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Elsayed WH, Alowa ZA. Impact of forward head posture correction on craniovertebral angle, neck disability, and spinal electromyography: A randomized controlled trial. J Back Musculoskelet Rehabil 2025; 38:83-92. [PMID: 39970467 DOI: 10.1177/10538127241296342] [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: 02/21/2025]
Abstract
BACKGROUND Forward head posture (FHP) is a common malalignment affecting the cervicothoracic spine. This deviation is associated with neck disability and muscle imbalance. OBJECTIVE This study aimed to investigate the efficacy of FHP correction using regional versus comprehensive spinal programs on the craniovertebral (CV) angle, neck disability, and spinal muscle activity. METHODS Sixty participants with FHP were randomly assigned to receive either a cervicothoracic correction program (control group) or a cervicothoracic plus lumbopelvic program (experimental group). The CV angle, neck disability index (NDI), and normalized electromyography as a percentage of maximum voluntary isometric contraction (%MVIC) from spinal muscles were measured before and after the intervention. RESULTS Post-intervention, both groups showed significant improvement across time in CV angle and NDI (p < 0.001, p = 0.002). However, the between-group comparison was not statistically significant. The NDI showed significant improvement only in the experimental group (p = 0.005). The minimal clinical important difference (MCID) obtained was 6.44 for the NDI. A reduction in %MVIC over time was observed in both groups for cervical erector spinae (Right, p = 0.006, Left, p = 0.001). The between-group comparison of spinal muscle activation was not significantly different. CONCLUSION The study suggested that FHP management using a cervicothoracic or cervicothoracic plus lumbopelvic protocol could improve cervical posture and lower cervical muscle demand. Incorporating a lumbopelvic into the cervicothoracic protocol was more effective in reducing short-term neck pain and disability than a cervicothoracic protocol alone. A comprehensive spine program may be a clinically beneficial rehabilitation protocol for FHP to improve neck pain and disability.
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Affiliation(s)
- Walaa H Elsayed
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zaenab A Alowa
- Department of Physical Therapy, AlJubail General Hospital, Aljubail, Jubail, Saudi Arabia
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Ware JW, Venere K, Miller SA, Freeman H, Scalzitti DA, Hoogeboom T. A Systematic Appraisal of Conflicts of Interest and Researcher Allegiance in Clinical Studies of Dry Needling for Musculoskeletal Pain Disorders. Phys Ther 2023; 103:pzad023. [PMID: 37384639 DOI: 10.1093/ptj/pzad023] [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] [Received: 03/29/2022] [Revised: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and methods of conflicts of interest (COI) reporting in published dry needling (DN) studies and to determine the frequency of researcher allegiance (RA). METHODS A pragmatic systematic search was undertaken to identify DN studies that were included in systematic reviews. Information regarding COI and RA were extracted from the full text of the published DN reports, and study authors were sent a survey inquiring about the presence of RA. A secondary analysis also was undertaken based on study quality/risk of bias scores that were extracted from the corresponding systematic reviews and study funding extracted from each DN study. RESULTS Sixteen systematic reviews were identified, containing 60 studies of DN for musculoskeletal pain disorders, 58 of which were randomized controlled trials. Of the DN studies, 53% had a COI statement. None of these studies disclosed a COI. Nineteen (32%) authors of DN studies responded to the survey. According to the RA survey, 100% of DN studies included at least 1 RA criterion. According to the data extraction, 1 RA criterion was met in 45% of the DN studies. The magnitude of RA per study was 7 times higher according to the surveys than in the published reports. CONCLUSION These results suggest that COI and RA might be underreported in studies of DN. In addition, authors of DN studies might be unaware of the potential influence of RA on study results and conclusions. IMPACT Improved reporting of COI/RA might improve credibility of results and help identify the various factors involved in complex interventions provided by physical therapists. Doing so could help optimize treatments for musculoskeletal pain disorders provided by physical therapists.
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Affiliation(s)
- John W Ware
- Infirmary Therapy Services, Mobile, Alabama, USA
| | - Kenny Venere
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Stephanie A Miller
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Heather Freeman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - David A Scalzitti
- Department of Health, Human Function, & Rehabilitation Sciences, George Washington University, Washington, DC, USA
| | - Thomas Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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He P, Fu W, Shao H, Zhang M, Xie Z, Xiao J, Li L, Liu Y, Cheng Y, Wang Q. The effect of therapeutic physical modalities on pain, function, and quality of life in patients with myofascial pain syndrome: a systematic review. BMC Musculoskelet Disord 2023; 24:376. [PMID: 37173661 PMCID: PMC10176871 DOI: 10.1186/s12891-023-06418-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is a common musculoskeletal pain and dysfunction, which is characterised by myofascial trigger points. Therapeutic physical modalities, as potentially effective treatment options, are commonly used in the clinical setting for the patients with MPS. OBJECTIVE This systematic review aimed to evaluate the safety and effectiveness of therapeutic physical modalities in the treatment of MPS, investigate its therapeutic mechanisms and provide a scientific evidence-based decision. METHODS According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Cochrane Central Library, Embase, and CINAHL databases were searched for randomized controlled clinical studies published from database inception to October 30, 2022. A total of 25 articles met the study inclusion criteria. Data were extracted from these studies and a qualitative analysis was performed. RESULTS Transcutaneous electrical nerve stimulation therapy, extracorporeal shock wave therapy, laser therapy, and other therapeutic physical modalities have been demonstrated to improve the pain symptoms, joint mobility, psychological state, and quality of life in the patients with MPS and no side effects have been reported. The curative effect of therapeutic physical modalities was found to be possibly associated with increased blood perfusion and oxygen supply in ischaemic tissues, reduced hyperalgesia in the peripheral and central nerves, and decreased involuntary muscle contractions. CONCLUSION The systematic review has shown that therapeutic physical modalities could provide a safe and effective therapeutic option for MPS. However, the consensus is currently lacking regarding the optimal treatment paradigm, therapeutic parameters, and mutual combination of therapeutic physical modalities. The clinical trials with robust quality are required to further promote the evidence-based application of therapeutic physical modalities for MPS.
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Affiliation(s)
- Peijue He
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Wenxuan Fu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hang Shao
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Meng Zhang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhuoli Xie
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Juan Xiao
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lijuan Li
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yiwei Liu
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Yi Cheng
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Wang
- Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- Rehabilitation Medicine Key Laboratory of Sichuan Province, Chengdu, Sichuan, People's Republic of China.
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Fernández-de-las-Peñas C, Nijs J, Cagnie B, Gerwin RD, Plaza-Manzano G, Valera-Calero JA, Arendt-Nielsen L. Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain. Life (Basel) 2023; 13:694. [PMID: 36983849 PMCID: PMC10059732 DOI: 10.3390/life13030694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, Spain
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Jette, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Robert D. Gerwin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
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Ahi ED, Sirzai H. Comparison of the effectiveness of dry needling and high-intensity laser therapy in the treatment of myofascial pain syndrome: a randomized single-blind controlled study. Lasers Med Sci 2022; 38:3. [PMID: 36538189 DOI: 10.1007/s10103-022-03687-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
Myofascial pain syndrome (MPS) is a very common disease in the population that seriously affects quality of life. Although many treatment modalities are used, there is still no common protocol. The aim of this study was to compare the effectiveness of high-intensity laser therapy (HILT) and dry needling options. This prospective study included 108 patients with neck and/or upper back pain, diagnosed with MPS, who were randomly separated into 3 groups: the exercise group, the exercise + HILT group (HILT group), and the exercise + dry needling group (needling group). The visual analog scale (VAS), neck disability index (NDI), short form-36 (SF-36) scores, and neck range of motion (ROM) values of the patients before and after treatment were recorded and compared between the groups. In all 3 groups, the VAS and NDI scores decreased and ROM levels increased after treatment. The results in the HILT and needling groups were statistically significantly better than those of the exercise group (p < 0.05).The addition of HILT and dry needling to exercises is seen as a more successful treatment option to reduce pain in MPS. Clinical trial registration number: NCT05078333.
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Affiliation(s)
- Emine Dundar Ahi
- Faculty of Health Sciences, Physiotherapy and Rehabilitation, Kocaeli Health and Technology University, Private Medar Hospital, Yeniköy Mahallesi Ilıca Caddesi No:29, Başiskele, Kocaeli, Turkey.
| | - Hulya Sirzai
- Private Romatem Hospital Physical Medicine and Rehabilitation Department, Fulya, Hakkı Yeten Cd. No:9 Kat:1, 34365, Şişli, Istanbul, Turkey
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Guzmán Pavón MJ, Cavero Redondo I, Martínez Vizcaíno V, Ferri Morales A, Lorenzo García P, Álvarez Bueno C. Comparative Effectiveness of Manual Therapy Interventions on Pain and Pressure Pain Threshold in Patients With Myofascial Trigger Points: A Network Meta-analysis. Clin J Pain 2022; 38:749-760. [PMID: 36350630 DOI: 10.1097/ajp.0000000000001079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Myofascial trigger points (MTPs) are one of the most important causes of musculoskeletal pain. Evidence has suggested a positive effect of manual therapy in the treatment of MTPs. However, a comprehensive review comparing the effect of different manual therapy techniques are lacking. Thus, we conducted a network meta-analysis of randomized controlled trials to determine the type of manual therapy technique that has the greatest positive influence in patients with MTPs. MATERIALS AND METHODS PubMed, Web of Science, Cochrane Library, and Scopus databases were searched to identify direct and indirect evidence comparing the effectiveness of different types of manual therapy interventions on pain intensity and pressure pain threshold (PPT) in patients with MTPs. Risk of bias was assessed using the Cochrane RoB2 tool. A pairwise meta-analysis for direct and indirect comparisons between intervention and control/nonintervention groups was carried out. RESULTS A total of 37 studies were eligible for analysis. Combined interventions had the highest effect size for pain (-1.40; 95% CI, -2.34, -0.47), and the highest probability to be the best intervention and the highest Surface Under the Cumulative Ranking (64.7% and 87.9%, respectively). Afferent reduction techniques, understood as the interventions aimed to restore muscle spindles helping to dictate sarcomere length and tone in MTPs, had the highest effect size for PPT (0.93; 95% CI, 0.47, 1.39), and the highest probability to be the best intervention and the highest Surface Under the Cumulative Ranking (34.7% and 71.2%, respectively). The results were consistent in sensitivity analyses, with minimal inconsistencies between direct and indirect results. DISCUSSION Manual therapy interventions should be considered an effective strategy for pain and PPT in patients with MTPs. The results suggest that among the different manual therapy modalities, combined and afferent reduction techniques are the most effective for pain and PPT, respectively.
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Affiliation(s)
- María J Guzmán Pavón
- Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Toledo
| | | | - Vicente Martínez Vizcaíno
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile
- Universidad de Castilla la-Mancha, Health and Social Research Center, Santa Teresa Jornet, s/n, Cuenca, España
| | | | - Patricia Lorenzo García
- Universidad de Castilla la-Mancha, Health and Social Research Center, Santa Teresa Jornet, s/n, Cuenca, España
| | - Celia Álvarez Bueno
- Universidad de Castilla la-Mancha, Health and Social Research Center, Santa Teresa Jornet, s/n, Cuenca, España
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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Perreault T, Ball A, Dommerholt J, Theiss R, Fernández-de-las-Peñas C, Butts R. Intramuscular Electrical Stimulation to Trigger Points: Insights into Mechanisms and Clinical Applications-A Scoping Review. J Clin Med 2022; 11:6039. [PMID: 36294360 PMCID: PMC9605351 DOI: 10.3390/jcm11206039] [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: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Intramuscular electrical stimulation (IMES) is a modality used by clinicians to treat myofascial pain. Recent studies have shown positive results for the use of IMES on pain outcomes, yet studies investigating the potential mechanisms of IMES directly to trigger points (TrPs) are lacking. We performed a scoping review of the literature to summarize the current evidence from human and animal studies on the mechanisms of IMES to the TrP location, and to identify gaps in the existing literature. Electronic literature searches were conducted across five databases from inception to 15 August 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Scopus and Cochrane Register of Controlled Trials. Four studies met our full criteria for inclusion in this review. Three studies assessed the effects of IMES to TrPs on human subjects with MPS, and only one study used an animal model with experimentally generated TrPs. Based on the results of the included studies, IMES within a TrP region was reported to normalize muscle blood flow, decrease endplate noise of the TrP and elicit antinociceptive effects, at least partially, through engaging supraspinal descending pain inhibitory systems. At present, no clinical implications can be determined on the use of IMES to TrPs due to the limited amount and quality of the available evidence. Further studies investigating the clinical effectiveness and also underlying mechanisms of IMES to TrPs are clearly needed.
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Affiliation(s)
- Thomas Perreault
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA
| | - Andrew Ball
- Atrium Health, Carolinas Rehabilitation, Charlotte, NC 28216, USA
- Myopain Seminars, Bethesda, MD 20814, USA
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Robert Theiss
- Department of Physical Medicine and Rehabilitation, Atrium Health, Carolinas Rehabilitation, Charlotte, NC 28203, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Raymond Butts
- Department of Rehabilitative Sciences, Gannon University, Ruskin, FL 33573, USA
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Hock M, Járomi M, Prémusz V, Szekeres ZJ, Ács P, Szilágyi B, Wang Z, Makai A. Disease-Specific Knowledge, Physical Activity, and Physical Functioning Examination among Patients with Chronic Non-Specific Low Back Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12024. [PMID: 36231325 PMCID: PMC9564581 DOI: 10.3390/ijerph191912024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Physical activity, physical functioning, and pain are some of the most critical factors of low back pain (LBP) treatment and prevention, but it was unknown that the back school program (BSP) influences the physical activity level of the patients with LBP. Data from 306 healthy patients and patients with chronic non-specific low back pain (cnsLBP) were used. We used the Global Physical Activity Questionnaire (GPAQ), the Low Back Pain Knowledge Questionnaire (LKQ), the visual analog scale, and the Roland-Morris Disability Questionnaire (RMDQ). The significance level was set at p < 0.05. The amount of sedentary time in cnsLBP patients enrolled in the BSP was significantly lower compared to the other two groups (p < 0.001). Significantly higher moderate-intensity activities, leisure time activities, and active transportation were observed in the cnsLBP patients enrolled in the BSP than in the other two groups (p < 0.001). RMDQ scores and the pain intensity of the cnsLBP patients enrolled in the BSP were significantly lower than in patients with LBP receiving only exercise therapy (p < 0.001). The physical activity level and low-back-pain-specific knowledge was significantly higher, while back-related disability and pain intensity were significantly lower among patients with low back pain syndrome who participated in a back school program.
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Affiliation(s)
- Márta Hock
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
| | - Melinda Járomi
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
| | - Viktória Prémusz
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
| | - Zsolt János Szekeres
- Division of Preventive Cardiology and Rehabilitation, Medical School, University of Pécs, 2 Rákóczi Str., H-7623 Pecs, Hungary
| | - Pongrác Ács
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
| | - Brigitta Szilágyi
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
| | - Zhe Wang
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
| | - Alexandra Makai
- Faculty of Health Sciences, University of Pécs, 3 Vörösmarty Str., H-7621 Pecs, Hungary
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Aksan Sadikoglu B, Analay Akbaba Y, Taskiran H. Effects of ischemic compression and instrument-assisted soft tissue mobilization techniques in trigger point therapy in patients with rotator cuff pathology: randomized controlled study. Somatosens Mot Res 2021; 39:70-80. [PMID: 34818976 DOI: 10.1080/08990220.2021.2005015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the ischaemic compression (IC) and instrument-assisted soft tissue mobilization (IASTM) in the treatment of MTrPs in addition to standard rehabilitation program in patients with rotator cuff tears. METHODS Participants with rotator cuff tears were included the study (n = 46). Patients were randomly divided into two groups; which were Group 1 (IC + standard rehabilitation program (n = 23)), and Group 2 (IASTM + standard rehabilitation program (n = 23)) groups. Pain were assessed by visual analog scale (VAS). Range of motion (ROM) was assessed by a universal goniometer. Active MTrPs were assessed according to the Travel and Simons criteria. Pressure pain threshold (PPT) were assessed by a digital algometer. Function were evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and American Shoulder and Elbow Surgeons Standardised Shoulder Assessment (ASES) Form. Anxiety and depression were evaluated by the Hospital Anxiety and Depression (HAD) scale. Satisfaction was assessed by the Global Rating of Change scale after 6 weeks treatment. RESULTS After the treatment, pain, ROM and the DASH, ASES, HAD scores improved in both groups (p < 0.05). The active MTrPs of 2 muscles, PPT of 4 muscles and DASH in Group 1 significantly improved compared to Group 2 (p < 0.05). CONCLUSION Although patients with low functionality accumulated in the IC group, the IC is more effective than the IASTM in increasing the PPT and functional improvement according to the results of the DASH score.
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Affiliation(s)
- Busra Aksan Sadikoglu
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Yildiz Analay Akbaba
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hanifegul Taskiran
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
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Myofascial pain in temporomandibular disorders: Updates on etiopathogenesis and management. J Bodyw Mov Ther 2021; 28:104-113. [PMID: 34776126 DOI: 10.1016/j.jbmt.2021.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/14/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Temporomandibular disorders (TMDs) are an umbrella term encompassing disorders of both the temporomandibular joint (TMJD) and masticatory musculature (MMD). The objective of this review is to provide an overview of the etiopathogenesis, clinical features and diagnosis of MMD, and to summarize the current trends in the therapeutic management. METHODS A review of the literature was performed from 1985 to 2020. The keywords included were "temporomandibular disorders OR temporomandibular joint disorders" AND "myofascial pain OR masticatory myofascial pain OR trigger point". A total of 983 articles were screened with abstracts and approximately 500 full text articles were included in the review based on their relevance to the topic. RESULTS MMD's present significant challenges in diagnosis and treatment. Effective treatment requires a clear diagnosis based on an understanding of pathophysiologic mechanisms, a detailed history with assessment of predisposing local and systemic factors, perpetuating factors, a comprehensive clinical evaluation and a diagnostic workup. CONCLUSION A thorough history and clinical examination are the gold standards for diagnosis of MMD. Serological testing may help identify underlying co-morbidities. Recent diagnostic modalities including ultrasound sonoelastography and magnetic resonance elastography (MRE) have shown promising results. The treatment goals for MMD are to control pain, restore mandibular function and facilitate the return to normal daily activity and improve the overall quality of life of a patient. Conservative modalities including home care regimens, pharmacotherapy, intraoral appliance therapy, local anesthetic trigger point injections, physiotherapy and complementary modalities may be beneficial in patients with MMD's.
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Myburgh C, Kildsgaard K, Damsgaard T, Corfixen K, Boyle E. Consistency of Dry-Needling Interventions Across High-Quality Randomized Trials: A Critical Systematic Exploration of Intervention Reporting and Fidelity. J Manipulative Physiol Ther 2021; 44:546-557. [DOI: 10.1016/j.jmpt.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022]
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12
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Kanhachon W, Boonprakob Y. Modified-Active Release Therapy in Patients with Scapulocostal Syndrome and Masticatory Myofascial Pain: A Stratified-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8533. [PMID: 34444281 PMCID: PMC8392135 DOI: 10.3390/ijerph18168533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 01/12/2023]
Abstract
Modified-active release therapy (mART) was developed to treat patients experiencing upper quarter pain. The objective of the study was to determine the effectiveness of the mART in treating pain, promoting function, and measuring emotions in patients with scapulocostal syndrome (SCS) and masticatory myofascial pain (MMP). A stratified-randomized controlled trial was employed in 38 participants separated into two groups. All participants underwent the same series visual analog scale (VAS), pressure pain threshold (PPT), mouth opening (MO), maximum mouth opening (MMO), craniovertebral angle (CV-angle), and pain catastrophizing scale Thai version (PCS-Thai-version) at the baseline. The mART group underwent the mART program three times a week for 4 weeks with a hot pack and an educational briefing while the control group received only a hot pack and the educational briefing. After treatment, both groups showed significant improvement (p < 0.05) in all parameters except MO, MMO, and CV-angle. When comparing outcomes between the groups, the mART group showed a statistically significant greater number of improvements than did the control group. In conclusion, the mART program can improve pain experienced by patients with SCS and MMP and it can be used as an adjuvant technique with conservative treatment.
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Affiliation(s)
- Wilawan Kanhachon
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand;
- Research Institute for Human High Performance and Health Promotion, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Yodchai Boonprakob
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand;
- Research Institute for Human High Performance and Health Promotion, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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13
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Moustafa IM, Diab AA, Hegazy F, Harrison DE. Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: a randomized, placebo-controlled trial. Sci Rep 2021; 11:15379. [PMID: 34321539 PMCID: PMC8319301 DOI: 10.1038/s41598-021-94548-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
A randomized controlled study was conducted to evaluate the effect of rehabilitation of the cervical sagittal configuration on sensorimotor integration and central conduction time in an asymptomatic population. Eighty (32 female) participants with radiographic cervical hypolordosis and anterior head translation posture were randomly assigned to either a control or an experimental group. The experimental group received the Denneroll cervical traction while the control group received a placebo treatment. Interventions were applied 3 × per week for 10 weeks. Outcome measures included radiographic measured anterior head translation distance, cervical lordosis (posterior bodies of C2–C7), central somatosensory conduction time (latency) (N13–N20), and amplitudes of potentials for spinal N13, brainstem P14, parietal N20 and P27, and frontal N30. Outcomes were obtained at: baseline, after 10 weeks of intervention, and at 3 months follow up. After 10 weeks and 3-months, between-group analyses revealed statistically significant differences between the groups for the following measured variables: lordosis C2–C7, anterior head translation, amplitudes of spinal N13, brainstem P14, parietal N20 and P27, frontal N30 potentials (P < 0.001), and conduction time N13–N20 (P = 0.004). Significant correlation between the sagittal alignment and measured variables were found (P < 0.005). These findings indicate restoration of cervical sagittal alignment has a direct influence on the central conduction time in an asymptomatic population.
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Affiliation(s)
- Ibrahim M Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE.,Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Aliaa A Diab
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Fatma Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Deed E Harrison
- CBP Nonprofit (A Spine Research Foundation), 950 E. Riverside Drive, Eagle, ID, USA.
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14
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Puntumetakul R, Saiklang P, Tapanya W, Chatprem T, Kanpittaya J, Arayawichanon P, Boucaut R. The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157811. [PMID: 34360103 PMCID: PMC8345381 DOI: 10.3390/ijerph18157811] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/19/2022]
Abstract
Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.
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Affiliation(s)
- Rungthip Puntumetakul
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand;
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-834196186
| | - Pongsatorn Saiklang
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok 26120, Thailand;
| | - Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand;
| | - Thiwaphon Chatprem
- Research Center of Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Jaturat Kanpittaya
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Preeda Arayawichanon
- Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Rose Boucaut
- iCAHE (International Centre for Allied Health Evidence), School of Health Sciences (Physiotherapy), University of South Australia, Adelaide, SA 5001, Australia;
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15
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Dalpiaz A, Kuriki HU, Barbosa RAP, Diefenthaeler F, Marcolino AM, Barbosa RI. Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial. J Manipulative Physiol Ther 2020; 44:61-71. [PMID: 33248747 DOI: 10.1016/j.jmpt.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/22/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether dry needling (DN) added to photobiomodulation (PBM) has effects on the treatment of active myofascial trigger points in the upper trapezius. METHODS This study was a randomized clinical trial, with 43 participants divided into 3 groups: DN and PBM (DNP), DN, and DN outside of the trigger point (DNout). Each group received 1 session of DN followed by PBM therapy with the machine turned on or off. Pain, disability, pain pressure threshold, and muscle activity were assessed before the intervention and afterward at intervals of 10 minutes, 30 minutes, 1 week, and 1 month. RESULTS Pain decreased after intervention in the DNP and DNout groups, with mean differences, respectively, of 1.33 cm (95% confidence interval [CI], 0.019-2.647) and 2.78 cm (95% CI, 1.170-2.973). Scores for the disability questionnaire decreased in all groups after intervention (F = 36.53, P < .0001) after the intervention, with mean differences of 3.8 points in the DNP group (95% CI, 1.082-5.518), 3.57 in the DN group (95% CI, 0.994-6.149), and 5.43 in the DNout group (95% CI, 3.101-7.756). There were no significant differences between or within groups in pain pressure threshold (F = 2.14, P = .139), with mean differences after 30 minutes of 0.139 kgf for the DNP group (95% CI, -0.343 to 0.622), 0.273 for the DN group (95% CI, -0.661 to 1.209), and -0.07 for the DNout group (95% CI, -0.465 to 0.324). Muscle activation for the DN group increased 8.49% after the intervention, where for the DNP group it decreased 11.5%, with a significant difference between groups. CONCLUSION DN added to PBM presented similar results compared to DNout and DN. In this sample, the effects of the application of DN outside of the trigger point had better effects on pain and disability scores than DN applied directly on the trigger point.
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Affiliation(s)
- Ameg Dalpiaz
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Heloyse Uliam Kuriki
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Renan Andrade Pereira Barbosa
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Fernando Diefenthaeler
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Alexandre Marcio Marcolino
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil
| | - Rafael Inacio Barbosa
- Center of Sciences, Technologies and Health, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil.
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16
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Guzmán-Pavón MJ, Cavero-Redondo I, Martínez-Vizcaíno V, Fernández-Rodríguez R, Reina-Gutierrez S, Álvarez-Bueno C. Effect of Physical Exercise Programs on Myofascial Trigger Points-Related Dysfunctions: A Systematic Review and Meta-analysis. PAIN MEDICINE 2020; 21:2986-2996. [PMID: 33011790 DOI: 10.1093/pm/pnaa253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points. METHODS A systematic search was conducted in Pubmed, Web of Science, and Scopus. Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included. Risk of bias was assessed using the Cochrane RoB2 tool. The DerSimonian-Laird method was used to compute the pooled effect sizes (ES) and their 95% confidence interval (95% CI) for pain intensity, pressure pain threshold, range of motion, and disability. RESULTS A total of 24 randomized controlled trials were included in this systematic review and meta-analysis. The pooled ES were -0.47 (95% CI = -0.61 to -0.33) for pain intensity, 0.63 (95% CI = 0.31 to 0.95) for pressure pain threshold, 0.43 (95% CI = 0.24 to 0.62) for range of motion, and -0.18 (95% CI = -0.45 to 0.10) for disability. CONCLUSIONS Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.
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Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
| | | | - Sara Reina-Gutierrez
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla la-Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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17
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Kongsagul S, Vitoonpong T, Kitisomprayoonkul W, Tantisiriwat N. Ultrasound-Guided Physiological Saline Injection for Patients with Myofascial Pain. J Med Ultrasound 2020; 28:99-103. [PMID: 32874868 PMCID: PMC7446687 DOI: 10.4103/jmu.jmu_54_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/23/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Based on the histological confirmation of the presence of nerve structure in the fascia, hence, myofascial pain was treated by the mechanism referred to as interfascial block. To date, the studies of physiological saline for treating patients with myofascial pain has been limited. Ultrasound (US) guided with physiological saline injection (PSI) technique has been routinely practiced among patients with myofascial pain in outpatient service at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. The main objective of this present study is to find the overview data including the percentage of patients responding, acceptable pain period, and adverse events. Materials and Methods: Electronic medical reports among 142 patients receiving US-guided PSI from August 1, 2016, to November 20, 2017, at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, were retrospectively reviewed by the first author. Procedures were performed by the last author. The analysis was independently performed by the first author. Results: One hundred and forty-two patients with complete medical records were compatible with analysis. The average age of patients was 55 years. Most of the patients were female (68.3%). Most of the patients (76.8%) had chronic suffering from myofascial pain. Approximately half of the patients (56.4%) are currently received pain-relieving medications. Upper trapezius muscle (19.5%) was the most common muscle receiving the procedure, followed by multifidus (10.0%) and quadratus lumborum (9.5%). Most of the patients (86.8%) received the procedure one muscle. Approximately 30% of the patients were able to stop pain-relieving medications after the procedure. The median of acceptable pain period was 63 days. The percentage of patients having an acceptable pain period >3 months was 43.9%. No major adverse events were demonstrated. Conclusion: US-guided PSI technique demonstrated pain reduction in 72.8% of the analyzed patients, with an acceptable pain period of 63 days. No major adverse events were demonstrated among all the patients. This technique should be considered as another invasive procedure for eradication myofascial trigger point.
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Affiliation(s)
- Sussaya Kongsagul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Timporn Vitoonpong
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Rehabilitation Medicin, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Wasuwat Kitisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natthiya Tantisiriwat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Rehabilitation Medicin, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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18
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Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Curr Opin Support Palliat Care 2020; 13:270-276. [PMID: 31313700 DOI: 10.1097/spc.0000000000000445] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points. RECENT FINDINGS The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated. SUMMARY The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.
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19
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Taulaniemi A, Kankaanpää M, Rinne M, Tokola K, Parkkari J, Suni JH. Fear-avoidance beliefs are associated with exercise adherence: secondary analysis of a randomised controlled trial (RCT) among female healthcare workers with recurrent low back pain. BMC Sports Sci Med Rehabil 2020; 12:28. [PMID: 32391158 PMCID: PMC7197113 DOI: 10.1186/s13102-020-00177-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Background Exercise is recommended for the treatment and management of low back pain (LBP) and the prevention of chronicity. Exercise adherence has been only modest in intervention studies among people with musculoskeletal pain. Fear-avoidance beliefs (FABs) are known to affect exercise adherence. The purpose was twofold: to examine which bio-psycho-social factors contributed to exercise adherence during a 6-month neuromuscular exercise intervention among female healthcare workers with recurrent LBP, and to investigate how exercising affects FABs at 6 and 12 months’ follow-up. Methods Some 219 healthcare workers aged 30–55 years with mild-to-moderate re-current non-specific LBP were originally allocated into: 1) exercise, 2) counselling, 3) combined exercise and counselling, and 4) control groups. In the present secondary analysis, groups 1 and 3 (exercise only and exercise+counselling) were merged to be exercisers and groups 2 and 4 were merged to be non-exercisers. Baseline variables of the exercise compliers (≥24 times over 24 weeks; n = 58) were compared to those of the non-compliers (< 1 time/week, 0–23 times; n = 52). The effects of the exercise programme on FABs were analysed by a generalised linear mixed model according to the intention-to-treat principle (exercisers; n = 110 vs non-exercisers; n = 109) at three measurement points (baseline, 6, and 12 months). A per-protocol analysis compared the more exercised to the less exercised and non-exercisers. Results A low education level (p = 0.026), shift work (p = 0.023), low aerobic (p = 0.048) and musculoskeletal (p = 0.043) fitness, and high baseline physical activity-related FABs (p = 0.019) were related to low exercise adherence. The exercise programme reduced levels of both physical activity- and work-related FABs, and there was a dose response: FABs reduced more in persons who exercised ≥24 times compared to those who exercised 0–23 times. Conclusion Healthcare workers who had lower education and fitness levels, worked shifts, and had high physical activity-related FABs had a lower adherence to the 6-month neuromuscular exercise programme. Exercising with good adherence reduced levels of FABs, which have been shown to be linked with prolonged LBP. Motivational strategies should be targeted at persons with low education and fitness levels and high FABs in order to achieve better exercise adherence.
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Affiliation(s)
| | - Markku Kankaanpää
- 2Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland
| | - Marjo Rinne
- 1UKK Institute for Health Promotion Research, Tampere, Finland
| | - Kari Tokola
- 1UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Parkkari
- 1UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jaana H Suni
- 1UKK Institute for Health Promotion Research, Tampere, Finland
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20
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Taulaniemi A, Kankaanpää M, Tokola K, Parkkari J, Suni JH. Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:328. [PMID: 31301741 PMCID: PMC6626624 DOI: 10.1186/s12891-019-2678-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Background Low back pain (LBP) is common among healthcare workers, whose work is physically strenuous and thus demands certain levels of physical fitness and spinal control. Exercise is the most frequently recommended treatment for LBP. However, exercise interventions targeted at sub-acute or recurrent patients are scarce compared to those targeted at chronic LBP patients. Our objective was to examine the effects of 6 months of neuromuscular exercise on pain, lumbar movement control, fitness, and work-related factors at 6- and 12-months’ follow-up among female healthcare personnel with sub-acute or recurrent low back pain (LBP) and physically demanding work. Methods A total of 219 healthcare workers aged 30–55 years with non-specific LBP were originally allocated to four groups (exercise, counselling, combined exercise and counselling, control). The present study is a secondary analysis comparing exercisers (n = 110) vs non-exercisers (n = 109). Exercise was performed twice a week (60 min) in three progressive stages focusing on controlling the neutral spine posture. The primary outcome was intensity of LBP. Secondary outcomes included pain interfering with work, lumbar movement control, fitness components, and work-related measurements. Between-group differences were analysed with a generalised linear mixed model according to the intention-to-treat principle. Per-protocol analysis compared the more exercised to the less exercised and non-exercisers. Results The mean exercise attendance was 26.3 (SD 12.2) of targeted 48 sessions over 24 weeks, 53% exercising 1–2 times a week, with 80% (n = 176) and 72% (n = 157) participating in 6- and in 12-month follow-up measurements, respectively. The exercise intervention reduced pain (p = 0.047), and pain interfering with work (p = 0.046); improved lumbar movement control (p = 0.042), abdominal strength (p = 0.033) and physical functioning in heavy nursing duties (p = 0.007); but had no effect on other fitness and work-related measurements when compared to not exercising. High exercise compliance resulted in less pain and better lumbar movement control and walking test results. Conclusion Neuromuscular exercise was effective in reducing pain and improving lumbar movement control, abdominal strength, and physical functioning in nursing duties compared to not exercising. Electronic supplementary material The online version of this article (10.1186/s12891-019-2678-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Taulaniemi
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland.
| | - Markku Kankaanpää
- Department of Physical and Rehabilitation Medicine, Tampere University Hospital, Tampere, Finland
| | - Kari Tokola
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Jari Parkkari
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Jaana H Suni
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
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21
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Moustafa IM, Diab AA, Hegazy F, Harrison DE. Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial. BMC Musculoskelet Disord 2018; 19:396. [PMID: 30419868 PMCID: PMC6233550 DOI: 10.1186/s12891-018-2317-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/24/2018] [Indexed: 11/26/2022] Open
Abstract
Background There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. Methods A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. Results After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001). Conclusion The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. Trial registration Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301, registered 11 January 2018 (retrospectively registered).
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Affiliation(s)
- Ibrahim M Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates. .,Basic Science Department, Faculty of Physical Therapy, Cairo University, 7 Mohamed Hassan El gamal Street-Abbas El Akaad, Nacer City, Egypt.
| | - Aliaa A Diab
- Basic Science Department, Faculty of Physical Therapy, Cairo University, 7 Mohamed Hassan El gamal Street-Abbas El Akaad, Nacer City, Egypt
| | - Fatma Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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22
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Madaleno FO, Santos BA, Araújo VL, Oliveira VC, Resende RA. Prevalence of knee osteoarthritis in former athletes: a systematic review with meta-analysis. Braz J Phys Ther 2018; 22:437-451. [PMID: 29636304 PMCID: PMC6235824 DOI: 10.1016/j.bjpt.2018.03.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/13/2018] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prevalence of knee osteoarthritis in former athletes is still unclear. OBJECTIVE To investigate prevalence of knee osteoarthritis in former athletes. Moreover, the secondary aim was to investigate whether poor methodological quality of included studies, different diagnosis criteria for knee osteoarthritis, different sports modality or sex impact on overall estimated prevalence of knee osteoarthritis in former athletes. METHODS Searches on MEDLINE, EMBASE, AMED, SPORTDiscus and CINAHL from the earliest record to February 2018 and hand-searching identified studies investigating prevalence of knee osteoarthritis in former athletes. Meta-analysis was conducted and the GRADE system summarized strength of the current recommendations. Sensitivity analyses investigated whether methodological quality, diagnostic criteria, type of sports or sex impacted on the overall estimated prevalence in former athletes. This review was registered at PROSPERO (CRD42016050903). RESULTS Fifteen studies were included and pooling of 3100 participants estimated overall prevalence of knee osteoarthritis in former athletes of 30.0% (95% CI: 20.0 to 40.0%). The strength of the current recommendations was low-quality. Sensitivity analyses suggested that different diagnostic criteria for knee osteoarthritis and type of sports may impact on the overall estimated prevalence. CONCLUSIONS Prevalence of knee osteoarthritis in former athletes was 30.0%. Researchers, clinicians and policymakers should be careful about potential prevalence differences among type of sports and diagnostic criteria. Current low-quality evidence shows that future high-quality studies are likely to impact on the estimated prevalence.
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Affiliation(s)
- Fernanda O Madaleno
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna A Santos
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa L Araújo
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vinicius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Renan A Resende
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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23
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Doi A, Sakasaki J, Tokunaga C, Sugita F, Kasae S, Nishimura K, Sato Y, Kuratsu T, Hashiguchi S, Shin MC, Yoshimura M. Both ipsilateral and contralateral localized vibratory stimulations modulated pain-related sensory thresholds on the foot in mice and humans. J Pain Res 2018; 11:1645-1657. [PMID: 30214274 PMCID: PMC6118348 DOI: 10.2147/jpr.s162379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose This study was aimed to investigate the effect of localized vibration on sensory thresholds in mice and humans using a novel quantitative method. Participants and methods The sensory thresholds of 7-week-old male C57BL/6J mice were measured with four sine-wave electrostimulation frequencies (5, 50, 250, and 2,000 Hz) before and after applying 2-minute vibration to the plantar side of the foot in mice. In human participants (16 males and 16 females; mean age, 21.0±0.8 years), the sensory threshold was measured at 50 Hz before and after applying 2-minute and 5-minute vibrations to the dorsal side of the foot. Results Application of a 2-minute vibration at either the ipsilateral or contralateral side modulated the sensory thresholds elicited by a 5- or 50-Hz right electrostimulation in mice. In human participants, application of a 5-minute vibration at either the ipsilateral or contralateral side modulated the sensory threshold elicited by 50-Hz right electrostimulation, but had no effect on local skin temperature. These results suggest that the right side of pain-related Aδ fibers (50 Hz) or C fibers (5 Hz) was modulated by the localized ipsilateral or contralateral side of vibratory stimuli, respectively, in mice and humans. Conclusion The ability of contralateral vibration to modify the right sensory thresholds suggests possible involvement of the central nervous system in vibratory modulation.
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Affiliation(s)
- Atsushi Doi
- Department of Physical Therapy, Kumamoto Health Science University, Kumamoto, Japan, .,Graduate School of Health Sciences, Kumamoto Health Science University, Kumamoto, Japan,
| | - Juntaro Sakasaki
- Department of Rehabilitation, Tokyo-Wangan Rehabilitation Hospital, Narashino, Japan
| | | | - Fumiya Sugita
- Department of Rehabilitation, Tamana Central Hospital, Tamana, Japan
| | - Syota Kasae
- Department of Rehabilitation, Shimizu Hospital, Kyoto, Japan
| | | | - Yushi Sato
- Department of Rehabilitation, Showa Hospital, Shimonoseki, Japan
| | - Takako Kuratsu
- Department of Rehabilitation, Konan Hospital, Kumamoto, Japan
| | - Sariya Hashiguchi
- Department of Rehabilitation, Asahino-Sogo Hospital, Kumamoto, Japan
| | - Min-Chul Shin
- Department of Physical Therapy, Kumamoto Health Science University, Kumamoto, Japan, .,Graduate School of Health Sciences, Kumamoto Health Science University, Kumamoto, Japan,
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24
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Yoshida S, Hagiwara Y, Tsuchiya M, Shinoda M, Koide M, Hatakeyama H, Chaweewannakorn C, Yano T, Sogi Y, Itaya N, Sekiguchi T, Yabe Y, Sasaki K, Kanzaki M, Itoi E. Involvement of neutrophils and interleukin-18 in nociception in a mouse model of muscle pain. Mol Pain 2018; 14:1744806918757286. [PMID: 29353540 PMCID: PMC5802617 DOI: 10.1177/1744806918757286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Muscle pain is a common condition that relates to various pathologies. Muscle overuse induces muscle pain, and neutrophils are key players in pain production. Neutrophils also play a central role in chronic pain by secreting interleukin (IL)-18. The aim of this study was to investigate the involvement of neutrophils and IL-18 in a mouse model of muscle pain. The right hind leg muscles of BALB/c mice were stimulated electrically to induce excessive muscle contraction. The left hind leg muscles were not stimulated. The pressure pain threshold, number of neutrophils, and IL-18 levels were investigated. Furthermore, the effects of the IL-18-binding protein and Brilliant Blue G on pain were investigated. In stimulated muscles, pressure pain thresholds decreased, and neutrophil and IL-18 levels increased compared with that in non-stimulated muscles. The administration of IL-18-binding protein and Brilliant Blue G attenuated hyperalgesia caused by excessive muscle contraction. These results suggest that increased IL-18 secretion from larger numbers of neutrophils elicits mechanical hyperalgesia.
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Affiliation(s)
- Shinichirou Yoshida
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihiro Hagiwara
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Masamichi Shinoda
- 3 Department of Functional Anatomy and Neuroscience, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Koide
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroyasu Hatakeyama
- 4 Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | | | - Toshihisa Yano
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhito Sogi
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuyuki Itaya
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuya Sekiguchi
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Yabe
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Sasaki
- 4 Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Makoto Kanzaki
- 4 Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Eiji Itoi
- 1 Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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