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MacLennan M, Ramirez-Campillo R, Byrne PJ. Self-Massage Techniques for the Management of Pain and Mobility With Application to Resistance Training: A Brief Review. J Strength Cond Res 2023; 37:2314-2323. [PMID: 37883406 DOI: 10.1519/jsc.0000000000004575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT MacLennan, M, Ramirez-Campillo, R, and Byrne, PJ. Self-massage techniques for the management of pain and mobility with application to resistance training: a brief review. J Strength Cond Res 37(11): 2314-2323, 2023-Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility, which contributes to abnormal muscle mechanics, reduced muscle length, and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power, which may lead to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function, and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs-associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain, including differing densities of foam rollers, roller massagers, tennis balls, and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SM device, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating foam rollers eliciting an increased reduction to pain perception, and tennis balls and soft massage balls were shown to be efficacious in targeting smaller affected areas.
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Affiliation(s)
- Minja MacLennan
- Department of Health and Sport Sciences, South East Technological University (Kilkenny Road Campus), Carlow, Ireland; and
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Paul J Byrne
- Department of Health and Sport Sciences, South East Technological University (Kilkenny Road Campus), Carlow, Ireland; and
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Hernández-Secorún M, Abenia-Benedí H, Borrella-Andrés S, Marqués-García I, Lucha-López MO, Herrero P, Iguacel I, Tricás-Moreno JM, Hidalgo-García C. Effectiveness of Dry Needling in Improving Pain and Function in Comparison with Other Techniques in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis. Pain Res Manag 2023; 2023:1523834. [PMID: 37664417 PMCID: PMC10469395 DOI: 10.1155/2023/1523834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/16/2022] [Accepted: 04/12/2023] [Indexed: 09/05/2023]
Abstract
The purpose of this systematic review and meta-analysis was to assess the short-, mid-, and long-term effectiveness of dry needling in improving pain and functional capacity of patients with chronic neck pain. Search strategy was performed on PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus biomedical databases. The risk of bias was assessed using the RoB2 tool. Randomised controlled clinical trials in which at least 1 of the groups received dry needling were included. 662 studies were found; 14 clinical trials were selected for qualitative analysis and 13 for quantitative analysis. The quality of most of the studies included was "high." All the studies reported improvements in cervical pain and/or disability, regardless of the protocol followed and the muscles targeted. No serious adverse effects were reported. Dry needling showed to be more effective when compared with other therapies in both women and men, without differences by sex. When the analysis was carried out by age, patients over 40 years old benefitted more than those below 40 years old. Our meta-analysis supports the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals.
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Affiliation(s)
- Mar Hernández-Secorún
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Hugo Abenia-Benedí
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Sergio Borrella-Andrés
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- Corpore 360°, Zaragoza 50008, Spain
| | | | - María Orosia Lucha-López
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - Pablo Herrero
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- iHealthy Research Group, ISS Aragón, University de Zaragoza, Zaragoza 50009, Spain
| | - Isabel Iguacel
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
| | - José Miguel Tricás-Moreno
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
| | - César Hidalgo-García
- Department of Physiatry and Nursing, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
- Physiotherapy Research Unit, University of Zaragoza, Zaragoza 50009, Spain
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Baeumler P, Hupe K, Irnich D. Proposal of a diagnostic algorithm for myofascial trigger points based on a multiple correspondence analysis of cross-sectional data. BMC Musculoskelet Disord 2023; 24:62. [PMID: 36694147 PMCID: PMC9872335 DOI: 10.1186/s12891-023-06129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Myofascial trigger points (MTrPS), the morphological correlate of myfascial pain syndromes (MPS), contribute to the worldwide high chronic pain burden. However, uncertainty about MTrP diagnostic criteria remains. Aim of this cross-sectional study was to characterize clusters of diagnostic criteria assessable during physical examination that might guide MTrP diagnosis. METHODS Thirteen MTrP diagnostic criteria proposed in relevant literature were assessed by standardized examinations in the trapezius and levator scapulae muscles of 61 chronic pain patients undergoing an interdisciplinary pain assessment. Hierarchical cluster analysis from multiple correspondence analysis was applied to data of the four muscles separately. Examining physicians classified the findings as MTrP, sufficient for diagnosis of an MPS and/or relevant for the patients' pain condition. RESULTS Taut bands, hypersensitive spots within a taut band, nodules within a taut band and referred pain (classical diagnostic criteria) were most frequent (28-66% M. trapezius, 8-21% M. levator scapulae). Restricted range of motion, pain during contraction, pain exacerbation during emotional stress, muscular weakness, jump sign, local twitch response and autonomic phenomena (complementary diagnostic criteria) occurred in 2-25% and hypersensitive spots and nodules outside of a taut band in 2-7% of the cases. Four clusters emerged: (1) no or just one diagnostic criterion, mostly a taut band alone; (2) a hypersensitive spot and/or nodule outside of a taut band partly in combination with complementary diagnostic criteria; (3) at least two classical diagnostic criteria (mostly a taut band containing a hypersensitive spot) partly in combination with complementary diagnostic criteria; (4) at least two, rather three, classical diagnostic criteria always in combination with complementary diagnostic criteria. Referred pain was specific to cluster 3 and 4. Among classical diagnostic criteria, palpable nodules within a taut band contributed least, and among complementary diagnostic criteria, restricted range of motion and pain during contraction contributed most to data representation. CONCLUSION We propose that the definite diagnosis of an MTrP requires a hypersensitive spot potentially felt as a nodule located within a taut band in addition to either referred pain, a local twitch response or at least two complementary diagnostic criteria, whereby signs of muscular dysfunction take on greater importance.
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Affiliation(s)
- Petra Baeumler
- grid.411095.80000 0004 0477 2585Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany
| | - Kerstin Hupe
- grid.411095.80000 0004 0477 2585Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany
| | - Dominik Irnich
- grid.411095.80000 0004 0477 2585Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany
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Carroll M, Ellis R, Kohut S, Garrett N, Fernández-de-Las-Peñas C. Associations Between Gluteus Medius Trigger Points With Hip Passive Range of Movement and Muscle Strength in Adults With Chronic Nonspecific Low Back Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:641-651. [PMID: 37318387 DOI: 10.1016/j.jmpt.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether there is a relationship between gluteus medius trigger points with hip passive range of motion and hip muscle strength in people with chronic nonspecific low back pain (LBP). METHODS This was a cross-sectional, blinded study that took place in 2 rural communities in New Zealand. Assessments were carried out in physiotherapy clinics in these towns. A total of 42 participants over 18 years old experiencing chronic nonspecific LBP were recruited. After meeting inclusion criteria, participants completed the following 3 questionnaires: Numerical Pain Rating Scale, Oswestry Disability Index, and Tampa Scale of Kinesiophobia. The primary researcher (a physiotherapist) assessed each participant's bilateral hip passive range of movement (using an inclinometer) and muscle strength (using a dynamometer). Following this, a blinded trigger point assessor examined the gluteus medius muscles for the presence of active and latent trigger points. RESULTS General linear modeling using univariate analysis revealed that there was a positive association between hip strength and trigger point status (P =.03 left internal rotation, P =.04 right internal rotation, and P =.02 right abduction). Participants with no trigger points showed higher strength values (eg, right internal rotation standard error: 0.64), and those with trigger points showed lower strength. Overall, muscles exhibiting latent trigger points were the weakest (eg, right internal rotation standard error: 0.67). CONCLUSION The presence of active or latent gluteus medius trigger points was associated with hip weakness in adults with chronic nonspecific LBP. There was no association between gluteus medius trigger points and hip passive range of movement.
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Affiliation(s)
- Marianne Carroll
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Richard Ellis
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation, Health and Rehabilitation Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Kohut
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation, Health and Rehabilitation Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
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Bagheri R, Taghizadeh Delkhoush C, Mirmohammadkhani M, Safavi Farokhi Z, Bakhshi S. Comparison of Dry Needling and Inhibitory Kinesio Taping in Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Randomized Controlled Trial. J Chiropr Med 2022; 21:23-31. [DOI: 10.1016/j.jcm.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 11/16/2022] Open
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Computer Kinesiology: New Diagnostic and Therapeutic Tool for Lower Back Pain Treatment (Pilot Study). BIOMED RESEARCH INTERNATIONAL 2020; 2020:2987696. [PMID: 32908878 PMCID: PMC7463396 DOI: 10.1155/2020/2987696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to demonstrate the effectiveness of the diagnostic and therapeutic medical information system Computer Kinesiology in physiotherapy in patients with low back pain who were not responding to conventional therapy. Computer Kinesiology is primarily intended for the diagnostics and therapy of functional disorders of the locomotor system. This pilot study population included 55 patients (Group 1) with acute and chronic back pain and 51 persons (Group 2) without back pain. The third group was a control group of 67 healthy volunteers with no evidence of musculoskeletal pathologies and no back pain. All 173 subjects were examined three times by the diagnostic part of the Computer Kinesiology method. Groups 1 and 2 were treated after every diagnostics. Group 3 was not treated. The effect was evaluated by H score. Improvements after therapy were defined by reducing the H score by at least 1 point. In Group 1, the H score decreased by at least 1 point in 87.3% (95% CI: 75.5-94.7) and in Group 2 in 78.4% (95% CI: 64.7-88.7). There was no change of distribution of H Score grade in Group 3. The improvement neither depended on gender, age, and BMI nor was it influenced by the length of the therapy. This study demonstrated a high therapeutic efficacy of the Computer Kinesiology system in patients with back pain (Group 1) and in persons without back pain (Group 2) who used the Computer Kinesiology system for primary and secondary prevention of back pain.
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Luiza da Silva Queiroz M, Bezerra Diniz PR, Nepomuceno Montenegro EJ, de Souza Costa Neto JJ, Santana de Albuquerque Filho E, Valença MM, Sobral de Oliveira Souza AI, da Silva Tenório A, Wanderley D, de Oliveira DA. MRI in migraineurs: are there abnormalities in the area where the myofascial trigger points are palpable and in volume measurements? J Bodyw Mov Ther 2020; 24:260-266. [PMID: 32825998 DOI: 10.1016/j.jbmt.2020.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Patients with migraine may present a higher quantity of myofascial trigger points (MTrP) and alterations in the cervical muscles when compared to non-migraineurs. The magnetic resonance imaging (MRI) is a robust method for the study of human soft tissues and could be useful to investigate these points. OBJECTIVES To identify the presence of MTrP in the descending fibers of the trapezius muscle in women with migraine and to quantify the muscle volume by MRI, correlating it with the headache characteristics. METHODS A cross-sectional analytic study was conducted among 14 women, eight in migraine group, and six in without migraine group. The presence of MTrP was evaluated using Simons' criteria, and linolenic acid capsules subsequently marked the areas. MRI was performed with 1.5T, T1-weighted sequence, and T2 in the axial, sagittal, and coronal planes. The T1-weighted sequences were performed with and without gadolinium contrast. RESULTS The T1-weighted image analysis with and without gadolinium did not show any signal alteration in the MTrP areas in both groups. The migraine group presented more MTrP in the trapezius muscle (MD [95%CI] = 1[1; 3]; MD [95%CI] = 1[0; 2] right and left side, respectively), and a smaller muscle volume (MD [95%CI] = -198.1[-338.7;-25.6], MD [95%CI] = -149.9[-325.05;-0.13] right and left side, respectively) than non-migraineurs. The migraine frequency presented a negative strong correlation with the trapezius volumes (r = -0.812; p = 0.014). CONCLUSION Migraineurs present more MTrP and a smaller muscle volume than non-migraineurs. The trapezius volume is negatively correlated with migraine frequency. MRI is not a suitable outcome measure for assessing MTrP.
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Affiliation(s)
| | - Paula Rejane Bezerra Diniz
- Post-graduation Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | | | | | | | | | | | - Débora Wanderley
- Physical Therapy Departament, Universidade Federal de Pernambuco, Recife, PE, Brazil.
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A soft massage tool is advantageous for compressing deep soft tissue with low muscle tension: Therapeutic evidence for self-myofascial release. Complement Ther Med 2019; 43:312-318. [DOI: 10.1016/j.ctim.2019.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 01/23/2023] Open
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Yeganeh Lari A, Okhovatian F, Naimi SS, Baghban AA. The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females. ACTA ACUST UNITED AC 2015; 21:204-9. [PMID: 26304789 DOI: 10.1016/j.math.2015.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 11/16/2022]
Abstract
AIM The purpose of this clinical trial experiment was to compare the effects of the combination of dry needling (DN) and the muscle energy technique (MET) on the upper trapezius latent myofascial trigger point. METHOD Sixty female patients, aged 18-30 with latent myofascial trigger points in the upper trapezius muscle were randomly divided into three groups: group 1 (n = 20) received DN and MET, group 2 (n = 20) received only MET, and group 3 (n = 20) received only DN. The visual analogue scale (VAS), pressure pain threshold (PPT), and range of active contra lateral flexion (CLF) were measured before each treatment. The patients were treated for three sessions in a one-week period with at least a two-day break between each session, and in session four, an assessment of primary outcomes was conducted without any treatment. RESULTS All three treatment groups showed decreases in pain (p = 0.001) and increases in PPT levels (p = 0.001) as well as increases in CLF (p = 0.001). But the group receiving trigger point DN together with MET showed more significant improvement than the other two groups in VAS, PPT and ROM. No significant differences were found between the MET-only group and the DN-only group. CONCLUSION Our results indicate that all three treatments used in this study were effective for treating MTP. According to this study, DN and MET is suggested as a new method for the treatment of MTP.
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Affiliation(s)
- Ameneh Yeganeh Lari
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Okhovatian
- Physiotherapy Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sedigheh sadat Naimi
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Basic Sciences, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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The Kinesio Taping Method for Myofascial Pain Control. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:950519. [PMID: 26185522 PMCID: PMC4491400 DOI: 10.1155/2015/950519] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/02/2015] [Accepted: 04/08/2015] [Indexed: 12/13/2022]
Abstract
Many people continue suffering from myofascial pain syndrome (MPS) defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs) clinically. Muscle spasm and block of blood circulation can be noticed in the taut bands. In the MTrP region, nociceptors can be sensitized by the peripheral inflammatory factors and contracture of fascia can also be induced. Traditional treatments of MPS include stretching therapy, thermal treatment, electrical stimulation, massage, manipulation, trigger points injection, acupuncture, and medicine. However, the pain syndrome may not be relieved even under multiple therapies. Recently, the Kinesio Taping (KT) method is popularly used in sports injuries, postoperative complications, and various pain problems, but little research is focused on MPS with KT method. In this paper, we review the research studies on the application to KT in treating MPS and other related issues. It appears that the KT application can elevate the subcutaneous space and then increase the blood circulation and lymph fluid drainage to reduce the chemical factors around the MTrP region. Therefore, it is suggested that KT method can be used as a regular treatment or added to the previous treatment for myofascial pain.
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Chou LW, Hsieh YL, Kuan TS, Hong CZ. Needling therapy for myofascial pain: recommended technique with multiple rapid needle insertion. Biomedicine (Taipei) 2014; 4:13. [PMID: 25520926 PMCID: PMC4264979 DOI: 10.7603/s40681-014-0013-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/31/2014] [Indexed: 11/06/2022] Open
Abstract
Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci (nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested mechanisms of needling analgesia include effects related to immune, hormonal or nervous system. Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is strongly recommended for myofasical pain therapy in order to resume patient's normal life rapidly, thus saving medical and social resources.
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Affiliation(s)
- Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Research Center for Chinese Medicine & Acupuncture, China Medical University Hospital, Taichung, Taiwan
| | - Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Zern Hong
- Department of Physical Therapy, Hung Kuang University, Chung-Chie Road, Taichung, Taiwan
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Skorupska E, Bednarek A, Samborski W. Tender Points and Trigger Points – Differences and Similarities. ACTA ACUST UNITED AC 2013. [DOI: 10.3109/10582452.2013.827773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Myofascial trigger point therapy for triceps surae dysfunction: a case series. ACTA ACUST UNITED AC 2013; 18:519-25. [PMID: 23756031 DOI: 10.1016/j.math.2013.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/21/2013] [Accepted: 04/19/2013] [Indexed: 11/23/2022]
Abstract
AIMS The main aim of the case series was to inform further experimental research to determine the effectiveness of myofascial trigger point (MTrP) therapy for the treatment of triceps surae dysfunction. PARTICIPANTS Ten participants with triceps surae dysfunction were recruited (4 females and 6 males); mean age±standard deviation=43±7.1 years. METHODS Participants were screened for inclusion/exclusion criteria and the following outcomes measures were assessed at baseline and discharge; lower extremity functional scale (LEFS), verbal numerical rating scale (NRS), MTrP prevalence, ankle dorsiflexion range of movement (ROM) and pressure pain threshold (PPT). Intervention involved trigger point (TrP) pressure release, self MTrP release and a home stretching programme. RESULTS There was a high prevalence of active/latent MTrPs and possible myofascial pain syndrome (MPS) for all 10 participants at baseline. Active MTrP prevalence decreased to 0%, while latent MTrPs were still present at discharge. There were positive changes in most outcome measures (LEFS, NRS, ROM and PPT) for all 10 participants. Short term to medium term treatment outcomes (6 week post discharge) showed an overall mean LEFS increase of 11 points from 61/80 at baseline to 72/80 at discharge. CONCLUSION This case series suggests that a brief course of multimodal MTrP therapy would be helpful for some patients with sub-acute or chronic calf pain. Important preliminary data was gathered, that will inform more rigorous research in this under investigated area.
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Han TI, Hong CZ, Kuo FC, Hsieh YL, Chou LW, Kao MJ. Mechanical pain sensitivity of deep tissues in children--possible development of myofascial trigger points in children. BMC Musculoskelet Disord 2012; 13:13. [PMID: 22316064 PMCID: PMC3298468 DOI: 10.1186/1471-2474-13-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 02/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is still unclear when latent myofascial trigger points (MTrPs) develop during early life. This study is designed to investigate the mechanical pain sensitivity of deep tissues in children in order to see the possible timing of the development of latent MTrPs and attachment trigger points (A-TrPs) in school children. METHODS Five hundreds and five healthy school children (age 4- 11 years) were investigated. A pressure algometer was used to measure the pressure pain threshold (PPT) at three different sites in the brachioradialis muscle: the lateral epicondyle at elbow (site A, assumed to be the A-TrP site), the mid-point of the muscle belly (site B, assumed to be the MTrP site), and the muscle-tendon junction as a control site (site C). RESULTS The results showed that, for all children in this study, the mean PPT values was significantly lower (p < 0.05) at the assumed A-TrP site (site A) than at the other two sites, and was significantly lower (p < 0.05) at the assumed MTrP site (site B) than at the control site (site C). These findings are consistent if the data is analyzed for different genders, different dominant sides, and different activity levels. CONCLUSIONS It is concluded that a child had increased sensitivity at the tendon attachment site and the muscle belly (endplate zone) after age of 4 years. Therefore, it is likely that a child may develop an A-Trp and a latent MTrP at the brachioradialis muscle after the age of 4 years. The changes in sensitivity, or the development for these trigger points, may not be related to the activity level of children aged 7-11 years. Further investigation is still required to identify the exact timing of the initial occurrence of a-Trps and latent MTrPs.
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Affiliation(s)
- Ting-I Han
- Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Taipei, Taiwan
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Abstract
Myofascial pain syndrome presents a significant physical and financial burden to society. In view of the aging demographics, myofascial pain promises to be an even greater challenge to health care in the future. Myofascial trigger points have been identified as important anatomic and physiologic phenomena in the pathophysiology of myofascial pain. While their pathophysiologic mechanisms are still unclear, emerging research suggests that trigger points may be initiated by neurogenic mechanisms secondary to central sensitization, and not necessarily by local injury. A variety of treatments are employed in the management of trigger points, including manual therapy, electrotherapy, exercise, and needle therapy. Therapeutic ultrasound demonstrates significant potential as a safe, cost-effective, and relatively noninvasive therapeutic alternative in the treatment and management of this modern day medical enigma.
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Hayashi K, Ozaki N, Kawakita K, Itoh K, Mizumura K, Furukawa K, Yasui M, Hori K, Yi SQ, Yamaguchi T, Sugiura Y. Involvement of NGF in the rat model of persistent muscle pain associated with taut band. THE JOURNAL OF PAIN 2011; 12:1059-68. [PMID: 21719352 DOI: 10.1016/j.jpain.2011.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 03/31/2011] [Accepted: 04/28/2011] [Indexed: 12/30/2022]
Abstract
UNLABELLED Myofascial pain syndrome (MPS) is an important clinical condition characterized by chronic muscle pain and a myofascial trigger point (MTrP) located in a taut band (TB). However, its pathogenic mechanism is still unclear. We developed an animal model relevant to conditions of MPS, and analyzed the mechanism of the muscle pain in this model. We applied eccentric contraction (EC) to a rat's gastrocnemius muscle (GM) for 2 weeks, and examined the mechanical withdrawal thresholds, histological changes, and expressions and contents of nerve growth factor (NGF). The mechanical withdrawal threshold decreased significantly at the next day of first EC and continued up to 9 days after EC. TBs were palpable at 3 to 8 days after initiation of EC. In EC animals, necrotic and regenerating muscle cells were found significantly more than in control animals. In EC animals, NGF expressions in regenerating muscle cells and NGF contents of GM were significantly higher than control animals. Administration of NGF receptor (TrkA) inhibitor K252a showed significant suppression of mechanical hyperalgesia in EC animals. Repeated EC induced persistent mechanical muscle hyperalgesia associated with TB. NGF expressed in regenerating muscle cells may have an important role in persistent mechanical muscle hyperalgesia which might be relevant to pathogenesis of MPS. PERSPECTIVE The present study shows that NGF expressed in regenerating muscle cells is involved in persistent muscular mechanical hyperalgesia. NGF-TrkA signaling in primary muscle afferent neurons may be one of the most important and promising targets for MPS.
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Affiliation(s)
- Koei Hayashi
- Department of Functional Anatomy and Neuroscience, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Arch Phys Med Rehabil 2011; 92:657-62. [PMID: 21440713 DOI: 10.1016/j.apmr.2010.11.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 11/25/2010] [Accepted: 11/25/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the effects of high-power pain threshold ultrasound (HPPTUS) therapy and local anesthetic injection on pain and active cervical lateral bending in patients with active myofascial trigger points (MTrPs) of the upper trapezius muscle. DESIGN Randomized single-blinded controlled trial. SETTING Physical medicine and rehabilitation department of university hospital. PARTICIPANTS Subjects (N=49) who had active MTrPs of the upper trapezius muscle. INTERVENTIONS HPPTUS or trigger point injection (TrP). MAIN OUTCOME MEASURES Visual analog scale, range of motion (ROM) of the cervical spine, and total length of treatments. RESULTS All patients in both groups improved significantly in terms of pain and ROM, but there was no statistically significant difference between groups. Mean numbers of therapy sessions were 1 and 1.5 in the local injection and HPPTUS groups, respectively. CONCLUSIONS We failed to show differences between the HPPTUS technique and TrP injection in the treatment of active MTrPs of the upper trapezius muscle. The HPPTUS technique can be used as an effective alternative to TrP injection in the treatment of myofascial pain syndrome.
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Affiliation(s)
- Halil Unalan
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Turkey
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Lin MT, Chen HS, Chou LW, Hong CZ. Treatment of Attachment Trigger Points in the Gluteal Muscles to Cure Chronic Gluteal Pain: A Case Report. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10582452.2010.538823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Srbely JZ, Dickey JP, Bent LR, Lee D, Lowerison M. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. THE JOURNAL OF PAIN 2009; 11:636-43. [PMID: 20015704 DOI: 10.1016/j.jpain.2009.10.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 09/22/2009] [Accepted: 10/02/2009] [Indexed: 12/19/2022]
Abstract
UNLABELLED This study investigated whether inducing central sensitization evokes segmental increases in trigger point pressure sensitivity. We evoked central sensitization at the C(5) segment and validated its presence via mechanical cutaneous sensitivity (brush allodynia) testing. Trigger point pressure sensitivity was quantified using the pain pressure threshold (PPT) value. A 50 cm(2) area of the C(5) dermatome at the right lateral elbow was pretreated with 45 degrees heat for 10 minutes. Test subjects (n = 20) then received topical capsaicin cream (0.075%; Medicis, Toronto, Canada) to the C(5) dermatome, whereas control subjects (n = 20) received a topical placebo cream (Biotherm Massage, Montreal, Canada). PPT readings were recorded from the infraspinatus (C(5,6)) and gluteus medius (L(4,5)S(1)) trigger points at zero (pre-intervention), 10, 20, and 30 minutes after intervention; all PPT readings were normalized to pre-intervention (baseline) values. The difference between the PPT readings at the 2 trigger point sites represents the direct influence of segmental mechanisms on the trigger point sensitivity at the infraspinatus site (PPT(seg)). Test subjects demonstrated statistically significant increases in Total Allodynia scores and significant decreases in PPT(seg) at 10, 20, and 30 minutes after application, when compared with control subjects. These results demonstrate that increases in central sensitization evoke increases in trigger point pressure sensitivity in segmentally related muscles. PERSPECTIVE Myofascial pain is the most common form of musculoskeletal pain. Myofascial trigger points play an important role in the clinical manifestation of myofascial pain syndrome. Elucidating the role of central sensitization in the pathophysiology of trigger points is fundamental to developing optimal strategies in the management of myofascial pain syndrome.
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Affiliation(s)
- John Z Srbely
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada.
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Srbely JZ, Dickey JP, Lowerison M, Edwards MA, Nolet PS, Wong LL. Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008; 139:260-266. [PMID: 18508198 DOI: 10.1016/j.pain.2008.04.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/28/2008] [Accepted: 04/15/2008] [Indexed: 10/22/2022]
Abstract
Musculoskeletal pain affects a significant proportion of the general population. The myofascial trigger point is recognized as a key factor in the pathophysiology of musculoskeletal pain. Ultrasound is commonly employed in the treatment and management of soft tissue pain and, in this study, we set out to investigate the segmental antinociceptive effect of ultrasound. Subjects (n=50) with identifiable myofascial trigger points in the supraspinatus, infraspinatus and gluteus medius muscles were selected from an outpatient rehabilitation clinic and randomly assigned to test or control groups. Test subjects received a therapeutic dose of ultrasound to the right supraspinatus trigger point while control groups received a sham (null) exposure. Baseline pain pressure threshold (PPT) readings were recorded at the ipsilateral infraspinatus and gluteus medius trigger-point sites prior to ultrasound exposure. The infraspinatus point was chosen due to its segmental neurologic link with the supraspinatus point; the gluteus medius acted as a segmental control point. Following the ultrasound intervention, PPT readings were recorded at 1, 3, 5, 10 and 15 min intervals at both infraspinatus and gluteus medius trigger points; the difference between infraspinatus and gluteus medius PPT values, PPT seg, represents the segmental influence on the PPT. The ultrasound test group demonstrated statistically significant increases in PPT seg (decreased infraspinatus sensitivity) at 1, 3 and 5 min, when compared with PPT seg in the sham ultrasound group. These results establish that low-dose ultrasound evokes short-term segmental antinociceptive effects on trigger points which may have applications in the management of musculoskeletal pain.
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Affiliation(s)
- John Z Srbely
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1 Centre for the Genetic Improvement of Livestock, University of Guelph, Guelph, Ont., Canada N1G 2W1 Academic Services, University of Guelph, Guelph, Ont., Canada N1G 2W1 Church Lane Rehabilitation Clinic, Guelph, Ont., Canada N1H 2W6 Biomedical Sciences, University of Guelph, Guelph, Ont., Canada N1G 2W1
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