5, P = 0.004; ES = 1.48) and duration (91.29, 284.74, P = 0.002; ES = 1.48), tablet count (1.83, 4.91, P = 0.01; ES = 1.04), and NDI (7.33, 20.16, P = 0.003; ES = 1.37). Within group differences were recorded in intervention group only for all dependent variables immediately after intervention and one week after the intervention (p < 0.05). CONCLUSION Manual therapy reduced headache pain intensity, frequency and duration, tablet count, and NDI score in patients with TTH.
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Affiliation(s)
- Negar Azhdari
- PhD Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Vosooghi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payman Petramfar
- Department of Neurology, School of Medicine Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimijaberi
- Department of Neurology, School of Medicine Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Lee S, Moon H, Ryu Y, Lee IS, Chae Y. Sensory and emotional responses to deep pressure stimulation at myofascial trigger points: a pilot study. Front Neurosci 2023; 17:1197302. [PMID: 37483352 PMCID: PMC10360180 DOI: 10.3389/fnins.2023.1197302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Although manual pressure, such as that used during a massage, is often associated with pain, it can simultaneously be perceived as pleasant when applied to certain body areas. We hypothesized that stimulation of myofascial trigger points (TPs) leads to simultaneous pain and pleasure. TPs are hyperirritable points located in the taut band of the skeletal muscle. Method In this study, we measured the muscle tone, muscle stiffness, and pressure pain threshold of TPs and control points in the left brachioradialis muscle of 48 healthy participants. We also applied deep compression to the two points and collected subjective data on pain, pleasantness, unpleasantness, and relief. Result Greater muscle stiffness was observed in the TPs versus control points (t = 6.55, p < 0.001), and the pain threshold was significantly lower in the TPs (t = -6.21, p < 0.001). Unpleasantness ratings after deep compression were significantly lower in the TPs compared with control points (t = -2.68, p < 0.05). Participants experienced greater relief at the TPs compared with control points (t = 2.01, p < 0.05), although the perceived pain did not differ between the two types of points. Conclusion We compared the properties of TPs and control points, and found that deep compression at TPs was associated with higher muscle tone and stiffness, lower unpleasantness ratings, and higher relief ratings compared with the control points. These findings suggest that, at least for some TPs, pain and pleasantness are simultaneously elicited by deep pressure stimulation.
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Affiliation(s)
- Seoyoung Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Heeyoung Moon
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Yeonhee Ryu
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - In-Seon Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
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Rajan AP, Gurudut P. Gross myofascial release of trunk with leg pull technique on low back pain with radiculopathy - A randomised controlled trial. Hong Kong Physiother J 2023; 43:61-71. [PMID: 37584046 PMCID: PMC10423682 DOI: 10.1142/s1013702523500087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/21/2023] [Indexed: 08/17/2023] Open
Abstract
Background Lower Back Pain (LBP) with radiculopathy is a potentially more serious form of mechanical low back pain. A paucity of literature exists about the effect of the gross myofascial release (MFR) technique on the management of LBP. Objective The study aimed to evaluate the effect of gross MFR when given as an adjunct to conventional physical therapy in subjects with low back pain with radiculopathy. Methods Forty subjects (n = 40 ) clinically diagnosed with LBP with radiculopathy were enrolled and randomly allocated to either the control group (n = 20 ) or the experimental group (n = 20 ). Both study groups received 5 sessions of intervention. The control group received conventional physical therapy while the experimental group received gross MFR of the trunk and lower limb along with conventional physical therapy. The outcome measures included were pressure pain threshold for the lower back and lower extremity, lumbar flexion and extension range of motion (ROM), percentage disability, and patient satisfaction towards the treatment which were measured pre-intervention (day 1) and post-treatment (day 5). The interaction between group and time was analysed using two-way mixed ANOVA. Results The results suggested that the experimental group was statistically significant over the control group in terms of pressure pain threshold in the lower back (p < 0 . 001 ) and lower limb (p = 0 . 003 ), disability (p < 0 . 001 ), and patient satisfaction (p = 0 . 034 ) and lumbar flexion (p = 0 . 002 ) except lumbar extension ROM (p = 0 . 973 ). Conclusion When given as an adjuvant to conventional physical therapy, gross myofascial release proved to provide a significant and faster short-term improvement over conventional treatment alone in subjects diagnosed with low back pain with radiculopathy.
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Affiliation(s)
- Abey P Rajan
- Department of Orthopaedic Physiotherapy KLE Institute of Physiotherapy Belagavi 590010, Karnataka State, India
| | - Peeyoosha Gurudut
- Department of Orthopaedic Physiotherapy KLE Institute of Physiotherapy Belagavi 590010, Karnataka State, India
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Xu A, Huang Q, Rong J, Wu X, Deng M, Ji L. Effectiveness of ischemic compression on myofascial trigger points in relieving neck pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2023:BMR220045. [PMID: 36872769 DOI: 10.3233/bmr-220045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Ischemic compression is widely used to clinically treat neck pain. However, no meta-analysis has been conducted to evaluate the effects of this process on neck pain. OBJECTIVE This study aimed to evaluate the effects of ischemic compression on the myofascial trigger points for improving neck pain-related symptoms (mainly pain, joint mobility limitation and function limitation) and to compare ischemic compression with other therapies. METHODS Electronic searches were conducted in PubMed, OVID, Web of Science, EBSCO, SCOUPS, Cochrane Library, PEDro, Wanfang, CNKI and Chinese VIP Database in June 2021. Only randomised controlled trials on the effects of ischemic compression on neck pain were included. The major outcomes were pain intensity, pressure pain threshold, pain-related disability and range of motion. RESULTS Fifteen studies involving 725 participants were included. Significant differences were observed between ischemic compression and sham/no treatment group in pain intensity, pressure pain threshold and range of motion immediately and in the short term. Significant effect sizes of dry needling were observed over ischemic compression in terms of improving pain intensity (SMD = 0.62; 95% CI: 0.08 to 1.16; P= 0.02), pain-related disability (SMD = 0.68; 95% CI: 0.19 to 1.17; P= 0.007) and range of motion (MD =-2.12; 95% CI: -2.59 to -1.65; P< 0.001) immediately after treatment. Dry needling also showed a significant small effect size for the short-term reduction of pain (SMD = 0.44; 95% CI: 0.04 to 0.85; P= 0.03). CONCLUSION Ischemic compression can be recommended in the immediate and short-term pain relief and increase in the pressure pain threshold and range of motion. Dry needling is superior to ischemic compression in relieving pain and improving pain-related disability and range of motion immediately after treatment.
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Affiliation(s)
- Anle Xu
- Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Qiangmin Huang
- Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, China.,Shanghai Ciyuan Rehabilitation Hospital, Sinopharm Healthcare, Shanghai, China
| | - Jifeng Rong
- Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xuejiao Wu
- Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Meikui Deng
- Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Lijuan Ji
- Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, China
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Effectiveness of Manual Trigger Point Therapy in Patients with Myofascial Trigger Points in the Orofacial Region-A Systematic Review. Life (Basel) 2023; 13:life13020336. [PMID: 36836693 PMCID: PMC9965624 DOI: 10.3390/life13020336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/15/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
The objective was to compile, synthetize, and evaluate the quality of the evidence from randomized controlled trials (RCTs) regarding the effectiveness of manual trigger point therapy in the orofacial area in patients with or without orofacial pain. This project was registered in PROSPERO and follows the PRISMA guidelines. Searches (20 April 2021) were conducted in six databases for RCTs involving adults with active or latent myofascial trigger points (mTrPs) in the orofacial area. The data were extracted by two independent assessors. Four studies were included. According to the GRADE approach, the overall quality/certainty of the evidence was very low due to the high risk of bias of the studies included. Manual trigger point therapy showed no clear advantage over other conservative treatments. However, it was found to be an equally effective and safe therapy for individuals with myofascial trigger points in the orofacial region and better than control groups. This systematic review revealed a limited number of RCTs conducted with patients with mTrPs in the orofacial area and the methodological limitations of those RCTs. Rigorous, well-designed RCTs are still needed in this field.
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Pala GG, Mutlu EK, Taşkıran H. Comparison of High Power Pain Threshold Ultrasound and Ischemic
Compression Techniques for the Treatment of Latent Myofascial Trigger Points: A
Randomized Controlled Study. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2022. [DOI: 10.1055/a-1956-3359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Objective Myofascial trigger points (MTrPs) have been defined as discrete
and hyperirritable areas located within a taut band of skeletal muscle or
fascia, which when compressed produce pain, tenderness, dysfunction and
autonomic phenomena. The treatment techniques aimed to return the fiber groups
to their optimum length and end plates to their optimum function. Ischemic
Compression (IC) and of High Power Pain Threshold Ultrasound (HPPT-US) are among
the treatment techniques used for MTrPs. The aim of the current study is to
compare the efficacy of IC and HTTP-US which was applied in different ways on
MTrPs treatment.
Patients and Methods This is a randomized prospective study conducted with
153 participants have at least three latent trigger points. Participants
received HPPT-US technique in which the intensity is kept constant at the pain
level, HPPT-US technique in which the intensity is kept constant at half the
pain level or IC. Outcome measures were the Visual Analog Scale, Beck Depression
Inventory, Neck Pain and Disability Scale, number of deactivated MTrPs and Pain
Pressure Threshold (PPT).
Results Pain, psychological status and disability improved in each group;
there was no significant difference between the groups (p>0.05). PPT
increased in each group; a significant difference was found between the groups
(p<0.05). IC was slightly more effective than HPPT-US.
Conclusion Our results have shown that HPPT-US which was applied in
different ways and IC were effective therapies for latent trigger points.
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Affiliation(s)
- Gamze Gülsün Pala
- Division of Physical Therapy and Rehabilitation, Faculty of Health
Sciences, Gazi University, Ankara, Turkey
| | - Ebru Kaya Mutlu
- Division of Physical Therapy and Rehabilitation, Faculty of Health
Sciences, Bandirma Onyedi Eylul University, Balıkesir,
Turkey
| | - Hanifegül Taşkıran
- Division of Physical Therapy and Rehabilitation, Faculty of Health
Sciences, Istanbul Aydin University, Istanbul, Turkey
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Carvalho HC, Machado NCSS, Yáñez-Silva A, Rocabado M, Júnior ARDP, Alves LP, Ribeiro W, Lazo-Osório RA. Autonomic nerve regulation in joint hypermobility patients with myofascial trigger points by Musculoskeletal Interfiber Counterirritant Stimulation (MICS). Med Eng Phys 2022; 109:103903. [DOI: 10.1016/j.medengphy.2022.103903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
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Król M, Kupnicka P, Bosiacki M, Chlubek D. Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review. Int J Mol Sci 2022; 23:ijms231710127. [PMID: 36077525 PMCID: PMC9456560 DOI: 10.3390/ijms231710127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023] Open
Abstract
Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.
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Affiliation(s)
- Małgorzata Król
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Correspondence:
| | - Mateusz Bosiacki
- Chair and Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Żołnierska 54, 71-210 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
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Pérez-Bellmunt A, Simon M, López-de-Celis C, Ortiz-Miguel S, González-Rueda V, Fernandez-de-Las-Peñas C. Effects on Neuromuscular Function After Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial. J Manipulative Physiol Ther 2022; 45:490-496. [PMID: 33431281 DOI: 10.1016/j.jmpt.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/26/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate changes in neuromuscular function, pain perception, and basic physical properties in latent myofascial trigger points (TrPs) after a single treatment session of ischemic compression in the gastrocnemius muscle. METHODS A randomized within-participant clinical trial with a blinded assessor was conducted. Twenty-nine asymptomatic volunteers with latent gastrocnemius-muscle TrPs were bilaterally explored. Each extremity was randomly assigned to the control group (no treatment) or the experimental group (90 seconds of ischemic compression over each TrP). Neuromuscular function of the gastrocnemius muscle was assessed using a MyotonPro. Muscle flexibility was analyzed using the lunge test and the passive ankle range of motion. The strength was determined with a handheld dynamometer (MicroFET2). Pain perception was analyzed with a 0-to-10 numerical pain rating scale and determination of pressure pain thresholds over each latent TrP. RESULTS The results revealed a reduction of 15.8% in pain perception and an increment of pressure tolerance of 9.9% without pain in the treatment group. Changes in muscle flexibility (active and passive) and most parameters for neuromuscular response (rigidity, elasticity, and relaxation) were also observed, but they were not significantly different between groups. The clinical effect sizes were moderate for pain perception (d = 0.69), pressure pain threshold (d = 0.78), muscle tone (d = 0.51), and elasticity (d = 0.54) in favor of the treated extremity. Small clinical effect sizes were observed for muscle physical outcomes. CONCLUSION The present study shows that the use of a single session of ischemic compression for latent gastrocnemius-muscle TrPs improved some sensory outcomes. The effects on ankle range of motion and neuromuscular responses were inconclusive.
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Affiliation(s)
| | - Mathias Simon
- Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain
| | | | | | | | - César Fernandez-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Marks SK, Rodriguez NA, Shah A, Garcia AN, Ritter L, Pierce AN. Clinical Review of Neuromusculoskeletal Complementary and Alternative Approaches for the Treatment of Chronic Pelvic Pain Syndrome. Cureus 2022; 14:e27077. [PMID: 35989846 PMCID: PMC9388957 DOI: 10.7759/cureus.27077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic pelvic pain syndrome (CPPS) is a functional pain disorder characterized by ongoing pain in the apparent absence of clinically identifiable causes. The prevalence of functional pain disorders demonstrates the importance of adequate management of ongoing symptomatology, but due to the uncertain etiology and myriad patient presentation phenotypes, reliable treatment options are difficult to implement. New interventions involving non-pharmacological approaches to pain management have been investigated across a spectrum of clinical and pre-clinical studies. Given that conservative care such as exercise, counseling, and musculoskeletal therapy is widely recommended as first-line treatment for CPPS, an updated review of these and related methodologies are needed. Familiarizing physicians and the public with the newest evidence for complementary and alternative medicine (CAM) and other conservative care treatments will assist with the promotion of evidence-based practices in a safe and reliable manner. This review aimed to summarize the current evidence and proposed mechanisms for non-pharmacological treatment specific to CAM and management of chronic pelvic pain centered on neuromusculoskeletal focused intervention such as acupuncture, auriculotherapy, manipulation, manual therapy, myofascial release, and phototherapy. The discussion suggests that reported improvements in pelvic pain or related symptomatology may be attributed to changes in the peripheral inflammasome and somatic origins of peripheral sensitization. Robustness of the included clinical studies is discussed throughout the review, and attention is paid to delineating inclusion criteria of formally diagnosed CPPS compared to general pelvic or abdominal pain. Overall, this review consolidates the current state of evidence regarding the utilization of non-traditional interventions using CAM techniques for the management of chronic pelvic pain and recommends a future direction for the field.
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Trigger point therapy – ischemic compression or perhaps cupping? BIOMEDICAL HUMAN KINETICS 2022. [DOI: 10.2478/bhk-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Study aim: To evaluate and compare the effectiveness of single ischemic compression and cupping therapy on the most common trigger point, on the descending part of the trapezius muscle.
Materials and methods: Twenty-five students (15 women and 10 men) aged 24.20 ± 1.27 years were enrolled in the study. The mobility of the cervical spine area was measured with a measuring tape. The pain pressure threshold of the trigger point of the trapezius muscle was tested using a Wagner FDX 50 Force Gage digital algometer. Each person participated in three tests with an interval of approximately one week between them. The following study protocol was followed; 1) cupping therapy, with a cup statically positioned on the trigger point for two minutes, 2) at a minimum interval of 7 days, ischemic compression performed with the thumb twice for 1 minute on each side 3) control test at an interval of another 7 days.
Results: Ischemic compression resulted in a statistically significant difference in cervical spine mobility scores (except for extension) and pain pressure threshold values. After applying cups, statistically significant differences were also observed in the results of cervical spine mobility and pain pressure threshold values. No statistically significant differences were found in the effectiveness of the therapies tested.
Conclusions: In the present study, single trigger point cupping and ischemic compression therapies improved cervical spine mobility and resulted in an increase in the pain pressure threshold in the trapezius muscle trigger point. These two therapies did not differ in terms of their effectiveness.
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Bagcier F, Yurdakul OV, Üşen A, Bozdag M. The relationship between gluteus medius latent trigger point and muscle strength in healthy subjects. J Bodyw Mov Ther 2022; 29:140-145. [DOI: 10.1016/j.jbmt.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/04/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
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Bau JG, Wu SK, Huang BW, Lin TTL, Huang SC. Myofascial Treatment for Microcirculation in Patients with Postural Neck and Shoulder Pain. Diagnostics (Basel) 2021; 11:diagnostics11122226. [PMID: 34943463 PMCID: PMC8700133 DOI: 10.3390/diagnostics11122226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
Vascular impairment is a crucial factor associated with chronic muscle pain, but relevant research from the microcirculatory aspect is lacking. Here, we investigated the differences in neck muscle microcirculation detected through laser-doppler flowmetry (LDF) and cervical biomechanics by a videofluoroscopic image in asymptomatic participants and patients with postural neck and shoulder pain. To understand the mechanism behind the effect of myofascial treatment, transverse friction massage (TFM) was applied and the immediate effects of muscular intervention on microcirculation were monitored. In total, 16 asymptomatic participants and 22 patients (mean age = 26.3 ± 2.4 and 25.4 ± 3.2 years, respectively) were recruited. Their neck muscle microcirculation and spinal image sequence were assessed. The differences in the baseline blood flow between the asymptomatic and patient groups were nonsignificant. However, the standard deviations in the measurements of the upper trapezius muscle in the patients were significantly larger (p < 0.05). Regarding the TFM-induced responses of skin microcirculation, the blood flow ratio was significantly higher in the patients than in the asymptomatic participants (p < 0.05). In conclusion, postintervention hyperemia determined through noninvasive LDF may be an indicator for the understanding of the mechanism underlying massage therapies and the design of interventions for postural pain.
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Affiliation(s)
- Jian-Guo Bau
- Department of Biomedical Engineering, Hungkuang University, Taichung City 433, Taiwan; (J.-G.B.); (B.-W.H.)
| | - Shyi-Kuen Wu
- Department of Physical Therapy, Hungkuang University, Taichung City 433, Taiwan
- Correspondence: (S.-K.W.); (S.-C.H.)
| | - Bo-Wen Huang
- Department of Biomedical Engineering, Hungkuang University, Taichung City 433, Taiwan; (J.-G.B.); (B.-W.H.)
| | - Tony Tung-Liang Lin
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung City 407, Taiwan;
| | - Shih-Chung Huang
- Division of Cardiology, Kuang-Tien General Hospital, Taichung City 433, Taiwan
- Correspondence: (S.-K.W.); (S.-C.H.)
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Cho SH. The effect of suboccipital muscle inhibition and posture correction exercises on chronic tension-type headaches. J Back Musculoskelet Rehabil 2021; 34:989-996. [PMID: 33935056 DOI: 10.3233/bmr-191667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Compared with healthy people, patients with chronic tension-type headache (CTTH) are likely to have forward head postures (FHP) and a higher number of active trigger points (aTrP) on the suboccipital muscle. OBJECTIVE This study aims to verify how the suboccipital muscle inhibition (SMI) on aTrPs and the FHP correction exercise can effectively reduce symptoms of the CTTH patients. METHOD The subjects of this study were 45 individuals with CTTH, divided into three groups of 15 patients each: a) the SMI group using the myofascial release technique; b) the SMIEx group subject to both the SMI therapy and FHP correction exercises; and c) the control group. Group A and B were given the relevant interventions twice a week for four consecutive weeks, and went through the headache impact test (HIT-6) and examinations on the pressure pain threshold (PPT) of the headache areas, the type and number of myofascial trigger points (TrP), the soft tissue PPT, and the posture before and after the intervention. RESULTS There was a significant improvement in the HIT-6, the headache PPT, the soft tissue PPT, the TrP, and the posture in Group A and B patients to whom the SMI technique and SMIEx interventions were applied. The biggest reduction and increase in the HIT-6 and the headache PPT respectively were seen in the SMIEx group. CONCLUSION According to this study, the SMIEx can be an effective intervention for patients with CTTH.
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Munk N, Nemati D, Benjamin EV, Davies A, Shue S, Bair MJ. Trigger point self-care for chronic neck pain: Pilot and feasibility. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sánchez-Infante J, Bravo-Sánchez A, Jiménez F, Abián-Vicén J. Effects of Dry Needling on Muscle Stiffness in Latent Myofascial Trigger Points: A Randomized Controlled Trial. THE JOURNAL OF PAIN 2021; 22:817-825. [PMID: 33636373 DOI: 10.1016/j.jpain.2021.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/06/2021] [Accepted: 02/03/2021] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on muscle stiffness. A total of 51 recreational physically active subjects with LTrPs in the upper trapezius volunteered to participate and were randomly divided into a DN-group (n = 27) and a sham-DN group (n = 24). Volunteers received 1-session of DN or placebo treatment. Muscle stiffness, measured with strain and shear-wave elastography, pressure pain threshold (PPT), post-needling soreness, and muscle thickness were evaluated before treatment, and at 30-min, 24-hours, and 72-hours follow-up after treatment. The DN-group showed lower values from baseline for muscle stiffness measured with shear-wave elastrography at 24-hours (from 44.44 ± 15.97 to 35.78 ± 11.65 kpa; P < .01) and at 72-hours (35.04 ± 12.61 kpa; P < .01) and with strain elastography at 72-hours (from 1.75 ± 0.50 to 1.36 ± 0.40 AU; P < .01). The DN-group showed higher values of PPT than the sham-DN group at 72-hours (4.23 ± 0.75 vs. 5.19 ± 1.16 kg/cm2; P < .05). There was a progressive decrease in post-needling soreness compared to pain during needling of 33.13 ± 21.31% at 30-min, 80.92 ± 10.06% at 24-hours, and a total decrease in post-needling soreness in all participants at 72-hours. DN therapy is effective in reducing short-term muscle stiffness and increasing the PPT in volunteers with LTrPs in the upper trapezius after a treatment session. PERSPECTIVE: This study found that one session of DN intervention in latent trigger points of the upper trapezius muscle reduced muscle stiffness and the pressure pain threshold for the dry needling group compared to the sham dry needling group.
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Affiliation(s)
- Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain; Hospital Universitario Virgen de la Salud, Castilla La Mancha, Toledo, Spain
| | - Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain.
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Şahin D, Kaya Mutlu E, Şakar O, Ateş G, İnan Ş, Taşkıran H. The effect of the ischaemic compression technique on pain and functionality in temporomandibular disorders: A randomised clinical trial. J Oral Rehabil 2021; 48:531-541. [PMID: 33411952 DOI: 10.1111/joor.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Interventions addressing pain and impaired functionality in individuals with temporomandibular disorders (TMDs) are needed. OBJECTIVE To compare the effects of 4 weeks of exercise combined with ischaemic compression and exercise alone in patients with TMDs. METHODS Fifty patients who were diagnosed with TMDs were randomised into Group 1 (exercise combined with ischaemic compression technique) (n = 25) or Group 2 (exercise alone) (n = 25). Both groups performed 4 weeks of Rocabado's exercise and 3 weeks of postural exercise, while Group 1 received ischaemic compression to the masseter muscle for a total of 3 sessions in addition to exercise. A ruler was used to assess range of motion (ROM) (painless mouth opening (PMO), maximum mouth opening, maximum assisted mouth opening (MAMO), left lateral movement and right lateral movement), the visual analogue scale and graded chronic pain scale were used to assess pain, an algometer was used to determine the pain pressure threshold (PPT), and the 8-item jaw functional limitation scale was used to assess, functionality. The assessments were performed at baseline, at week 1 and at week 4. RESULTS The participants in Group 1 exhibited larger PMO (F = 5.26, P = .02) and MAMO values (F = 6.71, P = .01) than did the patients in Group 2 at week 1. The effect size was small for MAMO (ES = 0.27) and moderate for PMO (ES = 0.51). However, there were no significant differences in any other outcomes between groups at week 1 or 4. CONCLUSION In summary, this randomised controlled trial indicates that exercise combined with ICT and exercise alone have similar effects on ROM, pain, the PPT and functionality in patients with TMDs.
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Affiliation(s)
- Duygu Şahin
- Division of Physiotheraphy and Rehabilitation, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey
| | - Ebru Kaya Mutlu
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Olcay Şakar
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Gökçen Ateş
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Şebnem İnan
- Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Hanifegül Taşkıran
- Division of Physiotheraphy and Rehabilitation, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey
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da Silva AC, De Noronha M, Liberatori-Junior RM, Aily JB, Gonçalves GH, Arrais-Lima C, de Araújo Vieira LMSM, Mattiello SM. The Effectiveness of Ischemic Compression Technique on Pain and Function in Individuals With Shoulder Pain: A Systematic Review. J Manipulative Physiol Ther 2020; 43:234-246. [PMID: 32747150 DOI: 10.1016/j.jmpt.2019.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/29/2019] [Accepted: 10/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain. METHODS This review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale. RESULTS The search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain. CONCLUSION The IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.
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Affiliation(s)
- Alyssa Conte da Silva
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Marcos De Noronha
- Department of Allied Health, La Trobe University, Bendigo, Victoria, Australia
| | | | - Jéssica Bianca Aily
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Glaucia Helena Gonçalves
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | - Cristina Arrais-Lima
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
| | | | - Stela Marcia Mattiello
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil.
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Manafnezhad J, Salahzadeh Z, Salimi M, Ghaderi F, Ghojazadeh M. The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial. J Back Musculoskelet Rehabil 2020; 32:811-818. [PMID: 30883334 DOI: 10.3233/bmr-181289] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic neck pain is associated with various myofascial trigger points (MTrPs). OBJECTIVE A single-blind randomized clinical trial was designed to compare the effects of extracorporeal shock wave therapy (ESWT) with dry needling (DN) techniques on the upper trapezius muscle trigger point in patients with non-specific neck pain (NSNP). METHODS Seventy patients with NSNP and active MTrPs of the upper trapezius muscle were randomly divided into two groups: an ESWT group (n= 35) and a DN group (n= 35). Treatment sessions were performed for three weeks and all participants received related intervention once a week. The outcome measures were pain intensity, measured by a numeric pain rating scale (NPRS), pain pressure threshold (PPT), measured with a digital algometer, and functional disability, evaluated by using the neck disability index (NDI). RESULTS NPRS and NDI were significantly decreased in the DN group and ESWT group (P< 0.05). Also, the PPT was significantly increased in the DN group and ESWT. However, there was no significant difference in pain intensity, NDI, and the PPT between the two groups (P⩾ 0.05). CONCLUSION Both ESWT and DN can be employed to treat MTrPs of the upper trapezius muscle in patients with NSNP.
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Affiliation(s)
- Javad Manafnezhad
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Zahra Salahzadeh
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Mehdi Salimi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Fariba Ghaderi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Morteza Ghojazadeh
- Physiology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Tabatabaiee A, Ebrahimi-Takamjani I, Ahmadi A, Sarrafzadeh J, Emrani A. Comparison of pressure release, phonophoresis and dry needling in treatment of latent myofascial trigger point of upper trapezius muscle. J Back Musculoskelet Rehabil 2019; 32:587-594. [PMID: 30584120 DOI: 10.3233/bmr-181302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Latent myofascial trigger point (LMTP) is a small hypersensitive area in skeletal muscles that becomes painful under compression or stimulation. LMTPs are relevant for various musculoskeletal disorders. Although several treatments have been introduced to treat LMTP, the most efficient one is yet to be found. OBJECTIVE The main purpose of the present study was to compare pressure release, phonophoresis of betamethasone and dry needling on the upper trapezius latent myofascial trigger point. METHODS Sixty participants (mean ± SD age, 23.6 ± 2.1 y), with at least one latent myofascial trigger point in the upper trapezius muscle, participated in this study. Subjects were randomly divided into three groups (pressure release, phonophoresis with betamethasone and dry needling groups) for two weeks. Pain intensity, pain pressure threshold and active cervical range of motion were assessed. RESULTS Significant pain decrease, active cervical range of motion and pain pressure threshold increase were observed in the three groups (p< 0.001). The dry needling and phonophoresis groups reported more significant improvement compared to the pressure release group (p< 0.001). There was no difference between the dry needling and phonophoresis groups. CONCLUSIONS Considering the significant, positive effects of all three methods, dry needling and phonophoresis seem to be more effective than pressure release.
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Effect of manual compressive therapy on latent myofascial trigger point pressure pain thresholds. J Bodyw Mov Ther 2019; 23:792-798. [PMID: 31733763 DOI: 10.1016/j.jbmt.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study compared the effects of 90 s of manual compressive therapy (MCT) on latent myofascial trigger points (LTPs) for 3 sessions per week for 4 weeks to determine changes in individual pressure pain threshold (PPT). A total of 30 (15 males, 15 females; age = 22 ± 4 y/o, height = 175 ± 18 cm, weight = 162.5 ± 57.5 kg) symptomatic subjects with LTPs volunteered for the study. METHODS PPT was measured at baseline and pre- and post-treatment for all 12 sessions with a pressure algometer across the 4-week treatment time frame. The MCT was applied to the control group on their LTP at pressure intended to provide a sham condition (1/10 on verbalized analog scale (VAS)). Two experimental groups had MCT applied either directly on the LTP (d-TP) or in close-proximity to their LTP (cp-TP) at moderate pressure (7/10 on VAS). RESULTS There was a significant increase in PPT from the first through twelfth treatment sessions (p < 0.001, partial η2 = 0.914). A significant increase in PPTs between treatment groups was acutely observed from pre- to post-therapy tests (p = 0.001, partial η2 = 0.146). The differences between pre- versus post-treatment PPT measures indicated significant differences (d-TP vs. control, p < 0.001; cp-TP vs. control, p = 0.007). No differences were observed between experimental groups (p = 0.215). CONCLUSIONS PPT continued to increase after several weeks of MCT when applied directly on or within 2.5 cm of an identified LTP compared to control.
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Samhan AF, Abdelhalim NM. Impacts of low-energy extracorporeal shockwave therapy on pain, pruritus, and health-related quality of life in patients with burn: A randomized placebo-controlled study. Burns 2019; 45:1094-1101. [PMID: 30827852 DOI: 10.1016/j.burns.2019.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/05/2019] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of post-burn pain and pruritus remain a potent challenge because of their bad effects on health-related quality of life (HRQOL). The main purpose of this study was to evaluate the impacts of low-energy extracorporeal shockwave therapy (low-energy ESWT) in the management of pain, pruritus, and HRQOL in patients with burn. METHODS Forty-five adult patients with burn, their age ranged from 18 to 55 years, were included in the study, they randomly assigned into 22 patients in the study group (low-energy ESWT) and 23 patients in the placebo group. The study group received low-energy ESWT (0.05-0.20mJ/mm2, a frequency of 4Hz with total shocks from 1000 to 2000 shocks) once per week for 4 successive weeks, while the placebo group received ESWT without energy. Both groups received traditional physical therapy program of selective different exercises (respiratory, range of motion, endurance, strengthening, balance, mobilization, stretching, and gait training) 3days per week for 4 weeks. Numerical Rating Scale (NRS) for pain and for pruritus, Pressure Pain Threshold (PPT), 12-Item Pruritus Severity Scale (12-PSS), and Burn Specific Health Scale-Brief (BSHS-B) were measured before and after treatment procedures in both groups. RESULTS NRS were decreased significantly in the study group than in the placebo group (P<0.05). PPT, 12-PSS, and BSHS-B scores were improved more significantly in the study group than in the placebo group (P<0.05) while body image and burn associated issues were improved at the same level in both groups (P>0.05). CONCLUSION The findings suggest that low-energy ESWT with traditional regular physical therapy may relive post-burn pain and pruritus, and improve HRQOL, particularly in adult patients with burn.
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Affiliation(s)
- Ahmed Fathy Samhan
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia.
| | - Nermeen Mohamed Abdelhalim
- Department of Physical Therapy, New Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University, Egypt; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
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Dry needling versus friction massage to treat tension type headache: A randomized clinical trial. J Bodyw Mov Ther 2019; 23:89-93. [DOI: 10.1016/j.jbmt.2018.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/13/2017] [Accepted: 01/09/2018] [Indexed: 12/18/2022]
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Moraska AF, Hickner RC, Rzasa-Lynn R, Shah JP, Hebert JR, Kohrt WM. Increase in Lactate Without Change in Nutritive Blood Flow or Glucose at Active Trigger Points Following Massage: A Randomized Clinical Trial. Arch Phys Med Rehabil 2018; 99:2151-2159. [DOI: 10.1016/j.apmr.2018.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 01/03/2023]
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Saadat Z, Hemmati L, Pirouzi S, Ataollahi M, Ali-Mohammadi F. Effects of Integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points. J Bodyw Mov Ther 2018; 22:937-940. [PMID: 30368338 DOI: 10.1016/j.jbmt.2018.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Upper trapezius trigger points are among the most common causes of neck pain. This study aimed to investigate the effects of integrated Neuromuscular Inhibition Technique (INIT) on pain intensity and threshold. MATERIALS & METHODS Thirty two female participants with upper trapezius trigger points were recruited in this study. The participants were assigned to control (n = 16) or intervention (n = 16). The intervention group received INIT in one session, consisted of muscle energy technique, ischemic compression and strain-counter strain. Pain threshold and intensity were measured using Pressure Pain Threshold (PPT) and Numerical Pain Scale (NPS). These measurements were performed at baseline, immediately after treatment and 24 h after treatment. FINDINGS The results showed that pain intensity significantly decreased in the intervention group immediately after treatment (P = .01) and 24 h after treatment (P = .009) in comparison with the control group. There were no significant differences in pressure pain threshold between both groups. CONCLUSION It seems that Integrated Neuromuscular Inhibition Technique can reduce pain intensity in patients with upper trapezius trigger points.
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Affiliation(s)
- Zahra Saadat
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ladan Hemmati
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Pirouzi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahnaz Ataollahi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Ali-Mohammadi
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Ziaeifar M, Arab AM, Mosallanezhad Z, Nourbakhsh MR. Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up. J Man Manip Ther 2018; 27:152-161. [PMID: 30935341 DOI: 10.1080/10669817.2018.1530421] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives: The purpose of this randomized controlled trial was to investigate the long-term clinical effect of dry needling with two-week and three-month follow up, on individuals with myofascial trigger points in the upper trapezius muscle. Methods: A sample of convenience (33 individuals) with a trigger point in the upper trapezius muscle, participated in this study. The individuals were randomly assigned to two groups: trigger point compression (N = 17) or dry needling (N = 16). Pain intensity, neck disability, and disability of the arm, hand, and shoulder (DASH) were assessed before treatment, after treatment sessions, and at two-week and three-month follow ups. Results: The result of repeated measures ANOVA showed significant group-measurement interaction effect for VAS (p = .02). No significant interaction was found for NPQ and DASH (p > .05). The main effect of measurements for VAS, NPQ, and DASH were statistically significant (p < .0001). The results showed a significant change in pain intensity, neck disability, and DASH after treatment sessions, after two weeks and three months when compared with before treatment scores in both groups. There was no significant difference in the tested variables after two-week or three-month as compared to after treatment sessions between the two groups. However, pain intensity after treatment sessions was significantly different between the two groups (p = .02). Discussion: Dry needling and trigger point compression in individuals with myofascial trigger point in the upper trapezius muscle can lead to three-month improvement in pain intensity and disability.
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Affiliation(s)
- Maryam Ziaeifar
- a Department of Physical Therapy , Iran University of Medical Sciences , Tehran , Iran
| | - Amir Massoud Arab
- b Department of Physical Therapy , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Zahra Mosallanezhad
- b Department of Physical Therapy , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mohammad Reza Nourbakhsh
- c Department of Physical Therapy , North Georgia College and State University , Dahlonega , GA , USA
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Romero-Morales C, Jaén-Crespo G, Rodríguez-Sanz D, Sanz-Corbalán I, López-López D, Calvo-Lobo C. Comparison of Pressure Pain Thresholds in Upper Trapezius and Temporalis Muscles Trigger Points Between Tension Type Headache and Healthy Participants: A Case-Control Study. J Manipulative Physiol Ther 2018; 40:609-614. [PMID: 29187312 DOI: 10.1016/j.jmpt.2017.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To date, the minimum clinical differences (MCDs) in the pressure pain thresholds (PPTs) of the upper trapezius and temporalis muscles have not yet been established in participants with tension-type headache (TTH). The purpose of the study was to evaluate the MCDs of the PPTs of the upper trapezius and temporalis in participants with TTH and those without TTH. METHODS The sample comprised 120 participants with TTH (n = 60; mean [standard deviation] years = 38.30 [10.05]) and without TTH (n = 60; 34 [8.20]). The participants were recruited from an outpatient clinic in Spain from 2014 to 2016. The PPTs of the most hyperalgesic trigger points of the upper trapezius and temporalis were assessed. RESULTS There were statistically significant differences, mean (standard deviation) kg/cm2, for the right upper trapezius PPT (P < .001; 1.52 [0.35] vs 2.37 [0.49]), the left upper trapezius PPT (P < .001; 1.53 [0.36] vs 2.29 [0.49]), the right temporalis PPT (P = .008; 1.56 [0.31] vs 1.72 [0.33]), and the left temporalis PPT (P = .001; 1.57 [0.27] vs 1.74 [0.30]) between participants with and without TTH, respectively. CONCLUSIONS The PPT MCDs for the right and left upper trapezius and the right and left temporalis were 0.85, 0.76, 0.16, and 0.17 kg/cm2, respectively, for the clinical management of trigger points in participants with TTH.
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Affiliation(s)
- Carlos Romero-Morales
- Physiotherapy Department, Physical Therapy & Health Sciences Research Group, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain.
| | | | - David Rodríguez-Sanz
- Physiotherapy Department, Physical Therapy & Health Sciences Research Group, Faculty of Health, Exercise and Sport, European University of Madrid, Villaviciosa de Odón, Madrid, Spain.
| | - Irene Sanz-Corbalán
- School of Nursing and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, La Coruña, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de, León, Spain
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Ischemic compression and kinesiotherapy on chronic myofascial pain in breast cancer survivors. J Bodyw Mov Ther 2018; 22:69-75. [DOI: 10.1016/j.jbmt.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 11/18/2022]
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Salavati M, Akhbari B, Ebrahimi Takamjani I, Ezzati K, Haghighatkhah H. Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome. J Chiropr Med 2017; 16:316-323. [PMID: 29276464 DOI: 10.1016/j.jcm.2017.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 01/26/2023] Open
Abstract
Objective The purpose of this study was to assess the intra- and interexaminer reliability of the upper trapezius muscle and fascia thickness measured by ultrasonography imaging and strain ratio by sonoelastography in participants with myofascial pain syndrome. Methods Thirty-two upper trapezius muscles were assessed. Two examiners measured the upper trapezius thickness and strain ratio 3 times by ultrasonography and sonoelastography independently in the test session. The retest session was completed 6 to 8 days later. Results A total of 87.5% of participants had trigger points on the right side, and 22.5% had trigger points on the left side. For the test session, the average upper trapezius thickness, fascia thickness, and strain ratio measured by first and second examiners were 11.86 mm and 11.56 mm, 1.23 mm and 1.25 mm, and 0.94 and 0.99, respectively. For the retest session, the previously mentioned parameters obtained by first and second examiners were 11.76 mm and 11.39 mm, 1.27 mm and 1.29 mm, and 0.96 and 0.99, respectively. The intraclass correlation coefficients indicated good to excellent reliability for both within-intraexaminer (0.78-0.96) and between-intraexaminer (0.75-0.98) measurements. Also, the intraclass correlation coefficients and standard errors of measurement of interexaminer reliability ranged between 0.88 to 0.93 and 0.05 to 0.44 for both muscle and fascia thickness and 0.70 to 0.75 and 0.04 to 0.20 for strain ratio of upper trapezius, respectively. Conclusion Upper trapezius thickness measurements by ultrasonography and strain ratio by sonoelastography are reliable methods in participants with myofascial pain syndrome.
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Affiliation(s)
- Mahyar Salavati
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behnam Akhbari
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ismail Ebrahimi Takamjani
- Physiotherapy Department, Rehabilitation Faculty of Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Ezzati
- Physiotherapy Department, Guilan University of Medical Sciences, Rasht, Iran
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Effect of ischemic compression for cervicogenic headache and elastic behavior of active trigger point in the sternocleidomastoid muscle using ultrasound imaging. J Bodyw Mov Ther 2017; 21:933-939. [PMID: 29037651 DOI: 10.1016/j.jbmt.2017.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/11/2016] [Accepted: 12/29/2016] [Indexed: 11/19/2022]
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Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. Am J Phys Med Rehabil 2017; 96:639-645. [PMID: 28248690 DOI: 10.1097/phm.0000000000000728] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache. DESIGN Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments. RESULTS PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (P < 0.0001 for suboccipital; P < 0.004 for upper trapezius). Post hoc analysis within the massage group showed (1) an initial, immediate increase in PPT (all P values < 0.05), (2) a cumulative and sustained increase in PPT over baseline (all P values < 0.05), and (3) an additional immediate increase in PPT at the final (12th) massage treatment (all P values < 0.05, except upper trapezius left, P = 0.17). CONCLUSIONS Single and multiple massage applications increase PPT at MTrPs. The pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the contribution of myofascial trigger points to myofascial pain; (2) Describe an effective treatment for decreasing tenderness of a myofascial trigger point; and (3) Discuss the relative values of single vs. multiple massage sessions on increasing pressure-pain thresholds at myofascial trigger points. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Subbarayalu AV, Ameer MA. Relationships among head posture, pain intensity, disability and deep cervical flexor muscle performance in subjects with postural neck pain. J Taibah Univ Med Sci 2017; 12:541-547. [PMID: 31435292 PMCID: PMC6694898 DOI: 10.1016/j.jtumed.2017.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives Information Technology (IT) professionals working with computers gradually develop forward head posture and, as a result, these professionals are susceptible to several neck disorders. This study intended to reveal the relationships between pain intensity, disability, head posture and deep cervical flexor (DCF) muscle performance in patients with postural neck pain. Methods A cross-sectional study was conducted on 84 IT professionals who were diagnosed with postural neck pain. The participants were recruited with a random sampling approach. A Visual Analogue Scale (VAS), the Northwick Park Neck Pain Questionnaire (NPQ), the Modified Head Posture Spinal Curvature Instrument (MHPSCI), and the Stabilizer Pressure Biofeedback Unit were used to measure neck pain intensity, neck disability, head posture, and DCF muscle performance, respectively. Results The Pearson correlation coefficient revealed a significantly strong positive relationship between the VAS and the NPQ (r = 0.734). The cranio-vertebral (CV) angle was found to have a significantly negative correlation with the VAS (r = −0.536) and a weak negative correlation with the NPQ (r = −0.389). Conclusion This study concluded that a smaller CV angle corresponded to greater neck pain intensity and disability. Furthermore, there is no significant relationship between CV angle and DCF muscle performance, indicating that head posture re-education through postural correction exercises would not completely correct the motor control deficits in DCF muscles. In addition, a suitable exercise regimen that exclusively targets the deep cervical flexor muscle to improve its endurance is warranted.
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Affiliation(s)
- Arun V Subbarayalu
- Studies and Research Unit, Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Mariam A Ameer
- Department of Physiotherapy College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, KSA
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Oliva Pascual-Vaca Á, Punzano-Rodríguez R, Escribá-Astaburuaga P, Fernández-Domínguez JC, Ricard F, Franco-Sierra MA, Rodríguez-Blanco C. Short-Term Changes in Algometry, Inclinometry, Stabilometry, and Urinary pH Analysis After a Thoracolumbar Junction Manipulation in Patients with Kidney Stones. J Altern Complement Med 2017; 23:639-647. [PMID: 28537418 DOI: 10.1089/acm.2017.0041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To determine the efficacy of a high-velocity low-amplitude manipulation of the thoracolumbar junction in different urologic and musculoskeletal parameters in subjects suffering from renal lithiasis. DESIGN Randomized, controlled blinded clinical study. SETTINGS/LOCATION The Nephrology departments of two hospitals and one private consultancy of physiotherapy in Valencia (Spain). SUBJECTS Forty-six patients suffering from renal lithiasis. INTERVENTIONS The experimental group (EG, n = 23) received a spinal manipulation of the thoracolumbar junction, and the control group (CG, n = 23) received a sham procedure. OUTCOME MEASURES Pressure pain thresholds (PPTs) of both quadratus lumborum and spinous processes from T10 to L1, lumbar flexion range of motion, stabilometry, and urinary pH were measured before and immediately after the intervention. A comparison between pre- and postintervention phases was performed and an analysis of variance for repeated measures using time (pre- and postintervention) as intrasubject variable and group (CG or EG) as intersubject variable. RESULTS Intragroup comparison showed a significant improvement for the EG in the lumbar flexion range of motion (p < 0.001) and in all the PPT (p < 0.001 in all cases). Between-group comparison showed significant changes in PPT in quadratus lumborum (p < 0.001), as well as in the spinous processes of all of the evaluated levels (p < 0.05). No changes in urinary pH were observed (p = 0.419). CONCLUSION Spinal manipulation of the thoracolumbar junction seems to be effective in short term to improve pain sensitivity, as well as to increase the lumbar spine flexion.
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Affiliation(s)
| | | | | | | | | | - Maria Angeles Franco-Sierra
- 5 Department of Physiatry and Nursing, Faculty of Health Sciences (Physiotherapy), University of Zaragoza , Zaragoza, Spain
| | - Cleofás Rodríguez-Blanco
- 1 Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain .,4 Madrid Osteopathic School, Madrid, Spain
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Kalichman L, Ben David C. Effect of self-myofascial release on myofascial pain, muscle flexibility, and strength: A narrative review. J Bodyw Mov Ther 2017; 21:446-451. [DOI: 10.1016/j.jbmt.2016.11.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/27/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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Reliability of assessment of upper trapezius morphology, its mechanical properties and blood flow in female patients with myofascial pain syndrome using ultrasonography. J Bodyw Mov Ther 2017; 21:35-40. [DOI: 10.1016/j.jbmt.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/17/2016] [Accepted: 03/24/2016] [Indexed: 12/20/2022]
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Clinical Effectiveness of Dry Needling Immediately After Application on Myofascial Trigger Point in Upper Trapezius Muscle. J Chiropr Med 2016; 15:252-258. [PMID: 27857633 DOI: 10.1016/j.jcm.2016.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/15/2016] [Accepted: 08/25/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of dry needling (DN) on pain intensity and pressure pain threshold (PPT) compared with ischemic compression (IC) immediately and 48 hours after each treatment session in individuals with myofascial trigger points in the upper trapezius muscle. METHODS Thirty-one patients with myofascial trigger points in the upper trapezius muscle participated in this study. Patients were randomly assigned to a standard (N = 17) or experimental group (N = 14). The treatment protocol for the standard group consisted of IC, whereas the patients in the experimental group received DN. RESULTS The results indicated that the effect size of the DN methods for pain intensity and PPT was considerably greater after 2 days compared with immediately after the treatment session. In contrast, the effect of the IC for PPT was greater immediately after treatment compared with the measures after 2 days. There was also no noticeable difference in the effect size for IC on pain intensity between the scores obtained immediately and 2 days after treatment. However, our data also revealed a greater effect size for DN on PPT after 2 days compared with the IC technique. CONCLUSIONS In this study, DN improved the pain intensity and PPT after 2 days. However, it had no clinical improvement immediately after application because of muscle soreness. Thus, assessment of the effect of DN immediately after application can be criticized, and the results should be interpreted with caution.
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Abu Taleb W, Rehan Youssef A, Saleh A. The effectiveness of manual versus algometer pressure release techniques for treating active myofascial trigger points of the upper trapezius. J Bodyw Mov Ther 2016; 20:863-869. [DOI: 10.1016/j.jbmt.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 10/22/2022]
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Espejo-Antúnez L, Castro-Valenzuela E, Ribeiro F, Albornoz-Cabello M, Silva A, Rodríguez-Mansilla J. Immediate effects of hamstring stretching alone or combined with ischemic compression of the masseter muscle on hamstrings extensibility, active mouth opening and pain in athletes with temporomandibular dysfunction. J Bodyw Mov Ther 2016; 20:579-87. [DOI: 10.1016/j.jbmt.2015.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/16/2015] [Accepted: 12/14/2015] [Indexed: 12/28/2022]
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Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Neck Mobility and Forward Head Posture are not Related to Headache Parameters in Chronic Tension-Type Headache. Cephalalgia 2016; 27:158-64. [PMID: 17257237 DOI: 10.1111/j.1468-2982.2006.01247.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The relationship between the changes in forward head posture (FHP), neck mobility and headache parameters was analysed in 25 patients with chronic tension-type headache (CTTH) undergoing a physical therapy programme. Side-view pictures were taken to measure the cranio-vertebral angle in the sitting and standing positions. A cervical goniometer was employed to measure the range of all cervical motions. A headache diary was kept to assess headache intensity, frequency and duration. All patients received six sessions of physical therapy over 3 weeks. Outcomes were assessed at baseline, after treatment and 1 month later. Neck mobility and headache parameters showed a significant improvement after the intervention, whereas posture changes did not reach statistical significance. No correlations were found between FHP, neck mobility and headache parameters at any stage. Changes in these outcomes throughout the study were not correlated either. FHP and neck mobility appear not to be related to headache intensity, duration or frequency in patients suffering from CTTH. Although patients showed a reduction in the range of motion in the neck, it is uncertain whether this is consistent with TTH.
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Affiliation(s)
- C Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain.
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The influence of Positional Release Therapy on the myofascial trigger points of the upper trapezius muscle in computer users. J Bodyw Mov Ther 2016; 20:767-773. [PMID: 27814857 DOI: 10.1016/j.jbmt.2016.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/26/2016] [Accepted: 03/21/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of the present study was to investigate the effect of Positional Release Therapy (PRT) in computer users via latent trigger points (LTrPs) of the upper trapezius muscle. MATERIALS AND METHODS Twenty-eight women with the upper trapezius MTrPs participated in this study. Subjects were randomly classified into two groups (14 in each group): the subjects in the Group 1 received PRT in shortened position while those in the group 2 received sham control in the neutral position of the upper trapezius muscle. They received three therapy sessions every other day for one week. The local pain intensity and Pressure pain threshold (PPT) were measured via Visual Analogue Scale (VAS) and algometry, respectively, before interventions and repeated 5 min after the first and third treatment sessions in each group. RESULTS One-way ANOVA was used for data analysis. After treatment, between groups comparison revealed that for PPT and VAS, there were significant differences between the two groups (VAS and PPT; P < 0.05). CONCLUSION Both groups (PRT and sham control) showed alleviation of pain and increase in PPT during three sessions of therapy although PRT showed to be more effective in these patients.
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Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain 2015; 31:159-68. [PMID: 25329141 DOI: 10.1097/ajp.0000000000000091] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Myofascial trigger points (MTrPs) are focal disruptions in the skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type HA (TTH). The present study applied massage focused on MTrPs of patients with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache (HA) pain. METHODS Fifty-six patients with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over 6 weeks, or to wait-list. Trigger point release massage focused on MTrPs in cervical musculature. HA pain (frequency, intensity, and duration) was recorded in a daily HA diary. Additional outcome measures included self-report of perceived clinical change in HA pain and pressure-pain threshold at MTrPs in the upper trapezius and suboccipital muscles. RESULTS From diary recordings, group differences across time were detected in HA frequency (P=0.026), but not for intensity or duration. Post hoc analysis indicated that HA frequency decreased from baseline for both massage (P<0.0003) and placebo (P=0.013), but no difference was detected between massage and placebo. Patient report of perceived clinical change was greater reduction in HA pain for massage than placebo or wait-list groups (P=0.002). Pressure-pain threshold improved in all muscles tested for massage only (all P's<0.002). DISCUSSION Two findings from this study are apparent: (1) MTrPs are important components in the treatment of TTH, and (2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on HA that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.
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Yeganeh Lari A, Okhovatian F, Naimi SS, Baghban AA. The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females. ACTA ACUST UNITED AC 2015; 21:204-9. [PMID: 26304789 DOI: 10.1016/j.math.2015.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 11/16/2022]
Abstract
AIM The purpose of this clinical trial experiment was to compare the effects of the combination of dry needling (DN) and the muscle energy technique (MET) on the upper trapezius latent myofascial trigger point. METHOD Sixty female patients, aged 18-30 with latent myofascial trigger points in the upper trapezius muscle were randomly divided into three groups: group 1 (n = 20) received DN and MET, group 2 (n = 20) received only MET, and group 3 (n = 20) received only DN. The visual analogue scale (VAS), pressure pain threshold (PPT), and range of active contra lateral flexion (CLF) were measured before each treatment. The patients were treated for three sessions in a one-week period with at least a two-day break between each session, and in session four, an assessment of primary outcomes was conducted without any treatment. RESULTS All three treatment groups showed decreases in pain (p = 0.001) and increases in PPT levels (p = 0.001) as well as increases in CLF (p = 0.001). But the group receiving trigger point DN together with MET showed more significant improvement than the other two groups in VAS, PPT and ROM. No significant differences were found between the MET-only group and the DN-only group. CONCLUSION Our results indicate that all three treatments used in this study were effective for treating MTP. According to this study, DN and MET is suggested as a new method for the treatment of MTP.
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Affiliation(s)
- Ameneh Yeganeh Lari
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Okhovatian
- Physiotherapy Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sedigheh sadat Naimi
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Basic Sciences, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Evidence for the Use of Ischemic Compression and Dry Needling in the Management of Trigger Points of the Upper Trapezius in Patients with Neck Pain. Am J Phys Med Rehabil 2015; 94:573-83. [DOI: 10.1097/phm.0000000000000266] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Loew LM, Brosseau L, Tugwell P, Wells GA, Welch V, Shea B, Poitras S, De Angelis G, Rahman P. Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis. Cochrane Database Syst Rev 2014; 2014:CD003528. [PMID: 25380079 PMCID: PMC7154576 DOI: 10.1002/14651858.cd003528.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Deep transverse friction massage, one of several physical therapy interventions suggested for the management of tendinitis pain, was first demonstrated in the 1930s by Dr James Cyriax, a renowned orthopedic surgeon in England. Its goal is to prevent abnormal fibrous adhesions and abnormal scarring. This is an update of a Cochrane review first published in 2001.Objectives To assess the benefits and harms of deep transverse friction massage for treating lateral elbow or lateral knee tendinitis.Search methods We searched the following electronic databases: the specialized central registry of the Cochrane Field of Physical and Related Therapies,the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, and the Physiotherapy Evidence Database (PEDro), up until July 2014. The reference lists of these trials were consulted for additional studies.Selection criteria All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing deep transverse friction massage with control or other active interventions for study participants with two eligible types of tendinitis (ie, extensor carpi radialis tendinitis (lateral elbow tendinitis, tennis elbow or lateral epicondylitis or lateralis epicondylitis humeri) and iliotibial band friction syndrome (lateral knee tendinitis)) were selected. Only studies published in English and French languages were included.Data collection and analysis Two review authors independently assessed the studies on the basis of inclusion and exclusion criteria. Results of individual trials were extracted from the included study using extraction forms prepared by two independent review authors before the review was begun.Data were cross-checked by a third review author. Risk of bias of the included studies was assessed using the "Risk of bias"tool of The Cochrane Collaboration. A pooled analysis was performed using mean difference (MD) for continuous outcomes and risk ratio (RR)for dichotomous outcomes with 95% confidence intervals (CIs).Main results Two RCTs (no new additional studies in this update) with 57 participants met the inclusion criteria. These studies demonstrated high risk of performance and detection bias, and the risk of selection, attrition, and reporting bias was unclear.The first study included 40 participants with lateral elbow tendinitis and compared (1) deep transverse friction massage combined with therapeutic ultrasound and placebo ointment (n = 11) versus therapeutic ultrasound and placebo ointment only (n = 9) and (2)deep transverse friction massage combined with phonophoresis (n = 10) versus phonophoresis only (n = 10). No statistically significant differences were reported within five weeks for mean change in pain on a 0 to 100 visual analog scale (VAS) (MD -6.60, 95%CI -28.60 to 15.40; 7% absolute improvement), grip strength measured in kilograms of force (MD 0.10, 95% CI -0.16 to 0.36) and function ona 0 to 100 VAS (MD -1.80, 95% CI -0.18.64 to 15.04; 2% improvement), pain-free function index measured as the number of painfree items (MD 1.10, 95% CI -1.00 to 3.20) and functional status (RR 3.3, 95% CI 0.4 to 24.3) for deep transverse friction massage,and therapeutic ultrasound and placebo ointment compared with therapeutic ultrasound and placebo ointment only. Likewise for deep transverse friction massage and phonophoresis compared with phonophoresis alone, no statistically significant differences were found for pain (MD -1.2, 95% CI -20.24 to 17.84; 1% improvement), grip strength (MD -0.20, 95% CI -0.46 to 0.06) and function (MD3.70, 95% CI -14.13 to 21.53; 4% improvement). In addition, the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for the pain outcome, which received a score of "very low".Pain relief of 30% or greater, quality of life, patient global assessment, adverse events, and withdrawals due to adverse events were not assessed or reported.The second study included 17 participants with iliotibial band friction syndrome (knee tendinitis) and compared deep transverse friction massage with physical therapy intervention versus physical therapy intervention alone, at two weeks. Deep transverse friction massage with physical therapy intervention showed no statistically significant differences in the three measures of pain relief on a 0 to 10 VAS when compared with physical therapy alone: daily pain (MD -0.40, 95% CI -0.80 to -0.00; absolute improvement 4%), pain while running (scale from 0 to 150) (MD -3.00, 95% CI -11.08 to 5.08), and percentage of maximum pain while running (MD -0.10, 95% CI -3.97 to 3.77). For the pain outcome, absolute improvement showed a 4% reduction in pain. However, the quality of the body of evidence received a grade of "very low."Pain relief of 30% or greater, function, quality of life, patient global assessment of success, adverse events, and withdrawals due to adverse events were not assessed or reported.Authors' conclusions We do not have sufficient evidence to determine the effects of deep transverse friction on pain, improvement in grip strength, and functional status for patients with lateral elbow tendinitis or knee tendinitis, as no evidence of clinically important benefits was found.The confidence intervals of the estimate of effects overlapped the null value for deep transverse friction massage in combination with physical therapy compared with physical therapy alone in the treatment of lateral elbow tendinitis and knee tendinitis. These conclusions are limited by the small sample size of the included randomized controlled trials. Future trials, utilizing specific methods and adequate sample sizes, are needed before conclusions can be drawn regarding the specific effects of deep transverse friction massage on lateral elbow tendinitis.
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Affiliation(s)
- Laurianne M Loew
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Lucie Brosseau
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | - George A Wells
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Vivian Welch
- University of OttawaBruyère Research Institute43 Bruyere StreetOttawaONCanadaK1N 5C8
| | - Beverley Shea
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Stephane Poitras
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Gino De Angelis
- University of OttawaDepartment of Epidemiology and Community MedicineRoom H128140 Ruskin StreetOttawaONCanadaK1Y 4W7
| | - Prinon Rahman
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
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Desai MJ, Bean MC, Heckman TW, Jayaseelan D, Moats N, Nava A. Treatment of myofascial pain. Pain Manag 2014; 3:67-79. [PMID: 24645933 DOI: 10.2217/pmt.12.78] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY The objective of this article was to perform a narrative review regarding the treatment of myofascial pain syndrome and to provide clinicians with treatment recommendations. This paper reviews the efficacy of various myofascial pain syndrome treatment modalities, including pharmacological therapy, injection-based therapies and physical therapy interventions. Outcomes evaluated included pain (visual analog scale), pain pressure threshold and range of motion. The evidence found significant benefit with multiple treatments, including diclofenac patch, thiocolchicoside and lidocaine patches. Trigger point injections, ischemic compression therapy, transcutaneous electrical nerve stimulation, spray and stretch, and myofascial release were also efficacious. The authors recommend focusing on treating underlying pathologies, including spinal conditions, postural abnormalities and underlying behavioral issues. To achieve maximum pain reduction and improve function, we recommend physicians approach myofascial pain syndrome with a multimodal plan, which includes a combination of pharmacologic therapies, various physical therapeutic modalities and injection therapies.
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Affiliation(s)
- Mehul J Desai
- George Washington University Medical Center, The GW Spine & Pain Center, 2131 K Street, NW Suite 600, Washington, DC, USA
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Efficacy of massage therapy on pain and dysfunction in patients with neck pain: a systematic review and meta-analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:204360. [PMID: 24695806 PMCID: PMC3950594 DOI: 10.1155/2014/204360] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/28/2013] [Indexed: 11/17/2022]
Abstract
Objective. To systematically evaluate the evidence of whether massage therapy (MT) is effective for neck pain.
Methods. Randomized controlled trials (RCTs) were identified through searches of 5 English and Chinese databases (to December 2012). The search terms included neck pain, neck disorders, cervical vertebrae, massage, manual therapy, Tuina, and random. In addition, we performed hand searches at the library of Nanjing University of Traditional Chinese Medicine. Two reviewers independently abstracted data and assessed the methodological quality of RCTs by PEDro scale. And the meta-analyses of improvements on pain and neck-related function were conducted. Results. Fifteen RCTs met inclusion criteria. The meta-analysis showed that MT experienced better immediate effects on pain relief compared with inactive therapies (n = 153; standardised mean difference (SMD), 1.30; 95% confidence interval (CI), 0.09 to 2.50; P = 0.03) and traditional Chinese medicine (n = 125; SMD, 0.73; 95% CI 0.13 to 1.33; P = 0.02). There was no valid evidence of MT on improving dysfunction. With regard to follow-up effects, there was not enough evidence of MT for neck pain. Conclusions. This systematic review found moderate evidence of MT on improving pain in patients with neck pain compared with inactive therapies and limited evidence compared with traditional Chinese medicine. There were no valid lines of evidence of MT on improving dysfunction. High quality RCTs are urgently needed to confirm these results and continue to compare MT with other active therapies for neck pain.
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Abstract
Myofascial trigger points (MTrPs) are hyperirritable points located within a taut band of skeletal muscle or fascia, which cause referred pain, local tenderness and autonomic changes when compressed. There are fundamental differences between the effects produced by the two basic types of MTrPs (active and latent). Active trigger points (ATrPs) usually produce referred pain and tenderness. In contrast, latent trigger points (LTrPs) are foci of hyperirritability in a taut band of muscle, which are clinically associated with a local twitch response, tenderness and/or referred pain upon manual examination. LTrPs may be found in many pain-free skeletal muscles and may be "activated" and converted to ATrPs by continuous detrimental stimuli. ATrPs can be inactivated by different treatment strategies; however, they never fully disappear but rather convert to the latent form. Therefore, the diagnosis and treatment of LTrPs is important. This review highlights the clinical implication of LTrPs.
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Affiliation(s)
- Derya Celik
- Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey.
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