Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle

Objectives: To screen for the presence of latent and active myofascial trigger points (MTrPs) in patients with unilateral shoulder and arm pain and perform topographical mapping of mechanical pain sensitivity bilaterally in the infraspinatus muscles. Methods: Nineteen patients with unilateral musculoskeletal shoulder pain participated in the study. The area overlying the infraspinatus on each side was divided into 10 adjacent sub‐areas of 1cm², corresponding to the area of a pressure algometer probe. Pressure pain threshold (PPT) was measured in each sub‐area bilaterally in the infraspinatus muscles. Following PPT measurement, an acupuncture needle was inserted into each sub‐area five times in different directions in order to induce local twitch response and/or referred pain. Results: A significantly lower PPT level in the infraspinatus muscle was detected on the painful side compared with the non‐painful side (P=0.001). PPT at midfiber region of the infraspinatus muscles was lower than that at other muscle parts (P<0.05). Multiple, but not single, active MTrPs were found in the infraspinatus muscle on the painful side and there were also multiple latent MTrPs bilaterally in the infraspinatus muscles. PPT at active MTrPs was much lower than the latent MTrPs and again lower than the non‐MTrPs. Conclusions: There exists bilateral mechanical hyperalgesia in patients with unilateral shoulder pain. Further, the association of multiple active MTrPs with unilateral shoulder pain and the heterogeneity of mechanical pain sensitivity distribution suggest a crucial role of peripheral sensitization in chronic myofascial pain conditions. Additionally, the locations of MTrPs identified with dry needling correspond well to PPT topographical mapping, suggesting that dry needling and PPT topographical mapping are sensitive techniques in the identification of MTrPs.     

The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle

Sustained manual pressure has been advocated as effective treatment for myofascial trigger points (MTrPs). This study aimed to investigate the effect of manual pressure release (MPR) on the pressure sensitivity of latent MTrPs in the upper trapezius muscle using a novel pressure algometer. Subjects (N=37, mean age 23.1±3.2, M=12, F=23) were screened for the presence of latent MTrPs in the upper trapezius muscle (tender band that produced referred pain to the neck and/or head on manual pressure). Subjects were randomly allocated into either treatment (MPR) or control (sham myofascial release) groups. The pressure pain threshold (PPT) was recorded pre- and post-intervention using a digital algometer, consisting of a capacitance sensor attached to the tip of the palpating thumb. There was a significant increase in the mean PPT of MTrPs in the upper trapezius following MPR (P<0.001), but not following the sham treatment. Pressure was monitored and maintained during the application of MPR, and a reduction in perceived pain and significant increase in tolerance to treatment pressure (P<0.001) appeared to be caused by a change in tissue sensitivity, rather than an unintentional reduction of pressure by the examiner. The results suggest that MPR may be an effective therapy for MTrPs in the upper trapezius.     

Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle

Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local ?njection in the treatment of active myofascial trigger points of the upper trapezius muscle.

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.     

Orthopaedic manual physical therapists-champions in education,manipulative therapy and movement control restoration

Abstract

Objectives:

Myofascial trigger points (MTrPs) are considered the principal clinical feature of myofascial pain syndrome (MPS). An MTrP consists of spot tenderness within a taut band of muscle fibers and its stimulation can produce both local and referred pain. The clinical diagnosis of MPS depends on correct history taking and a physical examination aimed at identifying the presence of MTrP. The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle.

Methods:

Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values.

Results:

The intraclass correlation coefficient ICC_(1,1) values were 0·62 (95% CI: 0·30–0·81) for X and 0·81 (95% CI: 0·61–0·91) for Y. The Bland–Altman plots for X and Y showed a mean of difference of 0·04 and ?0·2 mm, respectively. Limits of agreement for X ranged from ?26·3 to 26·2 mm and for Y from ?27 to 26·4 mm.

Discussion:

The ICC_(1,1) for the observed values revealed a moderate to high correlation and the Bland–Altman analysis showed means of difference very close to zero with narrow limits of agreement. An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol.     

实时组织弹性成像指导针刺激痛点治疗肌筋膜疼痛的疗效初探

目的应用实时组织弹性成像(RTE)确定肌筋膜激痛点(MTrPs),探讨其引导针刺治疗肌筋膜疼痛综合征(MPS)的应用价值。方法选择我院斜方肌MPS患者60例,按随机数字表法分为RTE组和传统针刺组各30例,比较两组患者治疗前后MTrPs弹性评分、疼痛评分的差异。对患者随访1年,比较两组患者的治疗效果及远期预后。结果两组治疗后MTrPs的弹性评分比较,差异有统计学意义(P<0.05)。RTE组治疗后视觉模拟评分(VAS)和疼痛评定指数(PRI)分别为(3.02±0.54)分、(3.34±0.62)分,均明显低于传统针刺组(3.89±0.36)分、(3.76±0.34)分,差异均有统计学意义(均P<0.05)。随访结果显示,RTE组的显效率为86.7%,累计无复发率为93.3%,传统针刺组的显效率为60.0%,累计无复发率为57.1%,两组比较差异均有统计学意义(均P<0.05)。结论RTE指导针刺MTrPs治疗MPS的疗效及预后均明显优于传统触诊法针刺,具有重要的临床价值。     

灰阶超声联合剪切波弹性成像评估肌筋膜疼痛综合征患者肌筋膜疼痛触发点

目的 探讨灰阶超声联合剪切波弹性成像（SWE）技术评估肌筋膜疼痛综合征（MPS）患者肌筋膜疼痛触发点（MTrPs）处肌肉形态及组织学特性的价值。方法 以28例MPS患者（36个MTrPs）为病例组,33名健康志愿者（33个正常肌肉点）为对照组。由2名检查者分别测量病例组MTrPs （上斜方肌）厚度、剪切波传播速度（SWV）及杨氏模量值（E）,1名检查者测量对照组上述参数,1周后2组均重复测量。采用组内相关系数（ICC）评价2名检查者检测结果的一致性,以Pearson检验分析MPS患者疼痛视觉模拟量表（VAS）评分与上斜方肌厚度、SWV及E的相关性。结果 2名检查者重复测量一致性、时间一致性及检查者间一致性均好或优（ICC 0.73~0.98）。病例组MPS患者上斜方肌厚度、SWV及E均高于对照组,差异均有统计学意义（P均<0.05）。MPS患者VAS评分与上斜方肌厚度无相关性（r=0.016,P=0.945）,与SWV （r=0.709,P<0.001）、E （r=0.653,P=0.002）均呈正相关。结论 灰阶超声联合SWE可定量评估MPS患者MTrPs处肌肉形态及组织学特性。     

A comparison between different modes of real-time sonoelastography in visualizing myofascial trigger points in low back muscles

Objective: Currently, there is a lack of objective means to quantify myofascial trigger points (MTrPs) and their core features. Our research compares (1) MTrPs and surrounding myofascial tissue using two-dimensional grayscale ultrasound (2DGSUS) and vibration sonoelastography (VSE); (2) the accuracy of both modes in visualizing MTrPs; (3) ‘active’ and ‘latent’ MTrPs, using VSE; and (4) the accuracy of both modes in visualizing deep and superficially located MTrPs.

Methods: Fifty participants with more than two MTrPs in their quadratus lumborum, longissimus thoracis, piriformis, and gluteus medius muscles were assigned to an active MTrP (low back pain) group or a latent (currently pain free) MTrP group. MTrP identification was based on their essential criteria. An electronic algometer measured repeatedly the tenderness of MTrPs with reference to pressure pain threshold values. A handheld vibrator was applied over MTrPs, while VSE and 2DGSUS readings were taken using an EUB-7500 ultrasound scanner.

Results: There was a significant difference between MTrP strain and that of the immediately surrounding myofascial tissue, as measured using VSE (P?=?0·001). VSE visualized all superficial and deep MTrPs with an accuracy of 100% (for both groups); the blinded results obtained using 2DGSUS achieved 33% and 35% accuracy, respectively. There was no significant difference found between the tissue strain ratios of active and latent MTrPs (P?=?0·929).

Discussion: Sonoelastography can visualize superficial and deep MTrPs, and differentiate them from surrounding myofascial structure through tissue stiffness and echogenicity. VSE was more accurate than 2DGSUS in visualizing and imaging MTrPs.     

Effectiveness of trigger point dry needling for multiple body regions: a systematic review

Background: Trigger point dry needling (TDN) is commonly used to treat musculoskeletal pain related to myofascial trigger points (MTrPs). To date, no systematic review of high-quality randomised controlled trials (RCTs) investigating TDN to multiple body regions exists.

Purpose: The aim of this review is to determine the effectiveness of TDN based on high-quality RCTs for all body regions.

Methods: To ensure thorough reporting, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed as the methodological basis for this systematic review. PubMed, Physiotherapy Evidence Database (PEDro), Cinahl, Cochrane and reference lists were searched for the years 2000–2014 and the terms ‘TDN’, ‘dry needling NOT trigger point’, ‘functional dry needling’ and ‘intramuscular manual therapy’. Inclusion criteria: RCTs with PEDro scores 6–10 investigating TDN. Exclusion criteria: duplicates, non-human participants, non-English language, exclusive focus on acupuncture or medicinal injections. Three investigators searched databases, applied criteria, read and assigned PEDro scores to every RCT. Nineteen studies met the criteria. As compared to either baseline or control groups, significant differences were found for pain (14 studies), range of motion (ROM) (five studies) and at least one item on function and quality of life measures (six studies).

Limitations: This review was limited by inclusion criteria, timeframe, language and databases searched.

Conclusion: The majority of high-quality studies included in this review show measured benefit from TDN for MTrPs in multiple body areas, suggesting broad applicability of TDN treatment for multiple muscle groups. Further high-quality research is warranted to standardise TDN methods to determine clinical applicability.     

Attenuated Skin Blood Flow Response to Nociceptive Stimulation of Latent Myofascial Trigger Points

Zhang Y, Ge H-Y, Yue S-W, Kimura Y, Arendt-Nielsen L. Attenuated skin blood flow response to nociceptive stimulation of latent myofascial trigger points.

Objectives

To investigate the effect of painful stimulation of latent myofascial trigger points (MTrPs) on skin blood flow and to evaluate the relative sensitivity of laser Doppler flowmetry (LDF) and thermography in the measurement of skin blood flow.

Design

Painful stimulation was obtained by a bolus injection of glutamate (0.1mL, 0.5M) into a latent MTrP located in the right or left brachioradialis muscles. A bolus of glutamate injection into a non-MTrP served as control. Pain intensity (visual analog scale [VAS]) was assessed after glutamate injection. Pressure pain threshold (PPT) was recorded bilaterally in the brachioradialis muscle before and after glutamate-induced pain. Skin blood flow and surface skin temperature were measured bilaterally in the forearms before, during, and after glutamate-induced pain with LDF and thermography.

Setting

A biomedical research facility.

Participants

Fifteen healthy volunteer subjects.

Interventions

Not applicable.

Main Outcome Measures

VAS, PPT, skin blood flow, and surface skin temperature.

Results

Glutamate injection into latent MTrPs induced higher pain intensity (F=7.16; P<.05) and lower PPT (F=11.41, P<.005) than into non-MTrPs. Glutamate injection into non-MTrPs increased skin blood flow bilaterally in the forearms, but skin blood flow after glutamate injection into latent MTrPs was significantly less increased at the local injection area or decreased at distant areas compared with non-MTrPs (all P<.05). Skin temperature was not affected after glutamate injection into either latent MTrPs or non-MTrPs (all P>.05).

Conclusions

The present study demonstrated an attenuated skin blood flow response after painful stimulation of latent MTrPs compared with non-MTrPs, suggesting increased sympathetic vasoconstriction activity at latent MTrPs. Additionally, LDF was more sensitive than thermography in the detection of the changes in skin blood flow after intramuscular nociceptive stimulation.     

剪切波弹性成像在肌筋膜疼痛综合征中的临床应用价值

目的应用剪切波弹性成像观察肌筋膜疼痛综合征患者肌筋膜疼痛触发点(MTrPs)处肌肉弹性改变情况,观察其在中医手法治疗中的应用。方法收集我院收治的60例肌筋膜疼痛综合征患者(观察组)和60例健康体检者(对照组)为研究对象,均行剪切波弹性成像检测,比较观察组与对照组肌肉杨氏模量值(E)、组织剪切波速度(SWV)、上斜方肌厚度、目测类比等级(VAS)评分。以后期病理生理学检测结果为标准,绘制受试者工作特征(ROC)曲线分析剪切波弹性成像诊断MTrPs的价值。根据观察组患者定位MTrPs方式差异分为2个亚组:常规组(30例)和辅助组(30例),对比常规组与辅助组治疗前和治疗后15 d的VAS评分、疼痛分级指数(PRI)评分、现有疼痛强度(PPI)评分,以及治疗1、2、3个疗程后的疼痛缓解显效率。结果观察组MTrPs处肌肉E、SWV、上斜方肌厚度、VAS评分均高于对照组,差异均有统计学意义(均P0.05)。ROC曲线分析显示,剪切波弹性成像诊断MTrPs的曲线下面积为0.948,敏感性为95.24%,特异性为94.44%,诊断准确率为95.00%。通过对比疗效发现,辅助组1、2、3个疗程治疗后的疼痛缓解显效率均显著高于常规组,治疗后15 d的VAS评分、PRI评分、PPI评分均低于常规组,差异均有统计学意义(均P0.05)。结论剪切波弹性成像评估肌筋膜疼痛综合征患者MTrPs处肌肉弹性改变具有较高的特异性和敏感性,有助于中医手法治疗定位,具有重要的临床价值。     

Sustained Nociceptive Mechanical Stimulation of Latent Myofascial Trigger Point Induces Central Sensitization in Healthy Subjects

The aim of the study is to test if sustained nociceptive mechanical stimulation (SNMS) of latent myofascial trigger points (MTrPs) induces widespread mechanical hyperalgesia. SNMS was obtained by inserting and retaining an intramuscular electromyographic (EMG) needle within a latent MTrP or a nonMTrP in the finger extensor muscle for 8 minutes in 12 healthy subjects. Pain intensity (VAS) and referred pain area induced by SNMS were recorded. Pressure pain threshold (PPT) was measured immediately before and after, and 10-, 20-, and 30-minutes after SNMS at the midpoint of the contralateral tibialis anterior muscle. Surface and intramuscular EMG during SNMS were recorded. When compared to nonMTrPs, maximal VAS and the area under VAS curve (VASauc) were significantly higher and larger during SNMS of latent MTrPs (both, P < .05); there was a significant decrease in PPT 10 minutes, 20 minutes, and 30 minutes postSNMS of latent MTrPs (all, P < .05). Muscle cramps following SNMS of latent MTrPs were positively associated with VASauc (r = .72, P = .009) and referred pain area (r = .60, P = .03). Painful stimulation of latent MTrPs can initiate widespread central sensitization. Muscle cramps contribute to the induction of local and referred pain.     

Short-term effects of kinesio taping on trigger points in upper trapezius and gastrocnemius muscles

Background

Kinesio taping is a possible therapeutic modality for myofascial pain, nevertheless, very scarce research has been performed on this subject.

Abstract 17: A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in 3 clinically distinct groups: normal, latent, and active.

Objectives: To determine (1) whether a novel microdialysis needle can successfully sample the biochemical milieu of trigger point 1 (TP1) in the upper trapezius muscle in healthy subjects and (2) whether there are measurable differences among those with symptoms and physical findings related to myofascial trigger points (MTrPs). Design: Prospective, controlled trial. Setting: Biomedical research hospital. Participants: 3 subjects were selected based on history and physical examination for 3 groups (N=9): group 1, normal (no neck pain, no MTrP); group 2, latent (no neck pain, MTrP present); and group 3, active (neck pain, MTrP present). Intervention: Pressure algometry was performed at TP1 to determine pain pressure threshold (PPT). Samples were obtained continuously with a microdialysis needle at regular intervals, starting with needle insertion, elicitation of a local twitch response, and then posttwitch. Main Outcome Measures: PPT and levels of pH, substance P, calcitonin gene-related peptide (CGRP), bradykinin, norepinephrine, tumor necrosis factor-alpha (TNF_α), and interleukin-1β (IL-1β). Results: The active group had a lower PPT (P<.08). Overall, the amount of substance P, CGRP, bradykinin, norepinephrine, TNF_α, and IL-1β was significantly higher in the active group than in the other 2 groups (P<.01). Overall, pH was significantly lower in the active group than in the other 2 groups (P<.03). At 5 minutes, peak levels of substance P and CGRP differed significantly in all 3 groups (3>2>1, P<.02). Conclusions: This technique recovered extremely small quantities (<0.5μL) of very small substances (molecular weight, <100kd) directly from soft tissue. There were significant differences in the levels of pH, substance P, CGRP, bradykinin, norepinephrine, TNF_α, and IL-1β in those subjects with an active MTrP (symptoms, MTrP present) compared with subjects with a latent MTrP (no symptoms, MTrP present) and normal subjects (no symptoms, no MTrP).     

Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache.

Referred pain and pain characteristics evoked from the upper trapezius muscle was investigated in 20 patients with chronic tension-type headache (CTTH) and 20 age- and gender-matched controls. A headache diary was kept for 4 weeks in order to confirm the diagnosis and record the pain history. Both upper trapezius muscles were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold (PPT) were recorded. The results show that referred pain was evoked in 85% and 50% on the dominant and non-dominant sides in CTTH patients, much higher than 55% and 25% in controls (P<0.01). Referred pain spread to the posterior-lateral aspect of the neck ipsi-lateral to the stimulated muscle in both patients and controls, with additional referral to the temple in most patients, but none in controls. Nearly half of the CTTH patients (45%) recognized the referred pain as their usual headache sensation, i.e. active TrPs. CTTH patients with active TrPs in the right upper trapezius muscle showed greater headache intensity and frequency, and longer headache duration than those with latent TrPs. CTTH patients with bilateral TrPs reported significantly decreased PPT than those with unilateral TrP (P<0.01). Our results showed that manual exploration of TrPs in the upper trapezius muscle elicited referred pain patterns in both CTTH patients and healthy subjects. In CTTH patients, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual headache pain, consistent with active TrPs. Our results suggest that spatial summation of perceived pain and mechanical pain sensitivity exists in CTTH patients.     

Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome

This article discusses muscle pain concepts in the context of myofascial pain syndrome (MPS) and summarizes microdialysis studies that have surveyed the biochemical basis of this musculoskeletal pain condition. Though MPS is a common type of non-articular pain, its pathophysiology is only beginning to be understood due to its enormous complexity. MPS is characterized by the presence of myofascial trigger points (MTrPs), which are defined as hyperirritable nodules located within a taut band of skeletal muscle. MTrPs may be active (spontaneously painful and symptomatic) or latent (non-spontaneously painful). Painful MTrPs activate muscle nociceptors that, upon sustained noxious stimulation, initiate motor and sensory changes in the peripheral and central nervous systems. This process is called sensitization. In order to investigate the peripheral factors that influence the sensitization process, a microdialysis technique was developed to quantitatively measure the biochemical milieu of skeletal muscle. Biochemical differences were found between active and latent MTrPs, as well as in comparison with healthy muscle tissue. In this paper we relate the findings of elevated levels of sensitizing substances within painful muscle to the current theoretical framework of muscle pain and MTrP development.     

Management of myofascial trigger point pain

Successful management of myofascial trigger point (MTrP) pain depends on the practitioner finding all of the MTrPs from which the pain is emanating, and then deactivating them by one of several currently used methods. These include deeply applied procedures, such as an injection of a local anaesthetic into MTrPs and deep dry needling (DDN), and superficially applied ones, including an injection of saline into the skin and superficial dry needling (SDN) at MTrP sites. Reasons are given for believing that DDN should be employed in cases where there is severe muscle spasm due to an underlying radiculopathy. For all other patients SDN is the treatment of choice. Following MTrP deactivation, correction of any postural disorder likely to cause MTrP reactivation is essential, as is the need to teach the patient how to carry out appropriate muscle stretching exercises. It is also important that the practitioner excludes certain biochemical disorders.     

Proximal myofascial pain in patients with distal complex regional pain syndrome of the upper limb

BackgroundPatients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases.AimsTo evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers’ tenderness and allodynia are associated with CRPS.MethodsA case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test.ResultsThe prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ² = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ² = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ² = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls.ConclusionThere is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.     

Effects of Deep Cervical Flexor Training on Pressure Pain Thresholds Over Myofascial Trigger Points in Patients With Chronic Neck Pain

Objective

The purpose of this study was to assess the effects of a low-load training program for the deep cervical flexors (DCFs) on pain, disability, and pressure pain threshold (PPT) over cervical myofascial trigger points (MTrPs) in patients with chronic neck pain.

Methods

Thirty patients with chronic idiopathic neck pain participated in a 6-week program of specific training for the DCF, which consisted of active craniocervical flexion performed twice per day (10-20 minutes) for the duration of the trial. Perceived pain and disability (Neck Disability Index, 0-50) and PPT over MTrPs of the upper trapezius, levator scapulae, and splenius capitis muscles were measured at the beginning and end of the training period.

Results

After completion of training, there was a significant reduction in Neck Disability Index values (before, 18.2 ± 12.1; after, 13.5 ± 10.6; P < .01). However, no significant changes in PPT were observed over the MTrPs.

Conclusion

Patients performing DCF training for 6 weeks demonstrated reductions in pain and disability but did not show changes in pressure pain sensitivity over MTrPs in the splenius capitis, levator scapulae, or upper trapezius muscles.     

A comparative study of Thai massage and muscle energy technique for chronic neck pain: A single-blinded randomized clinical trial

BackgroundMyofascial pain syndrome (MPS) is the most common form of muscle disorders. Traditional Thai massage (TM) and muscle energy (ME) technique have been used to treat patients with MPS for long time but head-to-head comparisons of these interventions have not been established.AimThe aim of the current study was to compare the effects of TM and the ME technique on pain intensity (PI), pressure pain threshold (PPT), neck disability (ND), and neck flexion range of motion (NFROM) in patients with chronic neck pain associated with myofascial trigger points (MTrPs).DesignA randomized, single-blinded clinical trial.SettingDepartment of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University.PopulationForty-five patients with chronic neck pain associated with MTrPs were recruited.MethodsThe patients were randomly allocated to the TM, ME, or control groups, with each having eight treatment sessions over a period of two weeks. PI, PPT, ND, and NFROM were assessed before, immediately after the first treatment session, and one day after the last treatment session.ResultsBased on the results, both TM and the ME technique resulted in a significant improvement in all parameters (p < 0.05) compared to the control group. Additionally, no significant difference was observed between TM and the ME technique in all parameters.ConclusionsThe application of TM or the ME technique can be a practical alternative approach for the treatment of chronic neck pain associated with MTrPs.