OBJECTIVEThe aim of the study was to compare the efficacy of radial extracorporeal shock wave therapy and dry needling in the treatment of myofascial trigger points in the upper trapezius muscle.
...DESIGNA total of 65 patients with myofascial trigger points were randomly divided into extracorporeal shock wave therapy group (n = 32) and dry needling group (n = 33). Patients received 3 wks of treatment at 1-wk intervals (in both groups). Visual analog scale, pressure pain threshold, Neck Disability Index, and shear modulus were evaluated before treatment, immediately after the first therapy, 1 mo, and 3 mos after the completion of the third therapy.
RESULTSSignificant improvements of visual analog scale, pressure pain threshold, and Neck Disability Index scores were observed at all time points after treatment (P < 0.01) in both treatment groups. The shear modulus of myofascial trigger points was reduced in both dry needling group (P < 0.05) and extracorporeal shock wave therapy group (P < 0.01) immediately after the first treatment. Significant reductions in shear modulus were maintained up to 3-mo posttreatment in both groups (P < 0.01). There were no significant differences between the radial extracorporeal shock wave therapy group and dry needling group.
CONCLUSIONSThe extracorporeal shock wave therapy is as effective as dry needling for relieving pain, improving function, and reducing shear modulus for patients with myofascial trigger points after a series of three treatments.
The etiology of plantar heel pain is multifactorial. Myofascial trigger points of abductor hallucis muscle one of the muscles that should be carefully evaluated and treated in patients diagnosed with ...plantar fasciitis.
An increase in spontaneous neurotransmission may be related to myofascial pain. Sympathetic neurons innervate most of the neuromuscular junction sand are involved in the modulation of synaptic ...transmission. Therefore, a direct action of stress on acetylcholine release is expected. For this reason, this study aims to evaluate the relationship between stress and spontaneous neurotransmission. Five acute stressors (immobilization, forced swimming, food and water deprivation, social isolation and ultrasound) were tested in 6 weeks adult Swiss male mice. Subsequently, these types of stress were combined to generate a model of chronic stress. The study of ACh release was evaluated before and after the application of stress by intracellular recording of spontaneous neurotransmission (mEPPs). In each one of the stressors, an increase in the frequency of mEPPs was obtained immediately after treatment, which remained elevated for 5 days and thereafter returned to control values after a week. With chronic stress, a much higher increase in the frequency of mEPPs was obtained and it was maintained for 15 days. In summary, stress, both in its acute and chronic forms, increased spontaneous neurotransmission significantly. There is a possibility that chronic stress is related with the genesis or maintenance of myofascial pain.
•Acute stress increases spontaneous neurotransmission moderately and late (24–48 h).•Spontaneous neurotransmission is maintained increased for less than a week.•Chronic stress potently increases spontaneous neurotransmission and for 2 weeks.•Chronic stress may be involved in the genesis or maintenance of muscular pain.
•Myofascial trigger points (MTrPs) are hyperirritable spots in skeletal muscle, commonly in hypermobile people.•Musculoskeletal interfiber counterirritant stimulation (MICS) is used through ischemic ...compression.•Autonomic nervous system (ANS) activity caused an increase in vagal tone and a decrease in sympathetic tone.•MICS technique reduces the pain perception intensity in MTrPs modulates the ANS activity, and increase heart rate variability (HRV).
Joint hypermobility (JH) conditions suggest dysfunction in the autonomic nervous system (ANS) (dysautonomia), associated with multifactor non-articular local musculoskeletal pain, and remains a complex treatment. This study aims to determine the effects of musculoskeletal interfiber counterirritant stimulation (MICS) as an innovative treatment of myofascial trigger points (MTrPs) on the upper trapezius muscle in JH patients. We evaluate the ANS activity by wavelet transform spectral analysis of heart rate variability (HRV) in sixty women, equally divided: MTrP, MTrP + general joint hypermobility (GJH), and MTrP + joint hypermobility syndrome (JHS). The protocol phases were rest, stimulation, and recovery, with clinical and home treatment for three-days. All groups show a significantly decreased in pain perception during and post-treatment, and an increased parasympathetic ANS activity under MICS in the GJH and JHS groups. The variables low-frequency (LF) vs. high-frequency (HF) showed significant differences during the protocol phases, and the LF/HF ratio maintained a predominance of sympathetic activity (SA) throughout the protocol. The new MICS technique reduces the pain perception and modulates the ANS activity by an increase in vagal tone, and a decrease in sympathetic tone. This modulation was followed by an increase in the HRV in JH patients after treatment with MICS. Clinical Trials: RBR-88z25c5.
Introduction: Myofascial trigger points are hypersensitive nodules with distinct characteristics that cause pain at the location of trigger point and refer pain to the surrounding structures. ...Material & Methods: A cross sectional study was conducted on tailors in the factories of twin cities of Pakistan. 349 male and female with the age of 20 to 60 years having complaint of myofascial trapezius trigger points were selected by Non probability convenient sampling technique. All the participants were assessed by using the Trapezius trigger points assessment form meanwhile forward head posture was assessed by using plumb line method. Results: Out of 349 participants 229(66.5%) were males and 120(33.5%) were females. The mean age of the participants was 34.13 ± 9.8 years. The results revealed that the frequency of active trigger points in trapezius muscle was 166(47.5%), latent (Passive trigger point) was 155(44.4%) and 28(8.1%) having mix type of trigger points. Frequency of Forward head posture shows 40(11.4%) were normal, 80(22.9%) were mild, 180(51.6%) were moderate and 49(14.1%) sever. Association between forward head posture and trigger points are high as P. Value was <0.001. Conclusion: It is concluded that frequency of active trigger points was higher in percentage as compared to the latent trigger points moreover both type of trigger points had higher association with the forward head posture.
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.
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.
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.
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.
Myofascial trigger points (MTrPs) are common in soft tissue musculoskeletal pain conditions. It is believed that MTrPs are local contractures within the extrafusal fibers of skeletal muscles. Further ...characterizing muscle pathophysiology is desirable to design effective treatments. This study was designed to measure muscle fiber architecture in the neighbourhood of MTrPs using ultrasound Shear Wave Elastography (SWE), a novel approach for quantitatively assessing muscle fiber. We hypothesized that muscle containing active (symptomatic) MTrPs has disorganized fiber architecture.
Twenty-four participants (14 women, ages 20–60 years) met criteria for chronic myofascial pain affecting the neck region. All underwent a clinical history and physical examination of the neck and upper trapezius to identify MTrPs and pain self-report. A Supersonic Aixplorer ultrasound imaging system with an L10-4 ultrasound transducer was used to image the upper trapezius muscle. A custom transducer holder (Fig. 1) enabled imaging through a 20mm diameter window placed over the palpable MTrP or normal tissue, and rotation of the imaging plane to precise angles from 0° (along fibers) to 90° (perpendicular to fibers). Peak shear wave velocity (SWV) is observed longitudinally along muscle fibers (0°), and is minimum across fibers (90°). Muscle fiber anisotropy (a measure of fiber alignment and organization) was quantified as the asymmetry (degrees) in the shear-wave velocity profile around the peak SWV.
Muscles with active (symptomatic) MTrPs (n=24) exhibited greater anisotropy (14.25±11.01°), compared to normal, asymptomatic muscle tissue (n=12), which is more isotropic (7.16±6.70°) (P<0.05) (Fig. 2). A positive correlation was found between the maximum anisotropy and average pain (Pearson's r=0.54).
Muscle containing active MTrPs is anisotropic compared to normal muscle tissue, suggesting muscle contractures are in regions of anisotropy. The degree of anisotropy correlates with pain levels.
To assess jaw and neck function, pressure pain threshold (PPT), and the presence of trigger points (TrPs) in disc displacement with reduction (DDWR) subjects compared to healthy subjects.
One hundred ...DDWR subjects and 100 matched controls were studied. Clinical evaluations included demographic data, range of motion, jaw and neck disability, PPT, and muscle TrPs.
DDWR subjects have limited pain-free opening limitation (p < 0.001), jaw and neck disability limitation (p < 0.001), and higher presence of active and latent TrPs limitation (p < 0.001) compared to healthy subjects.
DDWR subjects present a limited pain-free mouth opening, higher jaw and neck disability, lower PPT, and major presence of active and latent TrPs compared to healthy subjects. Cervical spine and TMJ evaluation and treatment should be considered in DDWR patients.
Postural habits and repetitive motion contribute toward the progress of myofascial pain by affecting overload on specific muscles, the quadratus lumborum (QL) muscle being the most frequently ...involved. The therapy of myofascial pain syndrome includes the release of myofascial pain syndrome using injective agents such as botulinum neurotoxin, lidocaine, steroids, and normal saline. However, an optimal injection point has not been established for the QL muscle. This study aimed to propose an optimal injection point for this muscle by studying its intramuscular neural distribution using the whole mount staining method. A modified Sihler's procedure was completed on 15 QL muscles to visualize the intramuscular arborization areas in terms of the inferior border of the 12th rib, the transverse processes of L1–L4, and the iliac crest. The intramuscular neural distribution of the QL had the densely arborized areas in the three lateral portions of L3–L4 and L4–L5 and the medial portion between L4 and L5.
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