Interrater Reliability in the Clinical Evaluation of Myofascial Trigger Points in Three Ankle Muscles

Dry needling of the flexor digitorum brevis muscle reduces postural control in standing: A pre-post stabilometric study

There are studies that show the better balance after dry needling in lumbar pain. However, the postural control effects after foot dry needling are unknown. Our objective was to check if dry needling reduces postural control. Eighteen subjects with flexor digitorum brevis (FDB) muscle Myofascial trigger point were evaluated pre- and post-deep dry needling. We measured stabilometric variables in a pre-post study. We have found significant differences in three stabilometric variables: surface with eyes closed (29.36-53.21 mm2 ) (p = 0.000), medium speed of the laterolateral displacement with eyes closed (1.42-1.64 mm/s) (p = 0.004), and medium speed of the anteroposterior displacement with eyes closed (1.30-1.53 mm/s) (p = 0.025). Dry needling therapy application in FDB muscle reduces standing postural control with eyes closed.

Effects on Neuromuscular Function After Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial

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.

Current advances and novel research on minimal invasive techniques for musculoskeletal disorders

The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.

Reliability of trigger points evaluation in the lower leg muscles

BACKGROUND

Myofascial trigger point diagnosis is a clinical palpatory skill dependent on the patient's subjective response. The inter- and intra-rater reliability of trigger point physical evaluation in the lower leg muscles has rarely been reported. Previous reliability studies suffered from the Kappa paradox.

OBJECTIVE

To evaluate the inter- and intra-rater reliability of trigger point recognition in the lower leg muscles implying a specific method to overcome the 1st Kappa paradox.

DESIGN

A reliability study with pre-second examiner exclusion to correct prevalence index.

SETTING

Physical therapy outpatient clinic, Beer-Sheva, Israel.

SUBJECTS

86 soldiers aged 18-30 referred for physical therapy with a diagnosis of musculoskeletal pain consented to take part in this study. 26 were excluded for lacking trigger points, leaving 60 subjects for analysis (31 women, 29 men).

METHODS

Both legs were evaluated, and the results were analyzed separately for symptomatic (N = 87) and asymptomatic legs (N = 31).Each subject was evaluated three times, twice by one examiner, and once by a second examiner. Dichotomous findings including palpable taut-band, tenderness, referred pain, and relevance of referred pain were recorded.

RESULTS

Inter-rater reliability for active trigger points ranged from 0.49 to 0.75 (median: 0.52) and intra-rater reliability ranged from 0.41 to 0.84 (median: 0.65) and. For total trigger points intra-rater reliability ranged from 0.52 to 0.79 (median: 0.67), and inter-rater reliability ranged from 0.44 to 0.77 (median: 0.66).

CONCLUSIONS

Physical examination is a reliable method of trigger point evaluation in lower leg muscles, and it can be used as a diagnostic method for trigger point evaluation.

Neuromuscular Mechanosensitivity in Subjects with Chronic Ankle Sprain: A Cross-Sectional Study

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries in sports, at work, and at home. Subjects who suffer from this injury may develop ankle instability. Functional instability has been associated with a high rate of resprain and impaired neuromuscular control in patients with ankle instability.

OBJECTIVE

Measurement of neural and muscular mechanosensitivity after ankle sprain injury and establishment of the relationship between these variables.

METHODS

A cross-sectional case-control study was performed with a sample of 58 students from Alcalá de Henares University (21 males and 37 females, mean age ± SD = 21 ± 3.7 years). Subjects were divided into two groups: a case group (N = 29, subjects with unstable ankle) and a control group (N = 29, healthy subjects). The pressure pain threshold (PPT) of the tibialis anterior, peroneus longus, and peroneus brevis muscles and mechanosensitivity of the common peroneus and tibial nerves were evaluated in all subjects through a manual mechanical algometer.

RESULTS

Neuromuscular PPTs showed significant differences (P < 0.05) between both groups, such that, compared with the control group, the case group exhibited significantly lower PPT levels. In the case group, a strong positive correlation was observed between neural and muscular homolateral mechanosensitivity in both lower limbs.

CONCLUSIONS

Participants with chronic ankle instability showed higher neuromuscular mechanosensitivity in muscles and nerves surrounding the ankle joint than healthy subjects. These findings indicate that low PPT values may be associated with symptoms that characterize this disease.

Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study

BACKGROUND

The effects of the dry needling technique and pain reduction have been demonstrated in numerous quality studies. However, the mechanical effects of dry needling are largely unknown.

METHODS

A total of 18 subjects with flexor digitorum brevis muscle myofascial trigger point were evaluated pre- and post-deep dry needling. We measured static footprint variables in a pre-post study.

MAIN FINDINGS

We found differences in rearfoot maximum pressure (119.22-111.63 KPa; p = 0.025), midfoot maximum pressure (13.68-17.26 KPa; p = 0.077), midfoot medium pressure (4.75-6.24 KPa; p = 0.035) and forefoot surface (86.58-81.75 cm²; p = 0.020). All variables with significant differences decrease, with the exception of forefoot surface which showed an increase.

CONCLUSIONS

After flexor digitorum brevis muscle dry needling, midfoot plantar pressures (maximum and medium) and forefoot surface were increased, and rearfoot maximum pressure was decreased.

Interrater and Intrarater Reliability and Minimum Detectable Change of Ultrasound for Active Myofascial Trigger Points in Upper Trapezius Muscle in Individuals With Shoulder Pain

OBJECTIVE

We sought to investigate the interrater and intrarater reliability of ultrasound and the minimum detectable change (MDC) for the trigger points (TrPs) active in the upper trapezius (UT) muscle in individuals with shoulder pain.

METHODS

Forty individuals with shoulder pain were investigated for the presence of active TrPs in the UT muscle by means of ultrasound for the parameters of gray scale, muscle thickness of UT muscle at rest, and contraction and area of TrPs. The intrarater reliability was performed on 2 days, and interrater reliability on the same day. For the gray scale, the reliability was evaluated using the kappa coefficient (κ), while the other parameters were measured by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and MDC.

RESULTS

For the gray scale, the intrarater agreement was almost perfect (κ = 1.00) and the interrater agreement was substantial (κ = 0.75). The intrarater and interrater reliability were excellent for most of the parameters, except for the area of TrPs (intrarater: ICC = 0.71, substantial; interrater: ICC = 0.52, substantial). The MDC for intrarater reliability varied between 0.04 and 0.05 (SEM% between 2.4% and 38.87%), and that for interrater reliability ranged from 0.05 to 0.07 (SEM% between 3.18% and 55.10%), with a higher value for area.

CONCLUSION

Parameters such as gray scale, resting muscle thickness, and muscle contraction of the UT muscle, obtained through ultrasound, showed excellent intrarater and interrater reliability with low SEM%. The intrarater and interrater reliability for the area deserves a caveat regarding their use.

Hip-Joint Posture and Movement Alterations Are Associated With High Interference of Pain in the Life of Patients With Greater Trochanteric Pain Syndrome

OBJECTIVE

Greater trochanteric pain syndrome (GTPS) is a common condition that can cause lateral hip pain. The single-leg-squat test (SLST) may be used by physicians in primary care environments to evaluate patients' dynamic stability. The aim of this study was to evaluate the dynamic stability and strength of lateral abduction hip movements in primary care patients with GTPS in relation to their perceived pain interference in life.

METHODS

A descriptive observational study was carried out in a primary health care center. Fifty-four participants with GTPS were included in this study and divided into lower- and higher-interference groups (n = 30 and 19, respectively) according to the Graded Chronic Pain Scale. Participants were evaluated for their lateral abduction hip strength and the SLST.

RESULTS

The SLST showed a statistically significant difference between groups with respect to hip-joint posture and movement level (P = .043) but not for other SLST domains or lateral abduction hip strength (P > .05).

CONCLUSION

Patients with GTPS with more pain interference in their lives had poorer dynamic stability with respect to hip-joint posture and movements based on the SLST but did not present impaired lateral hip abduction strength in comparison with those who perceived lower pain interference in life.

Comparison of dry needling and ischaemic compression techniques on pain and function in patients with patellofemoral pain syndrome: a randomised clinical trial

BACKGROUND

To compare the effectiveness of ischaemic compression (IC) applied directly to the knee versus dry needling (DN) with respect to pain, functional status and sensitivity to mechanical stimulation of vastus medialis obliquus (VMO) myofascial trigger points (MTrPs) in patients with patellofemoral pain syndrome (PFPS).

METHODS

A total of 54 patients with unilateral PFPS aged 20-30 years were selected randomly from patients referred to physical therapy clinics of Babol University of Medical Sciences in Iran. Twenty-seven patients were allocated to either IC or DN groups. Three sessions of treatment were applied over 1 week with follow-up at 1 week, 1 month and 3 months. Primary outcome measures comprised the Kujala questionnaire score for functional status, numerical pain rating scale (NPRS) for pain intensity and pressure pain threshold (PPT) for sensitivity to mechanical stimulation; these were measured and recorded before treatment and 1 week, 1 month and 3 months after the last treatment session.

RESULTS

There were no statistically significant differences in the between-group comparisons of any variables at the various follow-up points. Both groups (n = 27 participants each) had significant improvements (p < 0.05) in pain, functional status and PPT values at follow-up.

CONCLUSIONS

There were no differences in markers of pain, function or pressure sensitivity over a 3-month follow-up period between patients with PFPS treated with DN and IC. Temporal improvements in both groups suggested that the two techniques may be similarly effective for the treatment of PFPS.

Kinesiophobia and Pain Intensity Are Increased by a Greater Hallux Valgus Deformity Degree- Kinesiophobia and Pain Intensity in Hallux Valgus

Background: Hallux valgus (HV) has been previously associated with psychological disorders. Thus, the purposes of this study were to associate kinesiophobia and pain intensity with HV deformity degrees, as well as predict kinesiophobia and pain intensity based on HV deformity and demographic features. Methods: A cross-sectional study was carried out recruiting 100 subjects, who were divided into HV deformity degrees, such as I-no HV (n = 25), II-mild (n = 25), III-moderate (n = 25), and IV-severe (n = 25) HV. Kinesiophobia total and domains (activity avoidance and harm) scores and levels were self-reported by the Tampa Scale of Kinesiophobia (TSK-11). Pain intensity was self-reported by the numeric rating scale (NRS). Results: Statistically significant differences (p < 0.01; η² = 0.132–0.850) were shown for between-groups comparison of kinesiophobia total and domain scores (activity avoidance and harm) and levels, as well as pain intensity among HV deformity degrees. Post hoc comparisons showed statistically significant differences with a large effect size (p < 0.05; d = 0.85–4.41), showing higher kinesiophobia symptoms and levels and pain intensity associated with greater HV deformity degrees, especially for III-moderate and/or IV-severe HV deformity degrees versus I-no HV and/or II-mild deformity degrees. Both statistically significant prediction models (p < 0.05) for kinesiophobia (R² = 0.300) and pain intensity (R² = 0.815) were predicted by greater HV deformity degree and age. Conclusions: Greater kinesiophobia symptoms and levels and pain were associated with higher HV deformity degrees, especially severe and/or moderate HV with respect to no and/or mild HV. The kinesiophobia and pain intensity were predicted by greater HV deformity degree and age.

Fibularis tertius muscle in women & men: A surface anatomy cross-sectional study across countries

The fibularis tertius muscle (FTM) is a rare anatomic variation. The prevalence of this exclusively human structure, which is found in the anterior compartment of the leg, is often underestimated, and it is believed that foot and ankle conditions are more difficult to manage in patients with an FTM. The aim of this study was to assess the presence of the FTM palpation and determine whether its presence is associated with an individual’s sex, because the exact prevalence in males and females is unclear. An observational cross-sectional study was carried out. The study included 481 people (23.49% men and 76.51% women) with a mean age of 23.51±5.369 years, who were recruited from a Podiatric Medicine and Surgery Clinic (Spain). Data on routine demographic and clinical factors were recorded, and the presence or absence of the FTM was determined based on surface visual or palpated localization of the tendon (using a consistent protocol). The FTM was present in 38.25% (184/481) of the participants. Furthermore, FTM were present in 38.6% (142/481) of females and 37.2% (42/481) of males. The study revealed that the presence of the FTM varies between individuals and does not depend on an individual’s sex. Significant differences in the prevalence of the FTM between countries should be carefully evaluated rather than generalizing the results of this Spanish study to other non-Spanish populations. Larger numbers of participants should be enrolled in future studies in order to meet the statistical criteria.

Characteristics and distributions of myofascial trigger points in individuals with chronic tension-type headaches

[Purpose] To investigate the characteristics and distributions of the myofascial trigger point (TrP) and pressure pain threshold (PPT) of the active TrP in individuals with chronic tension-type headache (CTTH). [Participants and Methods] Fifty-three CTTH patients and 53 age and gender-matched individuals without CTTH (CON) were recruited. The TrPs and tenderness points were first identified by manual palpation, and the PPTs of the active TrPs were determined by using a manual algometer. [Results] The active TrP, latent TrP and tenderness point totals per person in the head, neck, shoulder and upper back in CTTH were 4.3 ± 2.1, 0.6 ± 1.0 and 1.9 ± 1.8, respectively, while those in CON were 0, 0.7 ± 1.5 and 1.9 ± 1.8, respectively. The PPT levels of the active TrPs were 0.7 ± 0.2 to 1.2 ± 0.6 kg/cm² in the muscles of the head, neck, shoulder and upper back. A larger number of active TrPs and lower PPT levels of the active TrPs were found in the head, neck and shoulder regions than in the upper back region. [Conclusion] Lower PPTs of the active TrPs in the head, neck and shoulder regions could influence the individuals with CTTH.

International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study

Objective

There is no consensus on the essential diagnostic criteria for diagnosing a trigger point (TrP). In fact, a variety of diagnostic criteria are currently being used. Our aim was to conduct a Delphi panel to achieve an international consensus on the cluster of criteria needed for the TrP diagnosis to reach a consensus on the definition of active and latent TrPs and to clarify different clinical considerations about TrPs.

Methods

Following international guidelines, an international three-round Delphi survey was conducted. Questions were created based on a systematic literature search of the diagnostic criteria for TrPs.

Results

Sixty experts from 12 countries completed all rounds of the survey. A cluster of three diagnostic criteria was proposed as essential for the TrP diagnosis: a taut band, a hypersensitive spot, and referred pain. Eighty percent of the experts agreed that the referred pain elicited by a TrP can include different sensory sensations and not just pain, that is, pain spreading to a distant area, deep pain, dull ache, tingling, or burning pain. Eighty-four percent of the international experts consistently answered that the main clinical differences between active and latent TrPs are the reproduction of any of the symptoms experienced by a patient and the recognition of pain. No specific location of the pain referral area and TrP location should be expected.

Conclusions

This Delphi panel has produced an expert-based standardized definition of a TrP with a discussion of the clinical components, including the definition of referred pain and the difference between active and latent TrPs, thereby providing a foundation for future research in MPS.

A critical overview of the current myofascial pain literature - November 2018

This is the first issue of this review column since the passing of Dr. Leon Chaitow. We would like to take a brief moment to acknowledge how much his mentorship, friendship, and confidence have meant to us. Leon was a force in osteopathic and naturopathic medicine and his influence reaches to all corners of the musculoskeletal realm crossing over many disciplines through his lectures, workshops, and of course, his many books, editorials, and articles. In the foreword to one of his books, Jan Dommerholt wrote that "Leon Chaitow […] continued the work of Travell and Simons, but also of many others, whose contributions he has skillfully woven into an intricate tapestry of clinical pearls, practical tips, and solid evidence-informed research." Dr. Chaitow was a synthesizer, who always considered what different clinicians and researchers could possibly contribute to a better understanding of pain and dysfunction and provide real solutions to real problems. Even when he would not necessarily agree with all suggested remedies, he maintained an open mind and was able to take a step back and consider the bigger picture. For example, Leon was not a big fan of dry needling, yet, he valued the importance of this approach and encouraged the inclusion of dry needling papers in this review article and in his journal. The Journal of Bodywork and Movement Therapies became his baby and, considering the growth of the journal, there is no question that Leon's intense focus and efforts are appreciated by many around the globe. We wish to extend our condolences to Leon's wife Alkmini and daughter Sasha. He will surely be missed, but we can find peace in knowing that his legacy will stay with us forever. In this issue, we have included several basic myofascial pain research articles. As usual, dry needling (DN) studies and case reports are the most commonly referenced papers, but we also included neuroscience and electromyography studies, sleep studies, interrater reliability studies, and case reports of adverse events.

Functionality, comorbidity, complication & surgery of hip fracture in older adults by age distribution

BACKGROUND

Hip fractures may be the greatest complication secondary to osteoporotic disorder. The objective of this study was to determine the influence of age distribution in the functionality, comorbidity, complications and surgical features of older adults with hip fractures.

METHODS

A prospective cohort study was carried out from 2013 to 2014. A sample of 557 adults over 75 years old with osteoporotic hip fractures was recruited from the Orthogeriatric Unit of the León University Hospital (Spain). Age distributions of 75-84, 85-90 and >90 years old were considered. Firstly, sociodemographic data, fracture type and hospital staying days were collected. Secondly, baseline functionality (Barthel index), ambulation, cognitive impairment and comorbidities were described. Thirdly, surgical intervention, urgency, type, American Association of Anesthesiologists (ASA) scores, non-surgical cause, and baseline pharmacologic treatments were determined. Finally, complications and features at hospital discharge were observed.

RESULTS

The age ranges did not show any statistically-significant differences (P<.05; R2=.000-.005) for gender, fracture type, or number of hospital staying days. Statistically-significant differences (P<.05; R2=.011-.247) between age groups were observed for Barthel index, cognitive impairment, dementia, osteoporosis, Parkinson's disease, aortic stenosis, surgery type, ASA-score, non-surgical cause, benzodiazepines, antidementia, anti-osteoporosis, insulin, pharmacologic treatments, renal function alteration, heart failure, destination and ambulation features. All other measurements did not show statistically-significant differences (P>.05; R2=.000-.010).

CONCLUSION

Age distributions greater than 75 years old may determine the functionality, comorbidities, surgical features, baseline pharmacologic treatments, complications and features at hospital discharge for older adults who suffer a hip fracture.

A critical overview of the current myofascial pain literature - July 2018

In the current issue of this clinical overview, we are pleased to include several basic research studies ranging from the differentiation of radicular and non-radicular low back pain based on the presence of trigger points (TrPs) to the role of TrPs in patients with osteoarthritis, the diagnostic criteria of TrP, the accurate placement of needles in the piriformis muscle with dry needling (DN), and the reliability of TrP identification, among others. As usual, there are many new DN studies, but also several review papers, and manual TrP research. Contributing authors come from as many as 15 different countries!

Ankle sprain as a work-related accident: status of proprioception after 2 weeks

Purpose

This study aims at verifying whether proprioception is abnormal or not, two weeks after a grade 1 and 2 ankle sprain in the scope of work-related accident.

Methods

A descriptive, observation and transversal study was designed to compare speed, movement and oscilation of centre of pressure in employees of companies signed up to a mutual company. Participants’ healthy feet comprised the control group, and feet that had undergone an ankle sprain due to a work-related accident comprised the cases group. The following stability tests were undertaken to both the healthy and injuried feet using a force plate: Monopodal Romberg test with eyes open, Monopodal Romberg test with eyes open on a 30 mm thick foam rubber, Monopodal Romberg test with eyes closed, and Romberg test as monopodal support with eyes closed on a 30 mm thick foam rubber. A multiple logistic regression analysis was performed. From the results of this regression model the COR curve test was performed.

Results

71.7% accuracy in the predictions was attained. The equation was as follows: Condition (injured or healthy) = 0.052⋅% RGC AP Movement − 0.81⋅MREO AP Movement. The variable MREO antero-posterior movement was used in the COR curve methodology. The area under the curve was greater than 0.65 and at a 95% confidence interval the 0.75 value was included, which in our case was the injured subject condition. Values for sensitivity, specificity, positive predictive value and negative predictive value were 0.667, 0.633, 64.5%, and 65.5%, respectively.

Conclusion

The participants in this study showed a diminished capacity for postural control in an ankle two weeks after an ankle sprain.

Tensiomyography, sonoelastography, and mechanosensitivity differences between active, latent, and control low back myofascial trigger points: A cross-sectional study

The myofascial pain syndrome (MPS) is considered the most common musculoskeletal condition. The lumbopelvic pain (LPP) is established as one of the most prevalent musculoskeletal disorders. Nevertheless, previous research has not yet studied the contractibility changes by tensiomyography between myofascial trigger point (MTrP) types and normal tissue. Therefore, the aim of this study was to determine the tensiomyography, sonoelastography, and pressure pain threshold (PPT) differences between the palpation area of active and latent MTrPs with regards to control points in the lumbar erector spinae muscles of subjects with LPP. A cross-sectional descriptive study was performed. A convenience sample of 60 points (20 active MTrPs, 20 latent MTrPs, and 20 control points) was registered bilaterally in the lumbar erector spinae muscles from subjects with nonspecific LPP. The palpation order of active MTrPs, latent MTrPs, or control points was randomized for each side. The outcome assessors were blinded to the order or point type. The outcome measurements order for each point was sonoelastography manual strain index, tensiomyography, and PPT, separated by 15 minutes. Five contractile objective parameters were: maximal radial displacement (Dm), contraction time (Tc), sustain time (Ts), delay time (Td), and half-relaxation time (Tr). Tensiomyography parameters did not show any statistically significant difference (P > 0.05) between active MTrPs, latent MTrPs, and control points. Nevertheless, PPT and sonoelastography showed statistically significant differences (P < 0.05) between all point types, except for active and latent MTrPs PPT comparison (P = 0.091). Regarding the active MTrPs, a moderate positive correlation was observed between PPT and Dm (P = 0.047; τB = 0.450). Considering the control points, a moderate positive correlation was shown between sonoelastography and Td (P = 0.044; τB = 0.328). The tensiomyography contractile properties did not seem to show differences, while the sonoelastography and mechanosensitivity presented a higher stiffness and a lower PPT, respectively, between the palpation area of active and latent MTrPs with regards to control points in the lumbar erector spinae muscles of subjects with LPP. Considering the correlations, further research is needed regarding the muscle contractile properties modifications under MPS treatments, especially Dm in active MTrPs and Td in normal sites.

Relationship of active trigger points with related disability and anxiety in people with tension-type headache

To investigate the differences in the presence of trigger points (TrPs) and their association with headache-related disability and mood disorders in people with frequent episodic tension-type headache (TTH) (FETTH) and chronic TTH (CTTH). One hundred twenty-two individuals with TTH participated. Clinical features of headache (i.e., intensity, duration, and frequency) were recorded on a headache diary. Headache-related disability was assessed with the Headache Disability Inventory, trait and state anxiety levels with State-Trait Anxiety Inventory, and depression with the Hospital Anxiety and Depression Scale. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Sixty-two (51%) patients were classified as FETTH, whereas 60 (49%) were classified as CTTH. Individuals with CTTH showed higher burden of headache and depression than FETTH (P < 0.001). Subjects with FETTH showed similar number of TrPs (total number: 5.9 ± 3.1, active TrPs: 4.7 ± 2.5, and latent TrPs: 1.2 ± 1.9) than those with CTTH (total number: 5.7 ± 3.2, active TrPs: 4.2 ± 3.0, and latent TrPs: 1.5 ± 1.8). The number of active TrPs was significantly associated with the burden of headache (r = 0.189; P = 0.037) and trait anxiety (r = 0.273; P = 0.005): the higher the number of active TrPs, the greater the physical burden of headache or the more the trait anxiety level. No association with the depression was observed. The presence of active TrPs in head and neck/shoulder muscles was similar between individuals with FETTH and CTTH and associated with the physical burden of headache and trait anxiety levels independently of the subgroup of TTH.