Immediate Effect of Acupuncture on Electromyographic Activity of the Upper Trapezius Muscle and Pain in Patients With Nonspecific Neck Pain: A Randomized,Single-Blinded,Sham-Controlled,Crossover Study

Objective

The objective of this study was to assess changes in upper trapezius myoelectric activity and pain in patients with nonspecific neck pain after a single session of acupuncture (ACP).

Myofascial trigger points in early life

OBJECTIVE: To determine whether latent myofascial trigger points (MTPs) can be identified in healthy infants and in healthy adult subjects. DESIGN: Blind comparison. SETTING: Ambulatory. PARTICIPANTS: A convenience sample of 60 healthy adults and 60 infants (age range, 0-12mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: An algometer was used to measure the pressure pain threshold (PPT) on 3 different sites, including a midpoint (assumed to be the MTP site) in the brachioradialis muscle. RESULTS: The mean PPT values at the MTP site were significantly lower than the other sites in the adult muscles. However, no significant differences in PPT values among these 3 sites were found in the infants. Taut bands were found in all the adult muscles but none in the infants. CONCLUSIONS: In the adult subjects, the midpoint of brachioradialis muscle was significantly more irritable than other sites and the midpoint was probably a latent MTP. However, in the infants younger than 1 year old, such a phenomenon could not be observed in this study. It is very likely that the latent MTPs might not exist in early life, but develop in later life.     

Effects of Spray and Stretch on Postneedling Soreness and Sensitivity After Dry Needling of a Latent Myofascial Trigger Point

Objectives

To investigate (1) the effect of spray and stretch versus control on reducing postneedling soreness of 1 latent myofascial trigger point (MTrP) and (2) whether higher levels of psychological distress are associated with increased postneedling pain intensity.

Design

A 72-hour follow-up, single-blind randomized controlled trial.

Setting

University community.

Participants

Healthy volunteers (N=70; 40 men, 30 women) aged 18 to 36 years (mean age, 21±4y) with latent MTrP in 1 upper trapezius muscle.

Intervention

All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into 2 groups: an intervention group, which received spray and stretch over the needled trapezius muscle, and a control group, which did not receive any intervention.

Main Outcome Measures

Visual analog scale (at postneedling, posttreatment, and 6, 12, 24, 48, and 72h after needling), pressure pain threshold (at preneedling, postneedling, and 24 and 48h after needling). Psychological distress was evaluated by using the Symptom Checklist-90-Revised.

Results

Repeated-measures analysis of variance demonstrated a significant interaction between group and time (F_3,204.8=3.19; P<.05; η_p²=.04) for changes in postneedling soreness. Between-group differences were significant only immediately after intervention (P=.002), and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity, and hostility were significantly correlated (P<.05) with postneedling pain intensity. Repeated-measures analysis of variance did not show a significant effect of spray and stretch on mechanical hyperalgesia (F_2.6,175=1.9; P=.131; η_p²=.02).

Conclusions

The spray and stretch had a short-term (<6h) effect in reducing postneedling soreness of a latent MTrP. Pressure pain threshold did not significantly change after spray and stretch. Psychological factors are related to postneedling pain.     

Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue

Sikdar S, Shah JP, Gebreab T, Yen R-H, Gilliams E, Danoff J, Gerber LH. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue.

Objective

To apply ultrasound (US) imaging techniques to better describe the characteristics of myofascial trigger points (MTrPs) and the immediately adjacent soft tissue.

Design

Four sites in each patient were labeled based on physical examination as active myofascial trigger points (A-MTrPs; spontaneously painful), latent myofascial trigger points (L-MTrPs; nonpainful), or normal myofascial tissue. US examination was performed on each subject by a team blinded to the physical findings. A 12∼5MHz US transducer was used. Vibration sonoelastography (VSE) was performed by color Doppler variance imaging while simultaneously inducing vibrations (∼92Hz) with a handheld massage vibrator. Each site was assigned a tissue imaging score as follows: 0, uniform echogenicity and stiffness; 1, focal hypoechoic region with stiff nodule; 2, multiple hypoechoic regions with stiff nodules. Blood flow in the neighborhood of MTrPs was assessed using Doppler imaging. Each site was assigned a blood flow waveform score as follows: 0, normal arterial flow in muscle; 1, elevated diastolic flow; 2, high-resistance flow waveform with retrograde diastolic flow.

Setting

Biomedical research center.

Participants

Subjects (N=9) meeting Travell and Simons' criteria for MTrPs in a taut band in the upper trapezius.

Interventions

Not applicable.

Main Outcome Measures

MTrPs were evaluated by (1) physical examination, (2) pressure algometry, and (3) three types of US imaging including gray-scale (2-dimensional [2D] US), VSE, and Doppler.

Results

MTrPs appeared as focal, hypoechoic regions on 2D US, indicating local changes in tissue echogenicity, and as focal regions of reduced vibration amplitude on VSE, indicating a localized, stiff nodule. MTrPs were elliptical, with a size of .16±.11cm². There were no significant differences in size between A-MTrPs and L-MTrPs. Sites containing MTrPs were more likely to have a higher tissue imaging score compared with normal myofascial tissue (P<.002). Small arteries (or enlarged arterioles) near A-MTrPs showed retrograde flow in diastole, indicating a highly resistive vascular bed. A-MTrP sites were more likely to have a higher blood flow score compared with L-MTrPs (P<.021).

Conclusions

Preliminary findings show that, under the conditions of this investigation, US imaging techniques can be used to distinguish myofascial tissue containing MTrPs from normal myofascial tissue (lacking trigger points). US enables visualization and some characterization of MTrPs and adjacent soft tissue.     

Comparison of Acupuncture to Injection for Myofascial Trigger Point Pain

Objectives: Many treatments have been proposed for myofascial pain syndrome. The objective of this study was to compare the analgesic effect of acupuncture to trigger point injection combined with cyclobenzaprine chlorhydrate and sodium dipyrone. Methods: A randomized study was performed in 30 patients divided into 2 groups: G1 received trigger point injection with 0.25% bupivacaine twice weekly, and both cyclobenzaprine chlorhydrate 10 mg/day and sodium dipyrone 500 mg every 8 hours; G2 received classical and trigger point acupuncture twice weekly. All patients were instructed in physical exercise. The following parameters were evaluated: pain intensity rated on a numerical scale, number of trigger points, and quality of life before and 4 weeks after treatment. Results: The pain scores and the number of trigger points reduced significantly in both groups, with no significant difference between groups. Significant improvement in the quality of life scores was observed for some of the functional domains in the 2 groups, whereas there was no improvement of the general health status domain in either group or of the emotional domain in G1. Conclusion: Acupuncture, when compared with trigger point injection, combined with cyclobenzaprine chlorhydrate and sodium dipyrone provided similar pain relief and improvement in quality of life measures at 4 weeks. ?     

Correlation Between Skin Temperature Over Myofascial Trigger Points in the Upper Trapezius Muscle and Range of Motion,Electromyographic Activity,and Pain in Chronic Neck Pain Patients

Objective

The purpose of this study was to assess the correlation between skin temperature over a myofascial trigger point in the upper trapezius muscle and range of motion of the cervical spine, electromyographic activity, and pain in patients with chronic neck pain.

New views of myofascial trigger points: etiology and diagnosis

Simons DG. New views of myofascial trigger points: etiology and diagnosis.Two studies appearing in Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs. However, the feedback loop suggested in this hypothesis has a few weak links, and studies by Shah and colleagues in particular supply a solid link for one of them. The feedback loop connects the hypothesized energy crisis with the milieu changes responsible for noxious stimulation of local nociceptors that causes the local and referred pain of MTPs. Shah’s reports quantify the presence of not just 1 noxious stimulant but 11 of them with outstanding concentrations of immune system histochemicals. The results also strongly place a solid histochemical base under the important clinical distinction between active and latent MTPs. The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment, and it images stress produced by adjacent tissues with different degrees of tension. This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues.     

Pathophysiology of Trigger Points in Myofascial Pain Syndrome

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Trigger point pathophysiology in myofascial pain syndrome, which involves muscle stiffness, tenderness, and pain that radiates to other areas of the body, is considered. The causes of trigger points and several theories about how they develop are reviewed, and treatment approaches, including stretching, physical therapy, dry needling, and injections, are offered.     

Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial

Objective

The aim of this study was to investigate short-term and long-term treatment effects of dry needling (DN) and manual pressure (MP) technique with the primary goal of determining if DN has better effects on disability, pain, and muscle characteristics in treating myofascial neck/shoulder pain in women.

Quantification of Dry Needling and Posture Effects on Myofascial Trigger Points Using Ultrasound Shear-Wave Elastography

Objectives

To determine (1) whether the shear modulus in upper trapezius muscle myofascial trigger points (MTrPs) reduces acutely after dry needling (DN), and (2) whether a change in posture from sitting to prone affects the shear modulus.

Design

Ultrasound images were acquired in B mode with a linear transducer oriented in the transverse plane, followed by performance of shear-wave elastography (SWE) before and after DN and while sitting and prone.

Setting

University.

Participants

Women (N=7; mean age ± SD, 46±17y) with palpable MTrPs were recruited.

Intervention

All participants were dry needled in the prone position using solid filament needles that were inserted and manipulated inside the MTrPs. SWE was performed before and after DN in the sitting and prone positions.

Main Outcome Measure

MTrPs were evaluated by shear modulus using SWE.

Results

Palpable reductions in stiffness were noted after DN and in the prone position. These changes were apparent in the shear modulus map obtained with ultrasound SWE. With significant main effects, the shear modulus reduced from before to after DN (P<.01) and from the sitting to the prone position (P<.05). No significant interaction effect between time and posture was observed.

Conclusions

The shear modulus measured with ultrasound SWE reduced after DN and in the prone position compared with sitting, in agreement with reductions in palpable stiffness. These findings suggest that DN and posture have significant effects on the shear modulus of MTrPs, and that shear modulus measurement with ultrasound SWE may be sensitive enough to detect these effects.     

激痛点缺血性压迫治疗颈肩肌筋膜疼痛综合征疗效观察

目的:观察激痛点缺血性压迫法治疗颈肩肌筋膜疼痛综合征的疗效。方法:选择颈肩肌筋疼痛膜综合征患者20例,按照随机数字表法分为对照组和治疗组,每组10例。对照组仅接受健康宣教;治疗组在对照组基础上实施激痛点缺血性压迫疗法。首先通过Booster Pro3筋膜枪渐次提高振动频率的方法松解斜方肌上束,提高痛阈,达到放松并激活上斜方肌的目的,随后使用缺血性压迫激痛点的方法进行干预,治疗1次/d,连续治疗2周。分别在治疗前、后,采用肌力与脊柱活动度测量仪测量颈部关节活动度与肌力,采用疼痛视觉模拟评分法(VAS)评价颈肩部的疼痛程度,采用颈椎功能障碍指数(NDI)评价颈部功能障碍水平。结果:与治疗前比较,治疗第1次结束即刻治疗组左右侧肌力明显增加,治疗后2周治疗组颈部关节活动度(前屈方向)、左右侧肌力明显增加,左屈、右屈、右旋方向上的VAS评分与NDI评分明显降低,差异有统计学意义(P<0.05);与对照组比较,治疗后2周治疗组颈部关节活动度(前屈方向)、左右侧肌力更高,左屈、右屈、右旋方向上的VAS评分与NDI评分更低,差异有统计学意义(P<0.05)。结论:激痛点缺血性压迫疗法治疗颈肩肌筋膜疼痛综合征,可以有效提高MPS患者颈部关节活动度、左右侧肌力,缓解颈部肌肉僵硬不适和疼痛,改善颈椎功能障碍状态,值得临床推广应用。     

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.     

Presence of Latent Myofascial Trigger Points and Determination of Pressure Pain Thresholds of the Shoulder Girdle in Healthy Children and Young Adults: A Cross-sectional Study

Objective

The primary objective of this study was to compare the number of myofascial trigger points (MTPs) and the pressure pain thresholds (PPTs) in the shoulder girdle, on the dominant and nondominant sides, between healthy children and adults. The secondary aim was to assess the correlations between the number of MTPs and the PPTs in these populations.

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

ObjectiveWe sought to investigate the interrater and intrarater reliability of ultrasound and the minimum detectable change (MDC) for the trigger points (TrPs) active in the upper trapezius (UT) muscle in individuals with shoulder pain.MethodsForty individuals with shoulder pain were investigated for the presence of active TrPs in the UT muscle by means of ultrasound for the parameters of gray scale, muscle thickness of UT muscle at rest, and contraction and area of TrPs. The intrarater reliability was performed on 2 days, and interrater reliability on the same day. For the gray scale, the reliability was evaluated using the kappa coefficient (κ), while the other parameters were measured by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and MDC.ResultsFor the gray scale, the intrarater agreement was almost perfect (κ = 1.00) and the interrater agreement was substantial (κ = 0.75). The intrarater and interrater reliability were excellent for most of the parameters, except for the area of TrPs (intrarater: ICC = 0.71, substantial; interrater: ICC = 0.52, substantial). The MDC for intrarater reliability varied between 0.04 and 0.05 (SEM% between 2.4% and 38.87%), and that for interrater reliability ranged from 0.05 to 0.07 (SEM% between 3.18% and 55.10%), with a higher value for area.ConclusionParameters such as gray scale, resting muscle thickness, and muscle contraction of the UT muscle, obtained through ultrasound, showed excellent intrarater and interrater reliability with low SEM%. The intrarater and interrater reliability for the area deserves a caveat regarding their use.     

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.     

针刺结合康复训练治疗脑卒中后遗留功能障碍

脑卒中(stroke)即中风,又称脑血管意外(cerebral vascular accident)本病十分常见,严重威胁人类健康。针刺结合康复训练的方法对卒中后的功能障碍恢复十分有益,如卒中后认知障碍、卒中后吞咽障碍、卒中后肢体功能障碍、卒中后情感障碍等。康复医学(Rehabilitation medicine)是一门新兴学科,旨在提高和恢复患者日常的生活能力和生活质量。康复医学科是综合医院必不可少的组成部分。针刺腧穴疗法与康复训练的联合应用近年来发现更有利于中风患者的康复,应用针灸与康复治疗技术的结合对卒中遗留有后遗症的应用进行分析总结,以此来进一步提高卒中后相关功能障碍临床康复的疗效。关键词脑卒中;针刺;腧穴;