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。     

The prevalence of myofascial trigger points in hip and thigh areas in anterior knee pain patients

BackgroundAnterior knee pain (AKP) is a widespread problem among young athletes and soldiers. There are many theories on the etiology of AKP but there is little reference to myofascial trigger points (MTrPs) as a possible contributor.AimTo evaluate the association between AKP and prevalence of active and latent MTrPs in the hip and thigh muscles in soldiers.MethodsA cross-sectional study was conducted in the Beer-Sheva military outpatient physical therapy clinic. Subjects were 42 men and 23 women referred for physical therapy, 33 with a diagnosis of AKP (cases) and 32 with upper limb complaints (without AKP, controls). All subjects underwent physical evaluation by an examiner blinded to their identity and medical condition. The following muscles were assessed bilaterally for active or latent MTrPs: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal).ResultsIn six out of eight areas, the cases had a higher prevalence of total active and latent MTrPs than the controls. When summarizing MTrPs by muscle, cases had significantly more MTrPs than controls in each muscle. The largest difference was found in vastus medialis and vastus lateralis; nearly half of the cases had MTrPs in these muscles.ConclusionsSubjects with AKP have a greater prevalence of MTrPs in their hip and thigh muscles than controls, indicating an association between MTrPs and AKP. Further research is necessary to determine whether MTrPs are the cause or the consequence of AKP.     

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.     

Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle

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.     

Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography

Rha D-w, Shin JC, Kim Y-K, Jung JH, Kim YU, Lee SC. Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography.

Objective

To evaluate the role of ultrasonography for detecting local twitch responses (LTRs) of myofascial trigger points (MTrPs) in deeply located lower-back muscles.

Design

Case-control study. Active MTrP was diagnosed in all patients based on the criteria proposed by Travell and Simons in their upper-trapezius or lower-back muscles. One investigator administered trigger point injections while observing LTRs on ultrasonography. The other investigator observed LTRs visually during the procedure.

Setting

University rehabilitation hospital.

Participants

Patients (n=41; mean age, 51.8±11.8y) with MTrPs in the upper-trapezius muscles and patients (n=62; mean age, 56.8±11.9y) with MTrPs in the erector spinae or quadratus lumborum were recruited from April 29 to October 31, 2010.

Interventions

Ultrasound-guided trigger point injection.

Main Outcome Measures

LTR detection rate according to the depth of MTrPs; subjective pain intensity using a visual analog scale before and immediately after the trigger point injection.

Results

In upper-trapezius muscles, all LTRs were detected by means of both ultrasonographic and visual inspection. In the lower-back muscles, many LTRs were detected only on ultrasonography during the trigger point injection. For deep muscles, ultrasound helped identify LTRs that were not detected by using visual assessment. Pain was alleviated more significantly in the group with LTRs during trigger point injections compared with the group without LTRs.

Conclusions

These findings suggest that ultrasonography was useful for detecting LTRs of MTrPs, especially for LTRs in the deep muscles. Ultrasound guidance may improve the therapeutic efficacy of trigger point injection for treating MTrPs in the deep muscles.     

Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials

ObjectiveThis systematic review of randomized controlled trials aimed to examine the effectiveness of dry needling in the treatment of myofascial trigger points and to explore the impact of specific aspects of the technique on its effectiveness.MethodsRelevant studies published between 2000 and 2015 were identified by searching PubMed, Scopus, The Cochrane Library and Physiotherapy Evidence Database. Studies identified by electronic searches were screened against a set of pre-defined inclusion criteria.ResultsFifteen studies were included in this systematic review. The main outcomes that were measured were pain, range of motion, disability, depression and quality of life. The results suggest that dry needling is effective in the short term for pain relief, increase range of motion and improve quality of life when compared to no intervention/sham/placebo. There is insufficient evidence on its effect on disability, analgesic medication intake and sleep quality.ConclusionsDespite some evidence for a positive effect in the short term, further randomized clinical trials of high methodological quality, using standardized procedures for the application of dry needling are needed.     

A self-determination theory-based self-myofascial release program in older adults with myofascial trigger points in the neck and back: A pilot study

Purpose: To examine the effectiveness and adherence to a self-determination theory (SDT)-based self-myofascial release (SMR) program in older adults with myofascial trigger points (MTrPs), and to investigate the factors that influence participant behavioral change while conducting the program in a home setting. Methods: An explanatory mixed-method design was used to evaluate a 12-week SDT-based SMR program, including a 4-week group-based education and practice (EP) phase and an 8-week home-based self-management (SM) phase. Pain intensity on palpation and sensitivity to pain were assessed at baseline and the post EP and post SM phase. Focus group interviews were conducted at the post SM phase. Findings: Fifteen participants completed the study. Pain intensity and sensitivity to pain significantly improved at the post SM phase compared with the baseline. Adherence increased during the SM phase compared with that during the EP phase. Four main themes emerged as factors that influenced participant behavioral change: 1) “awareness of the effectiveness”; 2) “a sense of duty to perform the exercise”; 3) “obedience to expert instruction”; and 4) “lack of friendship.” Conclusions: These results support the effectiveness of an SDT-based SMR program for the treatment of MTrPs and in motivating older adults to participate in the program.     

The association between myofascial trigger points and the incidence of chronic functional constipation

IntroductionChronic functional constipation (CFC) is the most prevalent type of constipation. Considering the proven effect of pelvic floor muscles dysfunction in these patients’ symptom and the fascial connection between pelvic floor and abdominal and lumbopelvic muscles, this study aimed to examine the possible relationship between this muscles and CFC.MethodWe conveniently selected 100 patients with CFC and 100 healthy participants based on the Rome IV criteria. Two groups were asked to complete the international physical activity questionnaire and food frequency questionnaire. Then both groups were assessed for the presence of trigger points in more prevalent pain sites for each muscle by pressure algometer with 50% of their caught pressure pain threshold.ResultsThere were no statistical differences between two groups in the intake of calories, carbohydrates, proteins, sugar, fiber, vegetables, and wheat products. Patients had a higher consumption of fat and dairy products. for the physical activity level, a statistical difference showed that patients were less physically active. The comparison of the presence and the number of trigger points for each muscle in patients and control groups indicated more than 50% impairment, and there was a significant difference between two groups.ConclusionsThis study revealed that the relationship between myofascial trigger points of abdominal and lumbopelvic muscles and constipation. In addition to that, it seems that a sedentary life may influence CFC patients’ condition. Moreover, it seems that the results of the dietary condition in patients could be because of conscious consumption of some certain foods.     

The effects of myofascial release technique for patients with low back pain: A systematic review and meta-analysis

ObjectiveThe purpose of this meta-analytic review was to quantitatively examine the effects of myofascial release technique (MFR) on pain intensity, back disability, lumbar range of motion, and quality of life in patients with low back pain (LBP).MethodsPotential articles were retrieved using five electronic databases (Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, and Wanfang). The search period was from inception to January 27, 2021. Two researchers independently completed record retrieval and selection, data extraction, and methodological quality assessment. Randomized controlled trials (RCTs) assessing the effect of MFR on pain intensity, back disability, lumbar range of motion, and quality of life in LBP patients were included. Pooled effect sizes were calculated using random effects models and 95 % confidence interval (95 % CI).ResultsData from eight RCTs (386 patients with back pain) meeting the inclusion criteria were extracted for meta-analysis with methodological quality assessment scores ranging from 6 to 10. Compared to the control intervention, MFR induced significant decrease in back disability (SMD = −0.35, 95 % confidence interval [CI] = −0.68, –0.02, P = 0.04, I² = 46 %, n = 284). MFR induced non-significant decrease in the pain intensity (SMD = −0.12, 95 % confidence interval[CI] = −0.35, 0.11, P = 0.32, I² = 0%, n = 294), non-significant improvement in quality of life (SMD = −0.09, 95 % confidence interval [CI] = −0.46, 0.28, P = 0.62, I² = 0%, n = 114), and non-significant improvement in lumbar range of motion (Flexion SMD = 0.57,95 % confidence interval [CI] = −0.09, 1.24, P = 0.09, I² = 54 %, n = 80) (Extension SMD = 0.68, 95 % confidence interval[CI] = −0.72, 2.08, P = 0.34, I² = 89 %, n = 80) (Right flexion SMD = 0.05, 95 % confidence interval[CI] = −0.90, 0.99, P = 0.92, I² = 78 %, n = 80) (Left flexion SMD = 0.14, 95 % confidence interval[CI] = −0.59, 0.88, P = 0.70, I² = 64 %, n = 80).ConclusionThe findings suggest that MFR can improve the effect of physical therapy alone and exercise therapy alone, and that MFR can be an effective adjuvant therapy. Meta-analysis showed that MFR has a significant effect on reducing back disability in patients with low back pain, but no significant effect on reducing pain intensity, improving quality of life, and improving lumbar range of motion.     

Effectiveness of traditional Thai massage versus Swedish massage among patients with back pain associated with myofascial trigger points

The aim of this study was to verify the effectiveness of traditional Thai massage (TTM) among patients with back pain associated with myofascial trigger points (MTrPs). Swedish massage (SM) was selected as the treatment for the comparison group. One hundred and eighty patients were randomly allocated to receive either TTM or SM for 6 sessions during a 3–4 week period, with follow-up 1 month later. Results indicated that pain intensity, assessed using the visual analog scale (VAS), among patients in both groups was reduced by more than half after 3 weeks of treatment and for up to one month afterwards (P<0.05) with no significant difference in VAS between the groups. Similar improvements were found for most other outcome measures. We conclude that TTM and SM are effective in reducing back pain among patients with MTrPs. We therefore suggest that massage therapy, and in particular Thai massage, be considered as an alternative primary health care treatment for this disorder.     

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.

按压肌筋膜触发点对功能性踝关节不稳患者的疗效研究

摘要目的：探讨按压肌筋膜触发点在功能性踝关节不稳（functional ankle instability, FAI）患者中的临床疗效。方法：选取西南大学医院康复医学中心门诊2021年5月—8月就诊的功能性踝关节不稳患者29例,随机分为试验组15例和对照组14例。试验组在踝关节平衡训练基础上增加按压肌筋膜触发点技术,对照组采用BOSU球进行踝关节平衡训练。分别在基线、干预第4周后和干预第8周后对两组患者进行疼痛视觉模拟评分（visual analogue scale, VAS）评估、踝关节功能量表评分（American Orthopedic Foot and Ankle Score,AOFAS）和Y平衡测试（Y-balance test, YBT）评估。结果：治疗前,两组患者在评估的各项指标上无明显差异（P>0.05）。治疗8周后,两组患者在VAS疼痛评分上均有显著降低（P<0.05）,Y平衡测试综合数值得到显著改善（P<0.01）,AOFAS踝关节功能评分得到显著提高（P<0.05）。治疗后,试验组在上述各项评估指标中均显著优胜于对照组（P<0.05）。结论：为期8周的平衡训练和平衡训练联合按压MTrPs治疗均对FAI患者有显著的临床康复疗效,而平衡训练联合按压MTrPs治疗在缓解FAI患者的疼痛、促进踝关节功能和动态平衡的改善等方面具有更好的康复效益。     

Acupuncture-like versus conventional transcutaneous electrical nerve stimulation in the management of active myofascial trigger points: A randomized controlled trial

PurposeMyofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. The transcutaneous electrical nerve stimulation (TENS) is a non-expensive, safe, feasible modality, used recently for the treatment of MPS with promising but limited results. The purpose of this study was to determine the efficacy of acupuncture-like TENS (AL-TENS) vs conventional TENS (C-TENS) in the treatment of active myofascial trigger points.MethodsThis randomized controlled trial study was carried out with 60 consecutive patients with active trapezius trigger points referred to Physical Medicine and Rehabilitation Clinic. Participants randomly assigned to receive AL-TENS, C-TENS or sham TENS (S-TENS). The Visual Analogue Scale (VAS), Pressure Pain Thresholds (PPTs), and neck range of motion (ROM) were measured at baseline, after the first treatment sessions, after the final treatment session, and 3 months after the end of the last treatment session. Patients function was evaluated by Disabilities of the Arm, Shoulder, and Hand (DASH) at baseline, after the final treatment sessions, and 3 months after the end of intervention.ResultsThe interaction effect of time and group was significantly different when evaluating VAS (df = 4.65, F = 2.50, p = 0.038) and DASH (df = 2.63, F = 7.25, p < 0.001) in favor of active groups, as well as neck total lateral bending in favor of AL-TENS group compared other two groups (df = 4.16, F = 5.23, p = 0.001). Both VAS and DASH improved significantly at all follow-ups in AL-TENS and C-TENS groups. Of note, significant immediate improvement in all outcomes was observed only with AL-TENS.ConclusionsAccording to the present study, both AL-TENS and C-TENS were superior to placebo in pain reduction and functional improvement. Although both TENS techniques have similar efficiency on pain reduction, functional and pain perception improvement, the AL-TENS was the superior approach when evaluating neck lateral bending ROM.     

The evaluation of electrodermal properties in the identification of myofascial trigger points

OBJECTIVES: To determine whether skin resistance measurements can objectively identify the location of myofascial trigger points (MTPs) and to differentiate between 3 states. DESIGN: Static group comparison. SETTING: Climate-controlled laboratory. PARTICIPANTS: Forty-nine participants (age, 20.5+/-2.6 y) were assigned to 1 of 3 groups based on clinical examination result: absent (n=21), latent (n=16), or active (n=12) MTP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Skin resistance (in kilo-ohms). RESULTS: The 16 data points were divided into 3 categories for analysis: MTP site, surrounding tissue proximal to the MTP (first ring), and area furthest from the MTP (second ring). There was a significant increase in skin resistance between the MTP (403.64+/-124.73 kOmega), first ring (419.66+/-123.04 kOmega), and second ring (454.61+/-163.19 kOmega) (P<.01). The measurements did not differ significantly between the 3 MTP states. CONCLUSIONS: The changes in skin resistance between the MTP and the surrounding tissue support the inclusion of this technique to help identify MTPs. The similarity between MTP states warrants investigation into the physiologic differences at specific anatomic locations.     

Comparative effect of lumbar myofascial release with electrotherapy on the elastic modulus of lumbar fascia and pain in patients with non-specific low back pain

ObjectivesLow back pain is a major health issue in most industrialized countries. Lumbar fascia is supported as a potential source of pain in the lumbar region. Myofascial release is a manual therapeutic approach that focuses on restoring altered soft tissue function. On the other hand, one of the most commonly used physical therapy methods for low back pain is electrotherapy. The purpose of this study was to compare the effect of lumbar Myofascial release and electrotherapy on clinical outcomes of Non-specific low back pain and elastic modulus of lumbar myofascial tissue.DesignRandomized, clinical trial.SettingOutpatient Low back pain clinic.Subjects32 subjects with low back pain.InterventionsSubjects were randomized into the myofascial release group (n = 16) and electrotherapy group(n = 16). Subjects in the myofascial release group received 4 sessions of myofascial release in the lumbar region, and the electrotherapy group received 10 sessions of electrotherapy.Main measuresLow back pain severity, and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment.ResultsAn independent sample T-test was used to compare baseline variables in both groups (p > 0.05) (effect size≥0.83), Paired T-test was used to compare within-group changes after performing myofascial release and electrotherapy (p ≤ 0.023) (effect size≥0.56), and the GLM Anova test was used to Comparison of Changes in the Elastic Modulus of the Lumbar Spine and Low Back Pain between-group (F (10,21) = 12.10, P < 0.0005) (effect size = 0.86).ConclusionThe improvements in the outcome measures suggest that lumbar myofascial release may be effective in subjects with non-specific low back pain. Data suggest that the elastic modulus of lumbar fascia and the severity of low back pain are directly linked. Decreasing the elastic modulus after myofascial release can directly affect reducing low back pain.