Article

Effect of Ischemic Compression on Trigger Points in the Neck and Shoulder Muscles in Office Workers: A Cohort Study

August 2013
Journal of Manipulative and Physiological Therapeutics 36(8)

August 2013
36(8)

DOI:10.1016/j.jmpt.2013.07.001

Source
PubMed

Authors:

Cagnie Barbara

Ghent University

Vincent Dewitte

Ghent University

Iris Coppieters

Maastricht University

Jessica Van Oosterwijck

Ghent University

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The purpose of this study was to determine the short-term effect of ischemic compression (IC) for trigger points (TPs) on muscle strength, mobility, pain sensitivity, and disability in office workers and the effect on disability and general pain at 6-month follow-up. Nineteen office workers with mild neck and shoulder complaints received 8 sessions of IC in which deep pressure was given on the 4 most painful TPs identified during examination. Outcome measures were general neck and shoulder complaints on a Numeric Rating Scale, Neck Disability Index (NDI), neck mobility (inclinometer), muscle strength (dynamometer), and pain sensitivity (Numeric Rating Scale and algometry). Subjects were tested at baseline (precontrol), after a control period of no treatment of 4 weeks (postcontrol), and after a 4-week intervention training (posttreatment). At 6-month follow-up, pain and disability were inquired. The results showed a statistically significant decrease in general neck/shoulder pain at posttreatment (P = .001) and at 6-month follow-up (P = .003) compared with precontrol and postcontrol. There was no significant main effect for NDI scores. Pressure pain threshold increased at posttreatment in all 4 treated TPs (P < .001). There was a significant increase in mobility and strength from precontrol/postcontrol to posttreatment (P < .05). This study has demonstrated that a 4-week treatment of TPs for IC resulted in a significant improvement in general neck and shoulder complaints, pressure pain sensitivity, mobility, and muscle strength in the short term in a small sample of office workers with mildly severe chronic pain. At 6-month follow-up, there was a further decrease in general pain, but no change in NDI scores.

Reabilitacijos mokslai: slauga, kineziterapija, ergoterapija, 2 (29) 2023

Article

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Dec 2023

Background: Neck pain is a common musculoskeletal issue affecting people worldwide, and manipulative therapy is implemented as a treatment for it. Aim: To analyse the effects of different manipulative therapy techniques on pain intensity, sensitivity and function in patients with neck pain. Methods. Studies between 2012 and April 2022 were selected to investigate the effectiveness of manipulative therapy on neck pain, function and disability. The databases PubMed ®, CNKI, Science Direct, Springer LINK, ResearchGate, Semantic Scholar, Taylor & Francis Online and Google Scholar were utilised. The selection criteria included studies involving human subjects with neck musculoskeletal pain, focusing on the effects of manipulative therapy on neck pain management and function. Results: 10 studies with 573 subjects were included. Strong evidence supported that manipulative therapy was effective in reducing pain and increasing the pain threshold and the function of the neck. A significant (p<0.05) positive effect was reported by 100% of studies that implemented the above parameters. Moderate evidence showed that manipulative therapy was effective in the management of the disability of the neck. The ratio of positive effect was 66.66% among involved studies with very significant results (p<0.01). Moderate evidence with a limited amount of study showed a significant increase in muscle strength after manipulative therapy (p<0.05). Conclusions. Manipulative therapy is effective in reducing neck pain intensity and sensitivity as well as improving neck function and reducing disability. The combined application of manipulative therapy is always more effective than the isolated application of manipulative therapy on patients with neck pain.

Eﬀectiveness of Manipulative Therapy on Neck Pain, Function and Disability. A Systematic ReviewManipuliacinės terapijos poveikis kaklo skausmui, funkcijai ir negaliai. Sisteminė apžvalga

Article

Full-text available

Dec 2023

Background: Neck pain is a common musculoskeletal issue affecting people worldwide, and manipulative therapy is implemented as a treatment for it. Aim: To analyse the effects of different manipulative therapy techniques on the pain intensity, sensitivity and function in patients with neck pain. Methods. Studies between 2012 - April 2022 were selected to investigate the effectiveness of manipulative therapy on neck pain, function and disability. The databases PubMed ®, CNKI, Science Direct, Springer LINK, ResearchGate, Semantic Scholar, Taylor & Francis Online and Google Scholar were utilised. The selection criteria included studies involving human subjects with neck musculoskeletal pain, focusing on the effects of manipulative therapy on neck pain management and function. Results: 10 studies with 573 subjects were included. Strong evidence supported that manipulative therapy was effective in reducing pain and increasing the pain threshold and the function of the neck. A significant (p<0.05) positive effect was reported by 100% of studies that implemented the above parameters. Moderate evidence showed that manipulative therapy was effective in the management of the disability of the neck. The ratio of positive effect was 66.66% among involved studies with very significant results (p<0.01). Moderate evidence with a limited amount of study showed a significant increase in muscle strength after manipulative therapy (p<0.05). Conclusions. Manipulative therapy is effective in reducing neck pain intensity and sensitivity as well as improving neck function and reducing disability. The combined application of manipulative therapy is always more effective than the isolated application of manipulative therapy on patients with neck pain. Keywords: Neck pain; manipulative therapy; effectiveness; pain threshold; pain intensity; neck function

Combining Patient Education With Dry Needling and Ischemic Compression for Treating Myofascial Trigger Points in Office Workers With Neck Pain: A Single-Blinded, Randomized Trial

Article

Full-text available

Dec 2020
J Chiropr Med

Objective: The purpose of this study was to compare immediate and short-term effects of combining dray needling (DN) + patient education vs ischemic compression (IC) + patient education for treating myofascial trigger points (MTP) in office workers with neck pain. Methods: This was a single-blinded, randomized trial. Thirty-two participants were randomly assigned to either DN + patient education or IC + patient education group. Both groups received 2 treatment sessions with a 48-hour time interval. Pain intensity, cervical range of motion, Neck Disability Index, and satisfaction were measured. Results: Pain intensity and neck disability level decreased, whereas the cervical range of motion (side-bending and rotation) increased in both groups. Analysis of variance revealed a significant interaction of group × treatment only for pain intensity, indicating a greater reduction in the IC group. Satisfaction generally increased in the follow-up assessment in both groups. Conclusion: Both intervention groups had some positive immediate and short-term effects after 2 treatment sessions. However, IC + patient education was more effective than DN + patient education in the treatment of MTPs in office workers with neck pain.

Immediate Effects of Ischemic Compression Therapy on Myofascial Trigger Points on Pain, Mobility and Strength in Individuals With Subacromial Impingement Syndrome: A Single-arm Study

Preprint

Full-text available

Aug 2020

Background: The myofascial trigger points (MTPs) may be associated with in shoulder dysfunction. Objective: To evaluate the immediate effect of ischemic compression therapy (ICT) and to verify the effect of the evaluation protocol on MTPs, pain, mobility and strength of shoulder. Methods: 15 individuals were assessed for the amount of MTPs, pressure pain threshold (PPT), range of motion (ROM), isometric strength of shoulder muscles and pain in performing these tests. The evaluations took place 48 hours before the ICT, immediately before, and after the ICT. Results: There was a reduction in the total amount of MTPs (p<0.01; Cliff’s d=0.24-0.35) and an increase in the PPT in the middle deltoid muscle (p=0.03) in the comparisons pre and post treatment, while there was no difference in ROMs and strength measures (p>0.05). The pain was less during the sagittal elevation ROM (p<0.01; d=0.80) and internal rotation (p=0.05; d=0.57), and during the performance of strength in arm elevation and external rotation (p=0.01; d=0.72 and d=0.68). There was generally no difference in the variables assessed between baseline and pre-treatment (p>0.06). Conclusion: The ICT immediately reduced the amount of MTPs and pain during mobility and strength. The evaluation protocol did not influence the studied variables. Trial registration: ReBEC (RBR-3DDG2K). Registered in July 5th, 2017 – Retrospectively registered, http://www.ensaiosclinicos.gov.br/rg/RBR-3ddg2k/.

Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points

Article

Full-text available

Mar 2020
BMRI

Myofascial pain syndrome, thought to be the main cause of neck pain and shoulder muscle tenderness in the working population, is characterized by myofascial trigger points (MTrPs). This study aimed to examine the immediate and short-term effect of the combination of two therapeutic techniques for improving neck pain and muscle tenderness in male patients with upper trapezius active MTrPs. This study was a pretest-posttest single-blinded randomized controlled trial. Sixty male subjects with mechanical neck pain due to upper trapezius active MTrPs were recruited and randomly allocated into group A, which received muscle energy technique (MET) and ischemic compression technique (ICT) along with conventional intervention; group B, which received all the interventions of group A except ICT; and group C, which received conventional treatment only. Baseline (Pr), immediate postintervention (Po), and 2-week follow-up (Fo) measurements were made for all variables. Pain intensity and pressure pain threshold (PPT) were assessed by a visual analog scale (VAS) and pressure threshold meter, respectively. All the three groups received their defined intervention plans only. Repeated-measures analysis of variance was used to perform intra- and intergroup analyses. Cohen’s d test was used to assess the effect size of the applied interventions within the groups. The intergroup analysis revealed significant differences among groups A, B, and C in VAS and PPT at Po (VAS-Po: F = 13.88, p=0.0001; PPT-Po: F = 17.17, p=0.0001) and even after 2 weeks of follow-up (VAS-Fo: F = 222.35, p=0.0001; PPT-Fo: F = 147.70, p=0.0001). Cohen’s d revealed a significant treatment effect size within all groups except group C (only significant for VAS-Po–VAS-Pr: mean difference = 1.33, p

Effects of Manual and Instrumental Therapy on the Treatment of Myofascial Pain Syndrome in Descending Trapezius of Women: A Blind Randomized Clinical Study

Article

Mar 2024

Objective. To investigate the effects of Manual Ischemic Compression (MIC) and Instrumental Ischemic Compression (ICG) and Pressure Algometer (ICA), in the treatment of women with MPS in descending trapezius. Patients and Methods. This is a double-blinded, randomized, placebo-controlled trial. Patients were randomized into 3 groups: MIC, ICG, and ICA. Pain, pressure pain threshold (PPT), electromyography, disability (NDI), anxiety (GAD-7), and adverse treatment effects (AE) were assessed. The Shapiro-Wilk test was performed to verify the normality of the data, followed by consistent tests, being considered significant when p < 0.05. Results. There was no intergroup difference for any analyzed variables. In the intragroup comparison, MIC group presented pain reduction (F: 7.70; p = 0.0002), between baseline and 1 week; and anxiety (p = 0.048), between baseline and 4 weeks. All groups showed increase in PPT (F: 37.62; p < 0.0001) and decrease in NDI score (F: 53.29; p < 0.0001). About AE, the MIC group reported the highest mean value of discomfort after the technique, 7.22. Conclusions. An intragroup improvement was observed in the pain and anxiety variables for the MIC group, when compared to the baseline with one week and four weeks, respectively. There was an improvement in all groups in the PPT and NDI; however, with no differences between groups in the post-treatment. Study registration. Brazilian Registry of Clinical Trials: ReBEC: RBR-2q24nb.

The impact of 8 weeks selected corrective exercises on neck pain, range of motion in the shoulder and neck of lifesaver women who suffering from forward head posture and myofascial pain syndrome

Article

Full-text available

Jun 2017

Background: The purpose of this research was studying the impact of 8 weeks selected corrective exercises on neck pain, range of motion in the shoulder and neck of lifesaver women who suffering from forward head posture and myofascial pain syndrome. Methods: The method of research is semi-experimental. The population consists of 30 lifesaver women who suffering from forward head posture and myofascial pain syndrome who they placed randomly in two groups of experimental (33±2.2) and control (33±2.5). Research plan was as the pre-test and post-test with control group. The exercise protocol was carried out by experimental groups for 8 weeks, 3 sessions per week, each session lasting 45 minutes. Studied variables include myofascial pain in the neck, shoulder and neck range of motion. The mean and standard deviation were used as descriptive statistics and in the section of inferential statistics analysis of covariance was used. Results: Results of research indicated that, the protocol on the reform exercise of neck pain (P=0.001), range of motion of shoulder joint (P=0.001) and neck range of motion (P=0.001) has significant difference. Conclusion: Therefore, lifesavers women can benefit from it as a training program to improve and prevent damage caused by head forward and myofascial pain syndrome.

EFEITOS DA AUTO LIBERAÇÃO MIOFASCIAL NA MELHORIA DA QUALIDADE DE VIDA EM TRABALHADORES DE SERVIÇOS GERAIS: UMA REVISÃO NARRATIVA

Article

Full-text available

Aug 2022

Denize Silva dos Santos

A auto liberação miofascial é uma terapia de automassagem para restrições dos tecidos moles com uso de instrumentos como rolo de espuma, bola de borracha, bastão, utilizada para reduzir a dor, melhorar a amplitude de movimento articular e tratar pontos gatilhos miofasciais provocados por movimentos repetitivos. No Brasil, há cerca de 1,6 milhões de trabalhadores do setor de serviços gerais que exercem atividades de limpeza e conservação, sendo uma função que pode gerar riscos à saúde. Considerando que a dor musculoesquelética crônica são fatores que geram impactos negativos na qualidade de vida e grande sobrecarga ao sistema de saúde, o presente estudo tem por objetivo discutir por meio de uma revisão narrativa, sobre os efeitos da prática de auto liberação miofascial na melhoria da qualidade de vida em trabalhadores de serviços gerais, sob uma perspectiva de melhora da condição física, do bem estar físico e mental. A metodologia utilizada foi a revisão bibliográfica narrativa, por meio de artigos indexados no PubMed, Biblioteca Virtual em Saúde (BVS), MEDLINE, LILACS e Scielo no período de 2012 a 2022. Os resultados evidenciaram que a auto liberação miofascial ALMF é um recurso usado tanto para prevenção, quanto para o tratamento e gerenciamento de distúrbios musculoesqueléticos. Conclui-se que a prática de auto liberação miofascial podem promover relaxamento muscular, reduzir restrições e disfunções musculoesqueléticas, resultantes de movimentos repetitivos, melhorando a saúde, sensação de bem-estar e qualidade de vida de trabalhadores de serviços gerais. Palavras-chave: Síndromes da Dor Miofascial; dor crônica; doenças musculoesqueléticas.

Effectiveness of ischemic compression pressure versus spray and stretch technique in the management of active myofascial trigger points of trapezius muscle.

Article

Full-text available

Sep 2021

Background: Now, a days myofascial trigger points are tremendously occurring and become a stressful part of nearly any person at any time in a lifetime. This study compares the effects of ischemic compression pressure with spray and stretch technique to treat active myofascial trigger points of the trapezius muscle in patients with neck pain. Methodology: A comparative interventional study was conducted at Dow University of Health Sciences from December 2016 and May 2017. Seventy patients (35 in each group) with active myofascial trigger points of trapezius were randomly assigned to group A (ischemic compression pressure) and group B (vapocoolant spray and stretch technique). Baseline and last session assessment of pain intensity, pain pressure tolerance, cervical range of motion and functional disability were measured through numerical pain-rating scale, algometer, goniometer and neck disability index, respectively. Results: Both groups showed significant improvement in all dependent variables of study which were neck pain, cervical range of motion and pain pressure tolerance (p-value<0.05). Group A showed greater improvement in pain intensity (p-value 0.015), pressure pain threshold (p-value 0.000) and cervical range of motion flexion, left side flexion and right-side flexion (p-value 0.002, 0.000 & 0.004) than group B. Conclusion: Both ischemic compression pressure & spray and stretch technique deactivated trigger points of upper fibers trapezius muscle in patients with neck pain, but the ischemic compression pressure was superior to the spray and stretch technique.

Effects of ischemic compression and instrument-assisted soft tissue mobilization techniques in trigger point therapy in patients with rotator cuff pathology: randomized controlled study

Article

Full-text available

Nov 2021

Purpose To compare the ischaemic compression (IC) and instrument-assisted soft tissue mobilization (IASTM) in the treatment of MTrPs in addition to standard rehabilitation program in patients with rotator cuff tears. Methods Participants with rotator cuff tears were included the study (n = 46). Patients were randomly divided into two groups; which were Group 1 (IC + standard rehabilitation program (n = 23)), and Group 2 (IASTM + standard rehabilitation program (n = 23)) groups. Pain were assessed by visual analog scale (VAS). Range of motion (ROM) was assessed by a universal goniometer. Active MTrPs were assessed according to the Travel and Simons criteria. Pressure pain threshold (PPT) were assessed by a digital algometer. Function were evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and American Shoulder and Elbow Surgeons Standardised Shoulder Assessment (ASES) Form. Anxiety and depression were evaluated by the Hospital Anxiety and Depression (HAD) scale. Satisfaction was assessed by the Global Rating of Change scale after 6 weeks treatment. Results After the treatment, pain, ROM and the DASH, ASES, HAD scores improved in both groups (p < 0.05). The active MTrPs of 2 muscles, PPT of 4 muscles and DASH in Group 1 significantly improved compared to Group 2 (p < 0.05). Conclusion Although patients with low functionality accumulated in the IC group, the IC is more effective than the IASTM in increasing the PPT and functional improvement according to the results of the DASH score.

Acute Effect of the Compression Technique on the Electromyographic Activity of the Masticatory Muscles and Mouth Opening in Subjects with Active Myofascial Trigger Points

Article

Full-text available

Nov 2020

Active myofascial trigger points (MTrPs) in masticatory muscles are associated with a reduced range of motion and muscle weakness within the stomatognathic system. However, it is hard to identify the most effective treatment technique for disorders associated with MTrPs. The objective of this study was to analyze the acute effect of the compression technique (CT) on active maximal mouth opening (MMO) and electromyographic activity of the masseter (MM) and temporalis anterior (TA) muscles in subjects with active myofascial trigger points in the MM muscles. The study group comprised 26 women (mean age 22 ± 2) with bilateral active myofascial trigger points (MTrPs) in the MM. The control group comprised 26 healthy women (mean age 22 ± 1) without the presence of MTrPs in the MM. Masticatory muscle activity was recorded in two conditions (during resting mandibular position and maximum voluntary clenching) before and after the application of the CT to the MTrPs in MM. After the CT application, a significant decrease in resting activity (3.09 µV vs. 2.37 µV, p = 0.006) and a significant increase in clenching activity (110.20 µV vs. 139.06 µV, p = 0.014) within the MM muscles were observed in the study group, which was not observed within TA muscles. Controls showed significantly higher active MMO values compared to the study group before CT (50.42 mm vs. 46.31 mm, p = 0.024). The differences between the study group after CT and controls, as well as among the study group before and after CT did not reach the assumed level of significance in terms of active MMO. The compression technique appears to be effective in the improvement of the active maximal mouth opening and gives significant acute effects on bioelectric masticatory muscle activity. Therefore, CT seems to be effective in MTrPs rehabilitation within the stomatognathic system.

Comparison between Effectiveness of Ischemic Compression and Muscle Energy Technique in Upper Trapezius Myofascial Trigger Points

Article

Full-text available

Nov 2023

Sensory and emotional responses to deep pressure stimulation at myofascial trigger points: a pilot study

Article

Full-text available

Jul 2023

Objective Although manual pressure, such as that used during a massage, is often associated with pain, it can simultaneously be perceived as pleasant when applied to certain body areas. We hypothesized that stimulation of myofascial trigger points (TPs) leads to simultaneous pain and pleasure. TPs are hyperirritable points located in the taut band of the skeletal muscle. Method In this study, we measured the muscle tone, muscle stiffness, and pressure pain threshold of TPs and control points in the left brachioradialis muscle of 48 healthy participants. We also applied deep compression to the two points and collected subjective data on pain, pleasantness, unpleasantness, and relief. Result Greater muscle stiffness was observed in the TPs versus control points ( t = 6.55, p < 0.001), and the pain threshold was significantly lower in the TPs ( t = −6.21, p < 0.001). Unpleasantness ratings after deep compression were significantly lower in the TPs compared with control points ( t = −2.68, p < 0.05). Participants experienced greater relief at the TPs compared with control points ( t = 2.01, p < 0.05), although the perceived pain did not differ between the two types of points. Conclusion We compared the properties of TPs and control points, and found that deep compression at TPs was associated with higher muscle tone and stiffness, lower unpleasantness ratings, and higher relief ratings compared with the control points. These findings suggest that, at least for some TPs, pain and pleasantness are simultaneously elicited by deep pressure stimulation.

Immediate effect of kinesio tapping V.S ischaemic compression on myofascial trigger points of trapezius muscle

Article

Jan 2021

Ischemic Compression Technique Versus Myofascial Release of Upper Trapezius Muscle in Mechanical Neck Pain in Females of Jouf University

Article

Full-text available

Jun 2023

Background. Neck pain can have an insidious [mechanical] or traumatic onset. Mechanical neck pain is de ined as pain in the cervical spine and shoulder area with symptoms of neck position, movements or contact with cervical muscles. Aim. is to compare the effect of ischaemic compression (IC) and myo icial release of the trapezius muscle in patients with mechanical neck pain. Materials and methods. A two-week randomized experimental study. Thirty female patients who had mechanical neck pain, aged from 18 to 55 years old, were randomized into 2 equal groups. Group A received myofascial release technique plus cryotherapy for two weeks, 3 sessions per week., while Group B received ischemic compression plus cryotherapy for two weeks, 3 sessions per week. All participants in both groups were evaluated before and after training for Visual Analog scale (VAS), Neck disability index (NDI) and cervical range of motion by Universal Goniometer. Results. There was a signi icant decrease in VAS and NDI post treatment in the group A and B compared with that pretreatment (p > 0.05). There was a signi icant increase in neck ROM post treatment in the group B and A compared with that pretreatment (p > 0.001). Comparison between the group A and B post treatment revealed a signi icant decrease in VAS and NDI of the group B compared with that of the group A (p > 0.05). Also, there was a signi icant increase in lexion, extension , side bending, and rotation of the group B compared with that of the group A (p > 0.001). Conclusions. It was concluded that application of ischemic compression 3 times / weeks for 2 weeks is an effective short-term method to reduce pain, increasing cervical ROM, and functional abilities of patients with mechanical neck pain. Streszczenie Informacje wprowadzające. Ból szyi mozė mieć przyczyny mechaniczne lub traumatyczne. Ból mechaniczny szyi de iniuje się jako ból w odcinku szyjnym kręgosłupa i okolicy barku z objawami dotyczącymi ułozėnia szyi, ruchów lub kontaktu z mięsńiami szyjnymi. Cel. Porównanie wpływu ucisku niedokrwiennego (IC) i mięsńiowo-powięziowego rozluzńienia mięsńia czworobocznego u pacjentów z mechanicznym bólem szyi. Materiały i metody. Dwutygodniowe randomizowane badanie eksperymentalne. Trzydziesći pacjentek z mechanicznym bólem szyi w wieku od 18 do 55 lat zostało losowo przydzielonych do 2 równych grup. Grupa A była poddawana terapii techniką rozluzńiania mięsńiowo-powięziowego oraz krioterapii przez dwa tygodnie, 3 sesje w tygodniu, natomiast grupa B była poddawana kompresji niedokrwiennej oraz krioterapii przez dwa tygodnie, 3 sesje w tygodniu. Wszystkie uczestniczki w obu grupach były oceniane przed i po treningu pod kątem wizualnej skali analogowej (VAS), wskazńika niepełnosprawnosći szyi (NDI) i zakresu ruchu kręgosłupa szyjnego za pomocą uniwersalnego goniometru. Wyniki: Po leczeniu w grupie A i B w porównaniu ze stanem przed leczeniem wystąpił istotny spadek wartosći VAS i NDI (p > 0,05). Wystąpił istotny wzrost zakresu ruchu szyi po leczeniu w grupach B i A w porównaniu z tym przed leczeniem (p > 0,001). Porównanie grup A i B po leczeniu wykazało istotny spadek VAS i NDI w grupie B w porównaniu z grupą A (p > 0,05). Zaobserwowano również znaczny wzrost zgięcia, wyprostu, zgięcia bocznego i rotacji w grupie B w porównaniu z grupą A (p > 0,001). Wnioski. Stwierdzono, zė zastosowanie ucisku niedokrwiennego 3 razy/tydzień przez 2 tygodnie jest skuteczną krótkoterminową metodą zmniejszenia bólu, zwiększenia zakresu ruchu szyi i zdolnosći funkcjonalnych pacjentów z mechanicznym bólem szyi. Słowa kluczowe kompresja niedokrwienna, mechaniczny ból szyi, mięsńiowo-powięziowy punkt spustowy Technika kompresji niedokrwiennej kontra rozluźnienie mięśniowopowięziowe górnego mięśnia czworobocznego w mechanicznym bólu szyi u kobiet z Uniwersytetu Jouf 157 nr 3/2021 (21) www.fizjoterapiapolska.pl Introduction There may be an insidious [mechanical] or painful onset of neck pain. Mechanical neck pain is characterized as pain with symptoms of neck position, movements, or contact with cervi-cal muscles in the cervical spine and shoulder region [1]. In the general population, the incidence of mechanical neck pain is 4554 percent, and in terms of lifestyle, up to 30 percent of men and 50 percent of women suffer from neck pain. Increased rates among office staff, users of computers and women. The prevalence of neck pain in women is higher than in men. [2] Prevalence of neck pain has been estimated to be between 13.4 and 22.2 percent. The risk of neck pain becomes chronic causing neck pain expensive in terms of absenteeism and health care costs [3]. Neck pain is characterized by referred pain , reduced mobility of the joint range and a twitch response due to mechanical deformation of the facial and muscular areas known as myofascial trigger points [MTPts]. Myofascial pain syndromes result from a high percentage of muscular pain. Myofascial trigger point is intense skeletal muscle tension that is associated with hypersensitive palpable nodules in a taut muscle band [4]. Micro trauma, macro trauma, overuse, physical stress and emotional stress are some of the factors affecting myofascial trigger points. The pathophysiology of its origin is not clear and recent research indicates that injured/overused muscle fibers have fewer oxygen and nutrients, leading to spontaneous muscle contractions [5]. In a recent narrative study of physiotherapeutic treatment for myofascial trigger points, it was concluded that the most used shortterm pain management methods were release of trigger point pressure, ischemic compression [6]. A manual therapy procedure, ischemic compression acts on the same concept of applying sustained pressure to the trigger point and relieving muscle stress, compression is applied pro gressively with the finger, thumb, elbow relative to how much the patient can bear and sustained for up to 90 seconds [7]. Myofascial release is a commonly used direct manual medicine procedure that uses specifically directed mechanical forces to manipulate different somatic dysfunctions and minimize myofascial restrictions. Myofascial release is effective in providing immediate pain relief when used with other traditional therapies to alleviate tissue tenderness [8, 9]. Additional clinical effects after treatment include edema and inflammation attenuation, analgesic usage reduction, enhanced posttrauma muscle recovery and increased range of motion in affected joints [10, 11]. This study is therefore designed to assess which technique is more effective ischemic compression or myofascial release in reducing pain, improve ROM and functional abilities of the patients.

Comparative Effects of Strain Counterstrain and Ischemic Compression Technique in Patients with Upper Trapezius Trigger Points

Article

Jan 2023

Background: The trigger points are hyperirritable spots found usually in the muscle fascia or within the taut bands of skeletal muscles that is painful on compression. Ischemic compression technique uses the application of sustained pressure with sufficient force and for long enough so as to slow down the flow of blood and releasing tension out of the muscle. Strain counterstrain (SCS), also known as positional release, is a passive positional treatment that relieves musculoskeletal pain and dysfunction by indirect hand manipulation. Objectives: The aim of this study was to compare the effects of ischemic compression technique and strain counterstrain technique on pain, neck lateral flexion and disability in patients with upper trapezius trigger points. Methodology: The RCT was conducted on 36 male and female participants aging 25-45 having maximum of 5 trigger points in the upper trapezius bilaterally. The patients were divided equally to ischemic compression and strain counterstrain group by lottery method. The treatment was given for 3 days a week for 4 weeks. The NPRS, NDI and cervical lateral flexion were used as outcome measure. The assessment of the outcome measures was done on baseline, after 2nd week and after 4th week. The data was analyzed by SPSS version 26 using appropriate tests depending upon the normality by keeping the level of significance at 0.05. Results: Out of 36 participants (Mean age 32.96 ± 5.91), 20 were male and 16 were female, 3 participants lost to follow up. The within group analysis of NPRS and NDI done by Friedman test and that of cervical flexion done by repeated measures ANOVA showed that the both the interventions has produced significant (p<0.05) effects on pain, neck disability and range of motion, but the between group analysis of NPRS and NDI done by Mann-Whitney test and that of Cervical ROM done by Independent samples t-test showed that none of the two technique produced significant results (p>0.05) as compared to the other in subjects with upper trapezius trigger points. Conclusion: A 4-week intervention of the ischemic compression and strain counterstrain produced significant results in reducing the intensity of pain, the cervical disability and improving the cervical range of motion, but the intergroup comparison showed that both the ischemic compression and strain counterstrain were equally effective and none of them produced significant results as compared to others on patients with upper trapezius trigger points. Keywords: Ischemic Compression Technique; Strain Counterstrain; Upper Trapezius Trigger Points.

PEDİATRİK HASTALIKLARDA GETAT UYGULAMALARI

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Jan 2023

Pressure Pain Threshold of the Upper Trapezius Trigger Point: A Systematic Review with Meta-Analysis of Baseline Values and Their Modification after Physical Therapy

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Full-text available

Dec 2022

Background: Myofascial trigger points (TrP) are diagnosed upon the presence of clinical signs among which hypersensitivity is considered one of the most important. The detection of the pressure pain threshold (PPT) is used to quantify the degree of hypersensitivity. However, there is a lack of normative data about how hypersensitive a TrP is. Therefore, the objective was to quantify the PPT for myofascial TrP in the upper trapezius muscle and its modification after manual or instrumental physical therapy interventions. Methods: A systematic review and meta-analysis were conducted among three databases (MEDLINE, Cochrane Library, and PEDro). Two independent reviewers conducted the electronic search and assessed the methodological quality of the included studies. Results: Eleven studies with a high-risk bias indicated that the PPT at TrP sites was 105.11 kPa lower (95% CI: -148.93; -61.28) at active TrP sites (Chi-squared = 1.07, df = 1 (p = 0.30), I2 = 7%) compared to the PPT of the upper trapezius muscles of healthy subjects. In addition, the PPT of TrP was also lower than the reference values coming from the pain-free population. Moreover, the PPT increased after both manual and instrumental treatment by 28.36 kPa (95% CI: 10.75; 45.96) and 75.49 kPa (95% CI: 18.02; 132.95), respectively. Conclusions: The results of the present study show that TrP has a decreased PPT when compared to healthy muscles and that physical therapy may increase the PPT. However, the clinical relevance of this decreased PPT needs to be further elucidated. Further, the high risk of bias in all the retrieved studies undermines the validity of the results.

Skin Displacement as fascia tissue manipulation at the lower back affects instantaneously the flexion-and extension spine, pelvis, and hip range of motion

Article

Full-text available

Nov 2022

The effect of fascia tissue manipulations through lumbodorsal skin displacement (SKD) on mobility is inconclusive likely depending on the location and displacement direction of the manipulation. This study aimed to assess whether lumbodorsal SKD affects the flexion -and extension range of motion (ROM), in healthy subjects. Furthermore, we aimed to test the effect of SKD at different locations and directions. The study results revealed that the effects of SKD are direction- and location dependent as well as movement (flexion/extension) specific. Lumbodorsal SKD during flexion and extension may be useful to determine whether or not a patient would benefit from fascia tissue manipulations.

Treatment of Myofascial Trigger Points of the Infraspinatus is Effective in Relieving Shoulder Pain and Improving Shoulder Functions

Article

Sep 2022

Progress of Muscle Chain Theory in Shoulder Pain Rehabilitation: Potential Ideas for Pulmonary Rehabilitation

Article

Full-text available

Sep 2022
EVID-BASED COMPL ALT

pulmonary dysfunction is very common in stroke patients.A study has shown that acute stroke patients often cause a series of pulmonary dysfunction due to primary damage to the respiratory center, which is an important reason for hindering disease treatment and recovery. American Thoracic Society (ATS) and the European Respiratory Society (ERS) pointed out that Pulmonary Rehabilitation（PR） can be applied to the rehabilitation of stroke patients to improve their lung function,PR can improve the respiratory muscle strength of stroke patients, which is beneficial to improve the respiratory function of patients. At the same time, it can also significantly increase the maximum oxygen intake of patients, effectively improve the cardiopulmonary function of stroke patients, and reduce respiratory complications such as aspiration pneumonia.However, the common dysfunction of joints and muscles such as shoulder pain after stroke will affect the process of pulmonary rehabilitation. This is mainly because the changes in the position of the shoulder girdle, the decrease in the range of motion of the cervical and thoracic spine, and the changes in the cervical spondylolisthesis position caused by the elevation of the upper limbs will directly affect the breathing movement during the pulmonary rehabilitation process. the instability of the spine will weaken the deep abdominal muscles and reduce the function of the diaphragm; moreover, changes in the alignment and stability of the cervical and thoracic spine will also lead to wrong breathing methods. Therefore, it is of practical clinical significance to evaluate the functional rehabilitation of shoulder joint muscles and evaluate the efficacy of stroke patients to improve their respiratory function. This article through extensive review of domestic and foreign literature in recent years, combined with clinical practice experience, this paper summarizes the practical application of chain structure theory in the fields of rehabilitation training, postural adjustment, pain relief, etc. and further studies the functional exercise method based on muscle chain theory. The research on the muscle chain of shoulder pain rehabilitation as a model to illustrate the positive effect of reconstructing neuroarticular muscle function on the respiratory system, hoping to provide new ideas for the treatment of respiratory diseases in stroke patients. Key words: stroke; Pulmonary rehabilitation;shoulder pain; muscle chain

Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review

Article

Mar 2022

Objective: The aim of this study was to identify the manual therapy (MT) methods and techniques that have been evaluated for the treatment of cervicogenic headache (CH) and their effectiveness. Background: MT seems to be one of the options with the greatest potential for the treatment of CH, but the techniques to be applied are varied and there is no consensus on which are the most indicated. Methods: A systematic search in Scopus, Medline, PubMed, Cinahl, PEDro, and Web of Science with the terms: secondary headache disorders, physical therapy modalities, musculoskeletal manipulations, cervicogenic headache, manual therapy, and physical therapy. We included articles published from 2015 to the present that studied interventions with MT techniques in patients with CH. Two reviewers independently screened 365 articles for demographic information, characteristics of study design, study-specific intervention, and results. The Oxford 2011 Levels of Evidence and the Jadad scale were used. Results: Of a total of 14 articles selected, 11 were randomized control trials and three were quasi-experimental studies. The techniques studied were: spinal manipulative therapy, Mulligan's Sustained Natural Apophyseal Glides, muscle techniques, and translatory vertebral mobilization. In the short-term, the Jones technique on the trapezius and ischemic compression on the sternocleidomastoid achieved immediate improvements, whereas adding spinal manipulative therapy to the treatment can maintain long-term results. Conclusions: The manual therapy techniques could be effective in the treatment of patients with CH. The combined use of MT techniques improved the results compared with using them separately. This review has methodological limitations, such as the inclusion of quasi-experimental studies and studies with small sample sizes that reduced the generalizability of the results obtained.

Evaluation of Shoulder Microcirculation Abnormality Using Laser Doppler Flowmetry

Article

Full-text available

Jan 2022

Severe neck-shoulder pain induces functional limitations in both life and work. The purpose of this study was to determine the characteristics of shoulder microcirculation abnormality in workers. This study recruited 32 workers and patients, both n = 16. Questionnaires were administered, and Laser Doppler Flowmetry (LDF) was used to measure microcirculatory blood flow (MBF) at the myofascial trigger points (MTrPs) on the shoulders. The absolute-deviationMMBF represented the mean MBF (MMBF) variability among subjects. The differences in the life characteristics, shoulder pain level, and microcirculatory characteristics at MTrPs between the two groups were compared. It was found that shoulder pain level was significantly higher in the patient than in the control group (p < 0.001). Deviation of the MMBF value beyond the postulated “normal range” of 60–80 was significantly higher in the patient than in the control group (p < 0.001). The MMBF deviation was significantly correlated with shoulder pain level, pain duration, and the symptom effect (p < 0.01, n = 32). A normal range for the MMBF of 60–80 on the shoulder near MTrPs is hypothesized for the first time based on this study. Noninvasive LDF can be used to assess abnormality in the MBF on shoulder MTrPs at an early stage.

Dry needling increases antioxidant activity and grip force in a rat model of muscle pain

Article

Dec 2021

Background Muscle pain syndromes (MPS) are one of the main causes of functional, structural and metabolic problems, being associated with tissue oxidative damage. Although dry needling is widely used in the treatment of MPS, there is little scientific evidence of its efficacy and underlying mechanisms of action. Objectives To investigate the effects of different dry needling techniques on thermal and mechanical hyperalgesia, locomotor and functional activity, and oxidative stress markers in a rat model of muscle pain. Methods A total of 48 male Wistar rats underwent injection of the gastrocnemius muscle with control neutral saline (pH 7) and remained untreated (Saline group), or acidic saline (pH 4) and remained untreated (ASA group) or received pregabalin (PG group), deep needling (DN group), superficial needling (SN group) or twitch needling (TN group) with n = 8 rats per group. Mechanical (von Frey test) and thermal hyperalgesia (acetone test), muscle edema (assessed with a caliper), strength and muscle function (grip force evaluation), surface thermography and locomotor and exploratory activities (open field test) were evaluated. The animals were then euthanized, and the gastrocnemius muscle was excised for assessment of oxidative analyses of lipid peroxidation with thiobarbituric acid reactive species (TBA-RS) and total glutathione (GSH) levels. Results All treatments significantly improved muscle strength and function when compared to the AS group (p < 0.05). Pregabalin reduced locomotor and exploratory activities, while the TN intervention increased the antioxidant response (p < 0.05). Conclusion Dry needling improved strength, functionality and locomotor activity in a rat model of muscle pain. Twitch needling induced an antioxidant effect.

Hypoalgesic and Motor Effects of Neural Mobilisation versus Soft-Tissue Interventions in Experimental Craniofacial Hyperalgesia: A Single-Blinded Randomised Controlled Trial

Article

Full-text available

Sep 2021

Objective: The present trial aimed to compare the effects of the mobilisation of the nervous system (NS) to those of a soft-tissue intervention in subjects exposed to an experimentally induced hyperalgesia of the masticatory muscles. Methods: The study was a single-blinded randomised controlled trial. A total of 49 participants (mean ± SD age: 41 ± 11 years; 61% female) with latent myofascial trigger points (LMTrPs) in the craniofacial region were randomly assigned to one of three groups: neural mobilisation (NM), soft-tissues techniques and stretching (STT-S), and control group (CG). An initial assessment (baseline) was performed before the provocation chewing masticatory test. The pre-treatment measurements were registered 24 h later. Next, the randomised intervention was applied, and afterwards, post-treatment data were obtained. Outcome measures included pain-free maximum mouth opening (MMO), pressure pain thresholds (PPTs) in the trigeminal and cervical region, and trigeminal and cervical two-point discrimination (TPD). Results: ANOVA revealed significant differences for the time × group interaction for pain-free MMO and PPTs. The results showed an improvement in the MMO and the PPTs for NM and STT-S groups but not for the CG. There were no differences between the NM and STT-S groups. However, the effect sizes were large for the NM and medium for the STT-S. No differences were found for TDP between groups nor over time. Conclusions: The results show that with NM and STT-S techniques, we could influence motor and sensory variables in asymptomatic subjects with LMTrPs after a masticatory provocation test. Both techniques increased MMO and PPTs in the short term. These beneficial effects lead us to consider the importance of including these methods in clinical practice.

Efectos del tratamiento del músculo diafragma en el dolor y la movilidad del hombro en pacientes con patología del manguito rotador

Thesis

Jan 2021

Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries. Introduction: The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. In the case of nervous system, according to several studies the phrenic nerve has communicating branches to the brachial plexus with connections to shoulder key nerves including the suprascapular, lateral pectoral, musculocutaneous, and axillary nerves, besides, the vagal innervation that receives the diaphragm and their connections with the sympathetic system could make this muscle treatment a remarkable way of pain modulation in patients with rotator cuff pathology. To these should be added a possible common embryological origin in some type of vertebrates. Considering the connection through myofascial system, the improving of chest wall mobility via diaphragm manual therapy could achieve a better function of shoulder girdle muscles with insertion or origin at ribs and those that are influenced by the fascia such as the pectoralis major muscle, latissimus dorsi and subscapularis. Objectives: • Main objective: To compare the immediate effect of diaphragm physical therapy in the symptoms of patients with rotator cuff pathology regarding a manual treatment over shoulder muscles. • Specific objectives: 1. To evaluate the immediate effectiveness of each of the three groups in shoulder pain using a numerical pain rating scale (NPRS) and compare between them. 27 2. To evaluate the immediate effectiveness of each of the three groups in shoulder range of motion (ROM) using an inclinometer and compare between them. 3. To evaluate the immediate effectiveness of each of the three groups in pressure pain threshold (PPT) using an algometer and compare between them. Material and method: A prospective, randomized, controlled, single-blind (assessor) trial with a previous pilot study in which a final sample size of 45 subjects was determined to people diagnosed with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (15 subjects per group): 1. A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group). 2. Diaphragm manual therapy techniques (diaphragm group). 3. Active diaphragm mobilization by hipopressive gymnastic (hipopressive group). The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NPRS of pain in shoulder movements and algometry. The data obtained were analyzed by an independent (blinded) statistician, who compared the effects of each one of the treatments using the Student’s t-test for paired samples or the Wilcoxon signed rank test, and calculated the post -intervention percentage of change in every variable. An analysis of variance (ANOVA) followed by the post-hoc test or a non-parametric Kruskal-Wallis test for non-parametric multiple-groups comparisons were performed to compare pre- to post-intervention outcomes between groups. Effect-size estimates of each intervention and between groups were calculated to allow interpretation of results in a more functional and meaningful way. Results: Both the control group and diaphragm group showed a statistically (p< 0.005) and clinically significant improvement, as well as a significant effect size (moderate to strong), on the NPRS in shoulder flexion and abduction movements. Regarding NPRS in shoulder external rotation, only the control group obtained a significant effect size. There was a significant increase in shoulder abduction and external rotation ROM (p< Efectos del tratamiento del músculo diafragma en el dolor y la movilidad del hombro en sujetos con patología del manguito rotador. 28 0.001) with a significant effect size in the control group. The PPT at the xiphoid process of the sternum showed a statistically (p< 0.001) and clinically significant improvement in the diaphragm group. The hipopressive gymnastic treatment was found to be no clinically effective in the shoulder pain and mobility, and showed a less efficacy than the other two groups. Conclusion: Both the shoulder non-direct treatment by a protocol of diaphragm manual therapy techniques and the rotator cuff MTP intervention showed been clinically effective in reducing pain (NPRS) immediately in shoulder flexion and abduction movements. The ROM assessment improvements obtained post- intervention by the diaphragm group have not been enough to consider them as clinically significant. The control group has obtained a significant effect size in shoulder abduction and external rotation ROM improvement. Both the control group and the diaphragm group treatments have been more effective in improving shoulder pain and mobility than the hipopressive group. The control group intervention has been the most effective in improving shoulder external rotation pain and mobility. The diaphragm group intervention was more effective in improving PPT at the xiphoid process than the other groups. Neither the effect size nor clinical significance proves the short-term benefit of the hipopressive gymnastic treatment in shoulder pain and mobility. Future studies are necessary to show the effectiveness of the diaphragm manual therapy applied in several sessions to determine its long-term effects in shoulder pain and mobility.

Electromyographic Assessment of the Efficacy of Deep Dry Needling versus the Ischemic Compression Technique in Gastrocnemius of Medium-Distance Triathletes

Article

Full-text available

Apr 2021
SENSORS-BASEL

Several studies have shown that gastrocnemius is frequently injured in triathletes. The causes of these injuries are similar to those that cause the appearance of the myofascial pain syndrome (MPS). The ischemic compression technique (ICT) and deep dry needling (DDN) are considered two of the main MPS treatment methods in latent myofascial trigger points (MTrPs). In this study superficial electromyographic (EMG) activity in lateral and medial gastrocnemius of triathletes with latent MTrPs was measured before and immediately after either DDN or ICT treatment. Taking into account superficial EMG activity of lateral and medial gastrocnemius, the immediate effectiveness in latent MTrPs of both DDN and ICT was compared. A total of 34 triathletes was randomly divided in two groups. The first and second groups (n = 17 in each group) underwent only one session of DDN and ICT, respectively. EMG measurement of gastrocnemius was assessed before and immediately after treatment. Statistically significant differences (p = 0.037) were shown for a reduction of superficial EMG measurements differences (%) of the experimental group (DDN) with respect to the intervention group (ICT) at a speed of 1 m/s immediately after both interventions, although not at speeds of 1.5 m/s or 2.5 m/s. A statistically significant linear regression prediction model was shown for EMG outcome measurement differences at V1 (speed of 1 m/s) which was only predicted for the treatment group (R2 = 0.129; β = 8.054; F = 4.734; p = 0.037) showing a reduction of this difference under DDN treatment. DDN administration requires experience and excellent anatomical knowledge. According to our findings immediately after treatment of latent MTrPs, DDN could be advisable for triathletes who train at a speed lower than 1 m/s, while ICT could be a more advisable technique than DDN for training or competitions at speeds greater than 1.5 m/s.

Investigating the effectiveness of adding microcurrent therapy to a traditional treatment program in myofascial pain syndrome in terms of neck pain and function

Article

Full-text available

Mar 2021

Introduction To investigate the effect of microcurrent on pain, pain threshold, range of motion, neck muscle strength, and neck function. Methods It is a pilot study involving 28 female subjects (aged 18–24 years) complaining of neck pain due to active unilateral trigger points in upper trapezius muscle. The subjects were randomly assigned to 2 groups: group I ( n = 15) received microcurrent (frequency: 20 Hz, intensity: 25–30 µA) and traditional treatment in the form of stretching exercise for upper fibre of trapezius, isometric strengthening exercise, ischaemic compression technique; group II ( n = 13) received only traditional treatment. All subjects received 2 sessions per week for 3 weeks. Results There was a significant improvement ( p < 0.05) in cervical range of motion, pain level, neck disability index, and pain threshold in both treatment groups. Isometric muscle strength was significantly increased ( p < 0.05) in group I, with no significant ( p > 0.05) difference in group II. Group I showed a more significant effect in all measured variables than group II. Neck disability index and muscle strength presented a significant change ( p < 0.05) with respect to group and time interaction. Conclusions Microcurrent therapy added to traditional treatment increased the effectiveness of myofascial pain syndrome treatment as compared with traditional treatment alone.

Ischemic Pressure vs Postisometric Relaxation for Treatment of Rhomboid Latent Myofascial Trigger Points: A Randomized, Blinded Clinical Trial

Article

Full-text available

Feb 2021
J MANIP PHYSIOL THER

Objective The purpose of this study was to investigate the effects of ischemic pressure (IP) vs postisometric relaxation (PIR) on rhomboid-muscle latent trigger points (LTrPs). Methods Forty-five participants with rhomboid-muscle LTrPs were randomly assigned into 3 groups and received 3 weeks of treatment—group A: IP and traditional treatment (infrared radiation, ultrasonic therapy, and transcutaneous electrical nerve stimulation); group B: PIR and traditional treatment; and group C: traditional treatment. Shoulder pain and disability, neck pain and disability, and pressure pain threshold (PPT) of 3 points on each side were measured before and after treatment. Results Multivariate analysis of variance indicated a statistically significant Group × Time interaction (P = .005). The PPT for the right lower point was increased in group A more than in groups B or C. Neck pain was reduced in group B more than in group C. Moreover, shoulder and neck disability were reduced in both groups A and B more than in group C. The PPTs of the left lower and middle points were increased in group B compared with groups A and C. The PPT of the left upper point was increased in group A more than in group C. There were significant changes in all outcomes in the 2 experimental groups (P < .05). No changes were found in the control group except in pain intensity, shoulder disability, and PPT of the left lower point. Conclusion This study found that IP may be more effective than PIR regarding PPT, but both techniques showed changes in the treatment of rhomboid-muscle LTrPs.

Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries: A dataset derived from a pilot clinical trial

Article

Full-text available

Feb 2021

The rotator cuff inflammatory or degenerative pathology is the main cause of shoulder pain. The shoulder and diaphragm muscle have a clear relation through innervation and the connection through myofascial tissue. A prospective, randomized, controlled, single-blind (assessor) pilot clinical trial was performed with a sample size of 27 subjects with rotator cuff injuries and with clinical diagnosis of myofascial pain syndrome at shoulder. The sample were divided into 3 groups of treatment (9 subjects per group): 1. A direct treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (control / rotator cuff group). 2. Diaphragm manual therapy techniques (diaphragm group). 3. Active diaphragm mobilization by breathing exercises (breathing exercises group). The pain and range of shoulder motion were assessed before and after treatment in all the participants by inclinometry, NRS of pain in shoulder movements and pressure algometry. Methodology and full data analyzing the effect of the three interventions are presented in this article. These data could give a basis for further experiments on revealing the underlying mechanism of action of the visceral manual therapy in reducing the symptoms of shoulder pain. Keywords Breathing exercises; diaphragm; musculoskeletal manipulations; phrenic nerve; shoulder pain; visceral pain.

Evaluation of the Combination of Muscle Energy Technique and Trigger Point Therapy in Asymptomatic Individuals with a Latent Trigger Point

Article

Full-text available

Nov 2020
Int J Environ Res Publ Health

(1) Background: The aim of the study was to determine the effect of the combination therapy of Muscle Energy Technique (MET) and Trigger Point Therapy (TPT) on the angular values of the range of movements of the cervical spine and on the pressure pain threshold (PPT) of the trapezius muscle in asymptomatic individuals. METHODS: The study involved 60 right-handed, asymptomatic students with a latent trigger point in the upper trapezius muscle. All qualified volunteers practiced amateur symmetrical sports. The study used a tensometric electrogoniometer (cervical spine movement values) and an algometer (pressure pain threshold (PPT) of upper trapezius). Randomly (sampling frame), volunteers were assigned to three different research groups (MET + TPT, MET and TPT). All participants received only one therapeutic intervention. Measurements were taken in three time-intervals (pre, post and follow-up the next day after therapy). (2) Results: One-time combined therapy (MET + TPT) significantly increases the range of motion occurring in all planes of the cervical spine. One-time treatments of single MET and single TPT therapy selectively affect the mobility of the cervical spine. The value of the PPT significantly increased immediately after all therapies, but only on the right trapezius muscle, while on the left side only after the therapy combining MET with TPT. (3) Conclusion: The MET + TPT method proved to be the most effective, as it caused changes in all examined goniometric and subjective parameters.

Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial

Article

Full-text available

Nov 2020
Int J Environ Res Publ Health

Introduction: Neck pain is a condition with a high incidence in primary care. Patients with chronic neck pain often experience reduction in neck mobility. However, no study to date has investigated the effects of manual mobilization of the upper cervical spine in patients with chronic mechanical neck pain and restricted upper cervical rotation. Objective: To evaluate the effect of adding an upper cervical translatoric mobilization or an inhibitory suboccipital technique to a conventional physical therapy protocol in patients with chronic neck pain test on disability and cervical range of motion. Design: Randomized controlled trial. Methods: Seventy-eight patients with chronic neck pain and restricted upper cervical rotation were randomized in three groups: Upper cervical translatoric mobilization group, inhibitory suboccipital technique group, or control group. The neck disability index, active cervical mobility, and the flexion-rotation test were assessed at baseline (T0), after the treatment (T1), and at three-month follow-up (T2). Results: There were no statistically significant differences between groups in neck disability index. The upper cervical translatoric mobilization group showed a significant increase in the flexion-rotation test to the more restricted side at T1 (F = 5.992; p < 0.004) and T2 (F = 5.212; p < 0.007) compared to the control group. The inhibitory suboccipital technique group showed a significant increase in the flexion-rotation test to the less restricted side at T1 (F = 3.590; p < 0.027). All groups presented high percentages of negative flexion-rotation tests. (T1: 69.2% upper neck translator mobilization group; 38.5% suboccipital inhibition technique group, 19.2% control group; at T2: 80.8%; 46.2% and 26.9% respectively). No significant differences in the active cervical mobility were found between groups. Conclusion: Adding manual therapy to a conventional physical therapy protocol for the upper cervical spine increased the flexion-rotation test in the short-and mid-term in patients with chronic neck pain. No changes were found in the neck disability index and the global active cervical range of motion.

The Effectiveness of Ischemic Compression Technique on Pain and Function in Individuals With Shoulder Pain: A Systematic Review

Article

Aug 2020
J MANIP PHYSIOL THER

Objective To systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain. Methods This review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale. Results The search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain. Conclusion The IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.

Effect of Exams Period on Prevalence of Myofascial Trigger Points in Neck in Secondary School Students

Article

Jan 2020

Treatment of myofascial trigger points of the infraspinatus is effective in relieving shoulder pain and improving shoulder functions: A randomized clinical trial

Preprint

Full-text available

Jan 2020

Background This study aimed to investigate the effects of ischemic compression treatment (ICT) and low-level laser therapy (LLLT) applied on the trigger points of the infraspinatus muscle on shoulder pain and function in patients with shoulder pain. Methods Thirty patients with shoulder pain were randomly categorized into the ICT group (n = 15) and LLLT groups (n = 15). ICT was performed on three myofascial trigger points (MTrPs) of the infraspinatus muscle twice a week for 4 weeks (eight sessions), with 5 minutes of treatment per trigger point. LLLT was performed similarly. Shoulder pain was assessed using the visual analogue scale (VAS) and pain pressure threshold (PPT), and shoulder function was assessed using the Korean Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, rotator cuff strength, and range of motion (ROM) of shoulder flexion and abduction. Results Significant changes in VAS score and PPT were found after the intervention in both groups (p < 0.05). Significant changes were observed in the Korean DASH score, rotator cuff strength, and ROM of shoulder flexion (p < 0.05) but not in the ROM of shoulder abduction (p < 0.05). There were no significant differences between the two groups. Conclusion This study showed that both ICT and LLLT applied on the MTrPs of the infraspinatus muscle were effective for relieving shoulder pain and improving shoulder functions in patients with shoulder pain.

Stretching exercises combined with ischemic compression in pectoralis minor muscle with latent trigger points: A single-blind, randomized, controlled pilot trial

Article

Dec 2019
Compl Ther Clin Pract

Background and purpose: Latent trigger points (LTrPs) in the pectoralis minor (PM) muscle lead to muscle tightness. This study aimed to investigate which type of stretching exercise used after ischemic compression (IC) was more effective on LTrPs in the PM muscle. Materials and methods: Forty participants with PM muscle tightness and an LTrP in the PM muscle were divided among groups 1 (IC with modified contract-relax proprioceptive neuromuscular facilitation (PNF) stretching), 2 (IC with static stretching), 3 (IC with myofascial release) and 4 (no intervention). The PM muscle index (PMI), PM length (PML), rounded shoulder posture, pressure pain threshold, pulmonary function, and maximal respiratory pressure were evaluated. Results: Improvement in the PMI and PML was found immediately after the intervention in groups 1 and 3 compared with baseline (p = 0.01). The overall group-by-time interaction in the repeated measures analysis of variance was significant for the PMI in favor of Group 1 (F1, 36 = 3.53, p = 0.02). Conclusion: IC may be followed by contract-relax PNF stretching to increase the length of PM muscle with LTrPs.

Analgesic Effects of Compression at Trigger Points Are Associated With Reduction of Frontal Polar Cortical Activity as Well as Functional Connectivity Between the Frontal Polar Area and Insula in Patients With Chronic Low Back Pain: A Randomized Trial

Article

Full-text available

Nov 2019

Background Compression of myofascial trigger points (MTrPs) in muscles is reported to reduce chronic musculoskeletal pain. Although the prefrontal cortex (PFC) is implicated in development of chronic pain, the mechanisms of how MTrP compression at low back regions affects PFC activity remain under debate. In this study, we investigated effects of MTrP compression on brain hemodynamics and EEG oscillation in subjects with chronic low back pain.Methods The study was a prospective, randomized, parallel-group trial and an observer and subject-blinded clinical trial. Thirty-two subjects with chronic low back pain were divided into two groups: subjects with compression at MTrPs (n = 16) or those with non-MTrPs (n = 16). Compression at MTrP or non-MTrP for 30 s was applied five times, and hemodynamic activity (near-infrared spectroscopy; NIRS) and EEGs were simultaneously recorded during the experiment.ResultsThe results indicated that compression at MTrPs significantly (1) reduced subjective pain (P < 0.05) and increased the pressure pain threshold (P < 0.05), (2) decreased the NIRS hemodynamic activity in the frontal polar area (pPFC) (P < 0.05), and (3) increased the current source density (CSD) of EEG theta oscillation in the anterior part of the PFC (P < 0.05). CSD of EEG theta oscillation was negatively correlated with NIRS hemodynamic activity in the pPFC (P < 0.05). Furthermore, functional connectivity in theta bands between the medial pPFC and insula cortex was significantly decreased in the MTrP group (P < 0.05). The functional connectivity between those regions was positively correlated with subjective low back pain (P < 0.05).DiscussionThe results suggest that MTrP compression at the lumbar muscle modulates pPFC activity and functional connectivity between the pPFC and insula, which may relieve chronic musculoskeletal pain.Trial registrationThis trial was registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000033913) on 27 August 2018, at https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038660.

Adjunctive Therapies: Myofascial Trigger Point Therapy

Chapter

Feb 2024

Ischemic compression associated with joint mobilization does not promote additional clinical effects in individuals with rotator cuff related shoulder pain: A randomized clinical trial

Article

Aug 2023

Manual therapy on the diaphragm is beneficial in reducing pain and improving shoulder mobility in subjects with rotator cuff injury: A randomized trial

Article

Jun 2023
INT J OSTEOPATH MED

Dear Dr Peña-Otero, As co-author of the article Manual therapy on the diaphragm is beneficial in reducing pain and improving shoulder mobility in subjects with rotator cuff injury: A randomized trial, we are pleased to let you know that the final version – containing full bibliographic details – is now available online. To help you and the other authors access and share this work, we have created a Share Link – a personalized URL providing 50 days' free access to the article. Anyone clicking on this link before September 23, 2023 will be taken directly to the final version of your article on ScienceDirect, which they are welcome to read or download. No sign up, registration or fees are required. Your personalized Share Link: https://authors.elsevier.com/c/1hXQC6D0fPwAN7 We encourage you to use this Share Link to download a copy of the article for your own archive. The URL is also a quick and easy way to share your work with colleagues, co-authors and friends. And you are welcome to add the Share Link to your homepage or social media profiles, such as Facebook and Twitter. You can find out more about Share Links on Elsevier.com. Did you know, as an author, you can use your article for a wide range of scholarly, non-commercial purposes, and share and post your article online in a variety of ways? For more information visit www.elsevier.com/sharing-articles. Kind regards, Elsevier Researcher Support

Acupressure technique applied to trigger points in the cervical region of students

Article

Full-text available

Dec 2022

A cervicalgia se caracteriza como dor na região cervical, e acomete de 48% a 78% dos estudantes de graduação. A presença de dor na região cervical pode estar relacionada ao desenvolvimento de pontos gatilhos, que são definidos como nódulos rígidos e dolorosos presentes em uma faixa tensa do músculo esquelético. Estes nódulos podem interferir nas atividades de vida diárias quando não realizado o tratamento adequado. Desta forma, realizar a técnica de acupressão em pontos gatilhos cervicais de estudantes universitários ajuda a reduzir o quadro álgico? Com base nestas informações, o objetivo deste estudo foi analisar se a aplicação da acupressão reduz a dor cervical de jovens universitários quando aplicada em pontos gatilhos. Foi realizado um estudo clínico de pré e pós-intervenção, com 10 graduandos de fisioterapia do 4° ano, idade entre 20 e 30 anos, que apresentaram quadro álgico em pontos gatilhos na região cervical e concordaram em participar da intervenção através da técnica de acupressão. De acordo com os dados obtidos no pré e pós avaliação foi possível observar melhora significativa do quadro álgico em pontos gatilhos na região cervical de graduandos de fisioterapia. Pode-se concluir que a acupressão mostrou-se eficaz para a redução da dor em pontos gatilhos em região cervical de universitários.

Trigger point therapy – ischemic compression or perhaps cupping?

Article

Full-text available

Sep 2022

Study aim : To evaluate and compare the effectiveness of single ischemic compression and cupping therapy on the most common trigger point, on the descending part of the trapezius muscle. Materials and methods : Twenty-five students (15 women and 10 men) aged 24.20 ± 1.27 years were enrolled in the study. The mobility of the cervical spine area was measured with a measuring tape. The pain pressure threshold of the trigger point of the trapezius muscle was tested using a Wagner FDX 50 Force Gage digital algometer. Each person participated in three tests with an interval of approximately one week between them. The following study protocol was followed; 1) cupping therapy, with a cup statically positioned on the trigger point for two minutes, 2) at a minimum interval of 7 days, ischemic compression performed with the thumb twice for 1 minute on each side 3) control test at an interval of another 7 days. Results : Ischemic compression resulted in a statistically significant difference in cervical spine mobility scores (except for extension) and pain pressure threshold values. After applying cups, statistically significant differences were also observed in the results of cervical spine mobility and pain pressure threshold values. No statistically significant differences were found in the effectiveness of the therapies tested. Conclusions : In the present study, single trigger point cupping and ischemic compression therapies improved cervical spine mobility and resulted in an increase in the pain pressure threshold in the trapezius muscle trigger point. These two therapies did not differ in terms of their effectiveness.

Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain

Article

Full-text available

Aug 2022

In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of "Pressure pain threshold" and "Neck shoulder pain" or "Back pain" as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.

Manual compression at myofascial trigger points ameliorates musculoskeletal pain

Chapter

Jan 2022

Myofascial trigger points (MTrPs), which are sensitive spot located taut bands in the muscle, are potential causes of musculoskeletal pain. Epidemiological studies showed significant relationships between presence of MTrPs and musculoskeletal pain in the neck, shoulder, low back, knee, etc., and the relationships between presence of MTrPs and disability in the life. These findings suggest that MTrPs may not only cause musculoskeletal pain, but also modulate (enhance) pain induced by primary organic disorders. Recent clinical trial studies reported that compression at MTrPs, which is one of manual therapy techniques, is effective to ameliorate musculoskeletal pain in various parts of the body. This chapter discusses beneficial effects of compression at MTrPs on musculoskeletal pain, and underlying mechanisms of MTrP compression effects.

Assessment of the influence of intermittent ischemic compression of latent trigger points on changes on the range of the lumbar spine mobility and myoelectric changes in the dorsal extensor muscle

Article

Sep 2021

Introduction: Pain in the lumbar spine (L) is a very serious health problem. The appearance of pain in the area of the back muscles with palpable small, sensitive points may indicate the presence of myofascial trigger points. There are many techniques used in the therapy of trigger points, including ischemic compression, which gives a therapeutic effect in the form of biomechanical normalization of muscle tissue restoring the normal functional state of a given muscle. Aim of the study: The aim of the study was to assessment of the influence of intermittent ischemic compression of latent trigger points on changes on the range of motion of the L spine and on myoelectric changes in the back extensor muscle. Material and Methods: The study included 32 students who were subjected to a single technique of intermittent ischemic compression according to Chaitow. The participants of the study performed the Thomayer test before and after the therapy to assess the range of spine mobility. The myoelectric changes in the back extensor muscle were assessed using NORAXON's EMG before and after the treatments following a protocol specifically developed for this purpose. The statistical analysis of the data was calculated using the Statistica 13 program. Results: One-time ischemic intermittent compression of the back extensor muscle statistically significantly increased the range of spine motion. The mean value of the tension of the back extensor muscle at rest after the therapy was reduced, showing statistically significant changes. The myoelectric changes in the back extensor muscle during flexion were not statistically significant Conclusions: The results showed the effectiveness of the ischemic intermittent compression technique in increasing the range of spine mobility after the treatment on the back extensor muscle. Intermittent ischemic compression leads to a decrease in the resting tension of the back extensor muscle, without affecting any significant changes during the flexion movement.

INFLUENCE OF FOAM ROLLING ON ELBOW PROPRIOCEPTION, STRENGTH, AND FUNCTIONAL MOTOR PERFORMANCE

Article

Feb 2021

Context: Foam rolling has recently been used frequently to increase flexibility. However, its effects on proprioception, strength and motor performance are not well known. In addition, very few studies have examined the effects of foam rolling in the upper extremity. Objective: To investigate the effects of foam rolling on elbow proprioception, strength, and functional motor performance in healthy individuals. Design: Randomized controlled study. Setting: Exercise laboratory of X Department, X University. Patients or Other Participants: Sixty healthy participants (mean age=22.83±4.07 years). Intervention(s): We randomly assigned participants into two groups: the foam rolling group (FRG) (4 weeks of foam rolling for the biceps brachii muscle) and control group (CG) (no foam rolling). Main Outcome Measure(s): We evaluated proprioception (joint position sense [JPS] and force matching), biceps brachii muscle strength, and functional motor performance (modified pull-up test [MPUT], closed kinetic chain upper extremity stability test [CKCUEST], and push-up test) at the baseline, and at the end of the 4th week and 8th week. Results: JPS at 45° elbow flexion, muscle strength, CKCUEST, and push-up test results improved after foam rolling and improvement was maintained at the follow-up (p<0.017). While the changes in groups for the results of proprioception and CKCUEST were similar among the three time points (p>0.05), there were significant improvements for the muscle strength from baseline to the second evaluation, and from baseline to the follow-up (p<0.001) in the FRG compared to the CG (p=0.004). The FRG was superior to the CG in the improvement of push-up test results among the three time points (p=0.040, p=0.001, p<0.001). Other data did not change (p>0.05). Conclusion: Foam rolling is effective in improving elbow JPS in small flexion angles, biceps brachii strength, and some parameters of upper extremity functional motor performance. These effects are maintained 4 weeks after application.

EFFECTIVENESS OF ISCHEMIC COMPRESSION ON TRIGGER POINTS FOR REDUCTION OF PAIN AND SPASM OF TRAPEZIUS MUSCLE

Article

Full-text available

Jan 2018

Myofascial trigger point is a hyperirritable nodule present in a palpable taut band of skeletal muscle, often results from muscle injury or repetitive strain that cause pain and tightness. Myofascial trigger points are one of the most common causes of chronic neck pain. This study aims to determine the efficacy of ischemic compression in comparison with myofascial stretching on trigger points of trapezius muscle for reduction of pain and spasm. Randomized Control Trial. The study was conducted in Ziauddin Hospital. 96 participants were enrolled in the study. Participants were divided into two groups equally and randomly, Group (A) an intervention group treated with hot pack, ultrasound therapy and ischemic compression, Group (B) a control group treated with hot pack, ultrasound therapy and myofascial stretching. This regime was followed thrice a week for three weeks. Statistically significant (P < 0.05) changes in the values were found in Group A and Group B for Visual Analog scale and Penn spasm frequency scale post treatment. The results showed that there is significant difference found after both interventions for the treatment of pain and spasm caused by myofascial trigger point. It cannot be said that ischemic compression is more effective than myofascial stretching for the treatment of myofascial trigger points of trapezius muscle.

Trigger point self-care for chronic neck pain: Pilot and feasibility

Article

Jun 2020

Objectives Trigger points are thought to be associated with chronic neck pain and can be treated with massage self-care techniques such as trigger point self-care. We sought to examine the feasibility of a developed group training approach for trigger point self-care to inform future efficacy focused clinical trials for chronic neck pain. Methods Self-identified adults with chronic neck pain were recruited to participate in one of two scheduled group training sessions. Data was collected pre- and post-training with follow-up at 1-, 4-, and 8-weeks. Measures included a trigger point self-care training objectives survey, daily self-report logs, and neck disability and pain via the Neck Disability Index. Training included interactive lecture, demonstration, supervised practice, and assessment for an individualized trigger point self-care plan. Handouts and tools were provided for training and home use. Results Five participants (women = 3; ages 22-58; White = 4) enrolled and completed the study. All participants completed each data collection point, attended a post-intervention focus group or interview, submitted their completed daily self-care log, and reported achieving all intended training objectives. All participants felt the downtown university location was convenient and non-clinical environment simulated a real-world educational/training experience. Two participants reported having some discomfort the day after training, most expected the training would help them, and several expressed excitement about learned content and empowerment to manage their own pain. Neck Disability Index scores at week-1 did not change for 1 participant, worsened for 1 participant, and improved for 3 participants. All participants’ Neck Disability Index scores were better than baseline at week-4 and week-8. Conclusions Our trigger point self-care group training approach was acceptable to study participants and is feasible to implement in future clinical trials. Larger studies including participants with more severe neck pain and disability are needed to test the trigger point self-care approach.

Myofascial Trigger Points in Adhesive Capsulitis: A Systematic Review

Article

Nov 2019

Reepa Ughreja

Myofascial Trigger Points in Adhesive Capsulitis: A Systematic Review

Article

Full-text available

Nov 2019

Introduction: Adhesive Capsulitis (AC) causes musculoskeletal disorder of shoulder which is a common reason for loss of function and disability in patients. Several interventions have been used for treatment of AC but very few of them have taken into consideration “Myofascial Origin” as a probable cause of pain. Aim: To review the current literature related to prevalence, diagnosis, and treatment of “Myofascial Trigger Points (MTrPs) in AC”. To compare the prevalence of MTrPs in Diabetic and Non-Diabetic patients. Materials and Methods: Google Scholar, Pubmed, Cochrane library, Central register for clinical trial were searched for published randomised controlled trials, systematic or literature reviews, case study, pilot study and book references in English language from inception till December 2018. Out of total 1833 results identified, 7 relevant studies with a total of 190 patients were finally selected for the review. Four studies were analysed for methodological quality using Pedro tool for randomised controlled trial and National Institutes of Health tool for observational study and case reports. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (PRISMA). Results: Among all the articles, three of them discussed about the prevalence of MTrPs in AC. These studies showed the greater prevalence of MTrPs in subscapularis muscle which may be the cause for pain and restricted shoulder movements. There was no study on diagnosis of MTrPs in AC. The studies (four in number) which showed the efficacy of treatment of MTrPs included techniques like Myofascial release technique+deep stroking (Niel Asher Technique), Ischaemic Compression of MTrPs, Dry Needling, Infiltration of Subscapularis TrPs with Subscapularis nerve block. Conclusion: MTrPs acts as an important contributing factor for causing pain, movement restriction and disability in the patients. Interventional studies have found significant improvement in shoulder pain and function but the exact method and the muscles which received the treatment were not mentioned. This review suggests that, there is need for good quality studies related to the prevalence, diagnosis and treatment of MTrPs in AC subjects with Diabetes Mellitus as well as without Diabetes Mellitus.

Skeletal muscle contractility, self-reported pain and tissue sensitivity in females with neck/shoulder pain and upper Trapezius myofascial trigger points– a randomized intervention study

Article

Full-text available

Nov 2012

Background: In relation to Myofascial Triggerpoints (MFTrPs) of the upper Trapezius, this study explored muscle contractility characteristics, the occurrence of post-intervention muscle soreness and the effect of dry needling on muscle contractile characteristics and clinical outcomes. Methods: Seventy-seven female office workers (25-46yrs) with and without neck/shoulder pain were observed with respect to self-reported pain (NRS-101), pressure-pain threshold (PPT), maximum voluntary contraction (Fmax) and rate of force development (RFD) at baseline (pre-intervention), immediately post-intervention and 48 hours post-intervention. Symptomatic and asymptomatic participant groups were each randomized into two treatment sub-groups (superficial (SDN) and deep dry needling (DDN)) after baseline testing. At 48 hours post-intervention participants were asked whether delayed onset muscle soreness (DOMS) and/or post-needling soreness had developed. Results: Muscle contractile characteristics did not differ between groups at baseline. Forty-six individuals developed muscle soreness (39 from mechanical testing and seven from needling). No inter-group differences were observed post-intervention for Fmax or RFD for the four sub-groups. Over the observation period, symptomatic participants reported less pain from both SDN (p= 0.003) and DDN (p=0.011). However, PPT levels were reduced for all participants (p=0.029). Those reporting DOMS experienced significant decreases in PPT, irrespective of symptom state or intervention (p=0.001). Conclusions: In selected female neck/shoulder pain sufferers, maximum voluntary contraction and rapid force generation of the upper Trapezius was not influenced by clinically relevant self-reported pain or the presence of diagnostically relevant MFTrPs. Dry needling, deep or superficial, did not affect measured functional outcomes over the 48-hour observation period. DOMS affected participants uniformly irrespective of pain, MFTrP status or intervention type and therefore is like to act as a modifier. Trial registration: Clinical Trials.gov- NCT01710735 SIGNIFICANCE AND INNOVATIONS: The present investigation is one of the first to examine the hypothesis of gross muscle contractile inhibition due to the presence of diagnostically relevant MFTrPs.Individuals suffering from clinically relevant levels of self-reported pain are able to tolerate maximum voluntary contraction testing, but delayed onset muscle soreness (DOMS) is a likely side-effect irrespective of symptom status. As a consequence, its confounding effect during subsequent testing must be taken into account.

Reliability and Usefulness of the Pressure Pain Threshold Measurement in Patients with Myofascial Pain

Article

Full-text available

Jun 2011

To assess the usefulness of a pressure algometer to measure pressure pain threshold (PPT) for diagnosis of myofascial pain syndrome (MPS) in the upper extremity and trunk muscles. A group of 221 desk workers complaining of upper body pain participated in this study. Five physiatrists made the diagnosis of MPS using physical examination and PPT measurements. PPT measurements were determined for several muscles in the back and upper extremities. Mean PPT data for gender, side, and dominant hand groups were analyzed. Sensitivity and specificity of Fischer's standard method were evaluated. PPT cut-off values for each muscle group were determined using an ROC curve. Cronbach's alpha for each muscle was very high. The PPT in men was higher than in females, and the PPT in the left side was higher than in the right side for all muscles tested (p<0.05). There was no significant difference in PPT for all muscles between dominant and non-dominant hand groups. Diagnosis of MPS based on Fischer's standard showed relatively high specificity and poor sensitivity. The digital pressure algometer showed high reliability. PPT might be a useful parameter for assessing a treatment's effect, but not for use in diagnosis or even as a screening method.

Changes in microcirculation of the trapezius muscle during a prolonged computer task

Article

Full-text available

Jan 2012
EUR J APPL PHYSIOL

The aim of this study is to investigate if there is a change in oxygen saturation and blood flow in the different parts of the trapezius muscle in office workers with and without trapezius myalgia during a standardized computer task. Twenty right-handed office workers participated; ten were recruited based on pain in the trapezius and ten as matching controls. Subjects performed a combination of typing and mousing tasks for 60 min at a standardized workstation. Muscle tissue oxygenation and blood flow data were collected from the upper trapezius (UT), the middle trapezius (MT) and the lower trapezius (LT), both on the left and right side at seven moments (at baseline and every tenth minute during the 1-h typing task) by use of the oxygen to see device. In all three parts of the trapezius muscle, the oxygen saturation and blood flow decreased significantly over time in a similar pattern (p < 0.001). Oxygenation of the left and right UT was significantly higher compared to the other muscle parts (p < 0.001). Oxygen saturation for the MT was significantly lower in the cases compared to the control group (p = 0.027). Blood flow of the UT on the right side was significantly lower than the blood flow on the left side (p = 0.026). The main finding of this study was that 1 h of combined workstation tasks resulted in decreased oxygen saturation and blood flow in all three parts of the trapezius muscle. Future research should focus on the influence of intervention strategies on these parameters.

The relationship between latent trigger point and muscle strength in healthy subjects: A double-blind study

Article

Full-text available

Dec 2011

Trigger points on the palpable taut bands of the muscles are promoted as an important cause of musculoskeletal pain. Our hypothesis was latent trigger points (LTrPs) could decrease muscle strength also in healthy people. The aim of our study was to investigate the relationship between LTrPs and muscle strength in a group of healthy adults. In total fifty healthy adults (20 women and 30 men) were included in the study. Trigger point examination for upper and middle trapezius, supraspinatus, serratus anterior and rhomboid major and minor were done bilaterally according to four criteria. Subjects who have at least two trigger points in dominant side were assigned to Group 1 (28 subjects), subjects who don't have any trigger points were assigned to Group 2 (23 subjects). Muscle strength for flexion and scaption was assessed with a Hand-Held Dynamometer (HHD) as break test on both sides. Both the subjects and the examiners were blind. For statistical analysis, independent sample t test was used to compare the differences between two groups. No significant differences were found in muscle strength between dominant and non-dominant sides in both groups (p >0.05). Significant difference was observed in both sides when comparison of muscle strength between Group 1 and 2, muscle strength was lower in subjects who had trigger points (p < 0.05). This study indicated that although there is not significant difference between dominant and non-dominant side, muscle strength is lower significantly in both %side sides in subjects who have trigger points in comparison with healthy subjects. Our results underline the importance of palpation of LTrPs in scapular and shoulder muscles in healthy subjects as they may contribute to the muscle strength. Further research is needed to facilitate a better understanding of the mechanism of LTrPs and to test the relationship with muscle strength.

Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

Article

Full-text available

Jul 2011
BMC MUSCULOSKEL DIS

Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. ISRCTN60264809.

Pressure algometry in healthy subjects: Inter-examiner variability

Article

Full-text available

Mar 1998
Scand J Rehabil Med

The purpose of this study was to estimate inter-examiner reliability of head and neck algometry. Pain perception thresholds were assessed with a mechanical pressure algometer in 21 healthy individuals. Thresholds were assessed at 13 symmetrical points on each side of the head and neck, at the deltoid muscle and at the median finger. The pressure range of the instrument proved insufficient to study the pain perception threshold on the finger, however. Two different examiners carried out one or two examinations in each subject during one day. The sequence of investigations was varied randomly. The inter-examiner reliability was found to be good, with a mean intra-class correlation coefficient (ICC) of 0.75. Intra-examiner reproducibility was excellent (mean ICC = 0.84). The mean inter-examiner coefficient of variation was 18.7%, while the mean coefficient of repeatability (CR) was 1.60 kg/cm2. In comparison, the mean intra-examiner coefficient of variation was 15% while the mean CR was 1.29 kg/cm2. Statistically significant differences between examiners were found for the frontal point (p < 0.01), while a trend towards lower thresholds in one of the two observers was seen in 10 of the 13 non-significant points. Inter-examiner reliability of side differences was excellent, with CR = 1.23 kg/cm2. In conclusion, manual algometry with a rather inexpensive mechanical device has a good to excellent inter-rater reliability. When studying patients, however, the possible bias introduced by different examiners should be taken into account, both regarding study design and data analysis.

Chronic Shoulder Pain of Myofascial Origin: A Randomized Clinical Trial Using Ischemic Compression Therapy

Article

Full-text available

Jun 2010

The aim of this clinical trial was to evaluate the effect of 15 myofascial therapy treatments using ischemic compression on shoulder trigger points in patients with chronic shoulder pain. Forty-one patients received 15 experimental treatments, which consisted of ischemic compressions on trigger points located in the supraspinatus muscle, the infraspinatus muscle, the deltoid muscle, and the biceps tendon. Eighteen patients received the control treatment involving 15 ischemic compression treatments of trigger points located in cervical and upper thoracic areas. Of the 18 patients forming the control group, 16 went on to receive 15 experimental treatments after having received their initial control treatments. Outcome measures included a validated 13-question questionnaire measuring shoulder pain and functional impairment. A second questionnaire was used to assess patients' perceived amelioration, using a scale from 0% to 100%. Outcome measure evaluation was completed for both groups at baseline after 15 treatments, 30 days after the last treatment, and finally for the experimental group only, 6 months later. A significant group x time interval interaction was observed after the first 15 treatments, indicating that the experimental group had a significant reduction in their Shoulder Pain and Disability Index (SPADI) score compared with the control group (62% vs 18% amelioration). Moreover, the patients perceived percentages of amelioration were higher in the experimental group after 15 treatments (75% vs 29%). Finally, the control group subjects significantly reduced their SPADI scores after crossover (55%). The results of this study suggest that myofascial therapy using ischemic compression on shoulder trigger points may reduce the symptoms of patients experiencing chronic shoulder pain.

Differences in muscle load between computer and non-computer work among office workers

Article

Full-text available

Dec 2009
ERGONOMICS

Introduction of more non-computer tasks has been suggested to increase exposure variation and thus reduce musculoskeletal complaints (MSC) in computer-intensive office work. This study investigated whether muscle activity did, indeed, differ between computer and non-computer activities. Whole-day logs of input device use in 30 office workers were used to identify computer and non-computer work, using a range of classification thresholds (non-computer thresholds (NCTs)). Exposure during these activities was assessed by bilateral electromyography recordings from the upper trapezius and lower arm. Contrasts in muscle activity between computer and non-computer work were distinct but small, even at the individualised, optimal NCT. Using an average group-based NCT resulted in less contrast, even in smaller subgroups defined by job function or MSC. Thus, computer activity logs should be used cautiously as proxies of biomechanical exposure. Conventional non-computer tasks may have a limited potential to increase variation in muscle activity during computer-intensive office work.

Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks

Article

Full-text available

Apr 2009
EUR J APPL PHYSIOL

Past studies on work-related musculoskeletal disorders (WMSD) have reported increased median muscle activities in terms of 50th% of amplitude probability distribution function (APDF), and this was thought to be a manifestation of altered motor control--an important mechanism contributing to WMSD. The present study aimed to examine whether such altered motor control was also present in other parameters of APDF--the 10th and 90th% values, which can be considered indicators of the low and high measures of muscle activity. The difference between 10th and 90th% APDF can be considered an indicator of the variation in muscle activity amplitude (the "APDF range"). Surface electromyography was examined in female office workers as Case (n = 21) and Control (n = 18) subjects. The APDF variables were measured in cervical erector spinae (CES) and upper trapezius (UT) muscles during typing, mousing and type-and-mouse, for 20 min each. The Case Group had significantly higher CES activity in the 10th, 90th% and APDF range compared to Controls. The UT muscles showed similar trends but the between-group differences were not statistically significant. These results have demonstrated the robustness of the APDF variables as sensitive indicators of motor control variations in symptomatic subjects with musculoskeletal disorders.

Individual and work related risk factors for neck pain among office workers: A cross sectional study

Article

Full-text available

Jun 2007

Work related neck disorders are common problems in office workers, especially among those who are intensive computer users. It is generally agreed that the etiology of work related neck disorders is multidimensional which is associated with, and influenced by, a complex array of individual, physical and psychosocial factors. The aim of the current study was to estimate the one-year prevalence of neck pain among office workers and to determine which physical, psychological and individual factors are associated with these prevalences. Five hundred and twelve office workers were studied. Information was collected by an online questionnaire. Self-reported neck pain during the preceding 12 months was regarded as a dependent variable, whereas different individual, work-related physical and psychosocial factors were studied as independent variables. The 12 month prevalences of neck pain in office workers was 45.5%. Multivariate analysis revealed that women had an almost two-fold risk compared with men (OR = 1.95, 95% CI 1.22-3.13). The odds ratio for age indicates that persons older than 30 years have 2.61 times more chance of having neck pain than younger individuals (OR = 2.61, 95% CI 1.32-3.47). Being physically active decreases the likelihood of having neck pain (OR = 1.85, 95% CI 1.14-2.99). Significant associations were found between neck pain and often holding the neck in a forward bent posture for a prolonged time (OR = 2.01, 95% CI 1.20-3.38), often sitting for a prolonged time (OR = 2.06, 95% CI 1.17-3.62) and often making the same movements per minute (OR = 1.63, 95% CI 1.02-2.60). Mental tiredness at the end of the workday (OR = 2.05, 95% CI 1.29-3.26) and shortage of personnel (OR = 1.71, 95% CI 1.06-2.76) are significantly associated with neck pain. The results of this study indicate that physical and psychosocial work factors, as well as individual variables, are associated with the frequency of neck pain. These association patterns suggest also opportunities for intervention strategies in order to stimulate an ergonomic work place setting and increase a positive psychosocial work environment.

Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain

Article

Full-text available

Apr 2008
BMC MUSCULOSKEL DIS

The minimal detectable change (MDC) and the minimal clinically important changes (MCIC) have been explored for nonspecific low back pain patients and are similar across different cultural settings. No data on MDC and MCIC for pain severity are available for neck pain patients. The objectives of this study were to estimate MDC and MCIC for pain severity in subacute and chronic neck pain (NP) patients, to assess if MDC and MCIC values are influenced by baseline values and to explore if they are different in the subset of patients reporting referred pain, and in subacute versus chronic patients. Subacute and chronic patients treated in routine clinical practice of the Spanish National Health Service for neck pain, with or without pain referred to the arm, and a pain severity > or = 3 points on a pain intensity number rating scale (PI-NRS), were included in this study. Patients' own "global perceived effect" over a 3 month period was used as the external criterion. The minimal detectable change (MDC) was estimated by means of the standard error of measurement in patients who self-assess as unchanged. MCIC were estimated by the mean value of change score in patients who self-assess as improved (mean change score, MCS), and by the optimal cutoff point in receiver operating characteristics curves (ROC). The effect on MDC and MCIC of initial scores, duration of pain, and existence of referred pain were assessed. 658 patients were included, 487 of them with referred pain. MDC was 4.0 PI-NRS points for neck pain in the entire sample, 4.2 for neck pain in patients who also had referred pain, and 6.2 for referred pain. MCS was 4.1 and ROC was 1.5 for referred and for neck pain, both in the entire sample and in patients who also complained of referred pain. ROC was lower (0.5 PI-NRS points) for subacute than for chronic patients (1.5 points). MCS was higher for patients with more intense baseline pain, ranging from 2.4 to 4.9 PI-NRS for neck pain and from 2.4 to 5.3 for referred pain. In general, improvements < or = 1.5 PI-NRS points could be seen as irrelevant. Above that value, the cutoff point for clinical relevance depends on the methods used to estimate MCIC and on the patient's baseline severity of pain. MDC and MCIC values in neck pain patients are similar to those for low back pain and other painful conditions.

Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: A systematic review

Article

Full-text available

Aug 2008
EUR SPINE J

The study is to provide a critical analysis of the research literature on clinimetric properties of instruments that can be used in daily practice to measure active cervical range of motion (ACROM) in patients with non-specific neck pain. A computerized literature search was performed in Medline, Cinahl and Embase from 1982 to January 2007. Two reviewers independently assessed the clinimetric properties of identified instruments using a criteria list. The search identified a total of 33 studies, investigating three different types of measurement instruments to determine ACROM. These instruments were: (1) different types of goniometers/inclinometers, (2) visual estimation, and (3) tape measurements. Intra- and inter-observer reliability was demonstrated for the cervical range of motion instrument (CROM), Cybex electronic digital instrument (EDI-320) and a single inclinometer. The presence of agreement was assessed for the EDI-320 and a single inclinometer. The CROM received a positive rating for construct validity. When clinical acceptability is taken into account both the CROM and the single inclinometer can be considered appropriate instruments for measuring the active range of motion in patients with non-specific neck pain in daily practice. Reliability is the aspect most frequently evaluated. Agreement, validity and responsiveness are documented less frequently.

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

Article

Mar 2006
INT J OSTEOPATH MED

Introduction Sustained manual pressure has been advocated as an effective treatment for myofascial trigger points (MTrPs).1, 2 and 3 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. Design Randomised blinded clinical trial. Methods Participants: Thirty-seven subjects (mean age 23.1 years ± 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). Intervention: Subjects were randomly allocated into either treatment (MPR pressure sustained for 60 s) or control (sham myofascial release) group. Outcome Measures: 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. Changes in pressure sensitivity were also measured during the application of MPR via a verbal analogue pain scale (0–10, 0 = no pain, 10 = severe pain). Results There was a significant increase in mean PPT 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. Conclusions The results suggest that MPR may be an effective therapy for MTrPs in the upper trapezius muscle.

Dutch muscuskeletal questionnaire: description and basic qualities

Article

Jan 2001

The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: A pilot study

Article

Jan 2006

The aim of this pilot study was to compare the effects of a single treatment of the ischemic compression technique with transverse friction massage for myofascial trigger point (MTrP) tenderness. Forty subjects, 17 men and 23 women, aged 19–38 years old, presenting with mechanical neck pain and diagnosed with MTrPs in the upper trapezius muscle, according to the diagnostic criteria described by Simons and by Gerwin, participated in this pilot study. Subjects were divided randomly into two groups: group A which was treated with the ischemic compression technique, and group B which was treated with a transverse friction massage. The outcome measures were the pressure pain threshold (PPT) in the MTrP, and a visual analogue scale assessing local pain evoked by a second application of 2.5 kg/cm2 of pressure on the MTrP. These outcomes were assessed pre-treatment and 2 min post-treatment by an assessor blinded to the treatment allocation of the subject. The results showed a significant improvement in the PPT (P=0.03P=0.03), and a significant decrease in the visual analogue scores (P=0.04P=0.04) within each group. No differences were found between the improvement in both groups (P=0.4P=0.4). Ischemic compression technique and transverse friction massage were equally effective in reducing tenderness in MTrPs.

Travell and Simon''s Myofascial Pain and Dysfunction: the Trigger Point Manual: Volume I

Article

Jan 1999

Changes in cervical range of motion, flexion-relaxation ratio and pain with visual display terminal work

Article

Jan 2013

Background: The static posture in visual display terminal (VDT) workers results in increased forward neck flexion and increased static muscle tension in the neck and shoulder regions. However, few studies have objectively quantified the change in head posture induced shoulder pain during VDT work. Objective: This study elucidated changes in pressure pain in the upper trapezius muscles, cervical ROM, and the cervical flexion--relaxation ratio after continuous long-term VDT work. Participants: Twelve young VDT workers were recruited. Methods: The pressure pain of the upper trapezius muscles, active CROM, and cervical flexion--relaxation ratio were measured in all subjects once before and once after VDT work. Results: The pressure pain threshold of the right upper trapezius muscle was 6.9 ± 1.6 lb before VDT work and 6.1 ± 1.0 lb after VDT work, revealing a significant increase with VDT work. The cervical extension, left and right lateral flexion, and left rotation measurers decreased significantly with VDT work. Conclusions: We postulate that even short-term VDT work has the potential to cause problems. It is necessary to develop a CROM self-measuring device and to monitor patients' musculoskeletal changes frequently.

Myofascial Pain Syndrome: Here We Are, Where Must We Go?

Article

Oct 2010

Robert D. Gerwin

ABSTRACT Objective: To present the current state of knowledge of myofascial pain syndrome [MPS] and to point the direction for new research. Findings: MPS was first defined clinically by Janet Travell, MD, and later by David Simons, MD. Pain neurophysiology has only recently provided the basis for understanding the sensorimotor manifestations of MPS. This article reviews the current state of knowledge concerning MPS. MPS is a form of myalgia characterized by local regions of muscle hardness and tenderness that cause referred pain. The signature feature is the trigger point, a tender, taut band of muscle that can be painful spontaneously or when stimulated. The active trigger point has identifiable pathophysiologic changes. Levels of substance P, calcitonin gene related peptide, bradykinin, and assorted cytokines, are elevated, indicating a chemical inflammation. Trigger point milieu pH is low, about pH 5, consistent with hypoxia and ischemia. Persistent, low-amplitude, high-frequency electrical discharges that look like endplate potentials characteristic. The taut band can be visualized using high definition ultrasonograpy and magnetic resonance sonography. Central sensitization in MPS has been documented in humans by functional magnetic resonance image scanning. The role of MPS in headache and pelvic pain has been extensively studied in the last few years. Conclusion: Although great progress has been made, studies are still needed to substantiate the energy crisis hypothesis of trigger point formation, to understand the nature of sustained muscle contraction that forms the taut band and of referred pain in humans, and to develop a more rationale and effective treatment.

Reinvestigation of the dysfunction in neck and shoulder girdle muscles as the reason of cervicogenic headache among office workers

Article

Aug 2012
DISABIL REHABIL

Purpose: Dysfunction of cervical and shoulder girdle muscles as reason of cervicogenic headache (CEH) was reinvestigated with clinical and neurophysiological studies. Methods: Forty office workers were randomized into two groups to verify efficiency of supervised kinesiotherapy (N = 20) aimed with improvement of muscle's activity and headache symptoms releasing. Headache intensity was evaluated with visual analog scale (VAS), range of cervical movement (ROM) with goniometer, trigger points (TrPs) incidence with palpation and muscle's strength with Lovett's scale. Reaction of patients for muscle's elongation was also evaluated. Surface electromyographical recordings were bilaterally analyzed at rest (rEMG) and during maximal contraction (mcEMG). Results: Deficits of cervical flexion and muscles strength were found in all patients. TrPs occurred predominantly in painful trapezius muscle. Incidence of trigger points coexisted with intensity of CEH. Results indicated on muscles dysfunction which improved only after supervised therapy. Positive correlations between increase in rEMG amplitudes and high VAS scores, high-amplitude rEMG recordings incidence and increased number of TrPs were found. Negative correlation was detected between amplitude in mcEMG and amplitude of rEMG recordings. Conclusions: Dysfunction of trapezius muscle was most responsible for CEH etiology. Proposed algorithm of kinesiotherapy was effective as complementary method of the CEH patients treatment.

Muscle Trigger Points, Pressure Pain Threshold, and Cervical Range of Motion in Patients With High Level of Disability Related to Acute Whiplash Injury

Article

Jun 2012
J ORTHOP SPORT PHYS

Cross sectional cohort study. To analyze the differences in the prevalence of trigger points (TrPs) between patients with acute whiplash-associated disorders (WADs) and healthy controls, and to determine if widespread pressure hypersensitivity and reduced cervical range of motion are related to the presence of TrPs in patients with acute WADs. The relationship between active TrPs and central sensitization is not well understood in patients with acute WADs. Twenty individuals with a high level of disability related to acute WAD and 20 age- and sex-matched controls participated in the study. TrPs in the temporalis, masseter, upper trapezius, levator scapulae, sternocleidomastoid, suboccipital, and scalene muscles were examined. TrPs are defined as hypersensitive spots in a palpable taut band, producing a local twitch response and referred pain when palpated. Pressure pain threshold (PPT) was assessed bilaterally over the C5-6 zygapophyseal joints, second metacarpal, and tibialis anterior muscle. Active cervical range of motion, neck pain, and self-rated disability using the Neck Disability Index were also assessed. The mean ± SD number of TrPs for the patients with acute WAD was 7.3 ± 2.8 (3.4 ± 2.7 were latent TrPs; 3.9 ± 2.5 were active TrPs). In comparison, healthy controls had 1.7 ± 2.2 latent and no active TrPs (P<0.01). In patients with acute WAD, the most prevalent sites for active TrPs were the levator scapulae and upper trapezius muscles. The number of active TrPs increased with higher neck pain intensity (P<0.001) and a higher number of days since the accident (P=.003). Patients had significantly lower PPTs in all tested locations and less active cervical range of motion than controls (P<.001). In the patient group, there were significant negative correlations between the number of active TrPs and PPT over the C5-C6 joints and cervical range of motion in flexion, extension, and rotation in both directions: the greater the number of active TrPs, the lower the bilateral PPT over the neck and the greater the cervical range of motion limitation. The local and referred pain elicited from active TrPs reproduced neck and shoulder pain patterns in individuals with acute WADs with higher levels of disability. Patients with acute WADs exhibited widespread pressure hypersensitivity and reduced cervical mobility. The number of active TrPs was related to higher neck pain intensity, the number of days since the accident, higher pressure pain hypersensitivity over the cervical spine, and reduced active cervical range of motion.

Referred Pain From Myofascial Trigger Points in Head, Neck, Shoulder, and Arm Muscles Reproduces Pain Symptoms in Blue-collar (Manual) and White-collar (Office) Workers

Article

Jul 2012
CLIN J PAIN

To describe the prevalence and referred pain area of trigger points (TrPs) in blue-collar (manual) and white-collar (office) workers, and to analyze if the referred pain pattern elicited from TrPs completely reproduces the overall spontaneous pain pattern. Sixteen (62% women) blue-collar and 19 (75% women) white-collar workers were included in this study. TrPs in the temporalis, masseter, upper trapezius, sternocleidomastoid, splenius capitis, oblique capitis inferior, levator scapulae, scalene, pectoralis major, deltoid, infraspinatus, extensor carpi radialis brevis and longus, extensor digitorum communis, and supinator muscles were examined bilaterally (hyper-sensible tender spot within a palpable taut band, local twitch response with snapping palpation, and elicited referred pain pattern with palpation) by experienced assessors blinded to the participants' condition. TrPs were considered active when the local and referred pain reproduced any symptom and the patient recognized the pain as familiar. The referred pain areas were drawn on anatomic maps, digitized, and measured. Blue-collar workers had a mean of 6 (SD: 3) active and 10 (SD: 5) latent TrPs, whereas white-collar workers had a mean of 6 (SD: 4) active and 11 (SD: 6) latent TrPs (P>0.548). No significant differences in the distribution of active and latent TrPs in the analyzed muscles between groups were found. Active TrPs in the upper trapezius, infraspinatus, levator scapulae, and extensor carpi radialis brevis muscles were the most prevalent in both groups. Significant differences in referred pain areas between muscles (P<0.001) were found; pectoralis major, infraspinatus, upper trapezius, and scalene muscles showed the largest referred pain areas (P<0.01), whereas the temporalis, masseter, and splenius capitis muscles showed the smallest (P<0.05). The combination of the referred pain from TrPs reproduced the overall clinical pain area in all participants. Blue-collar and white-collar workers exhibited a similar number of TrPs in the upper quadrant musculature. The referred pain elicited by active TrPs reproduced the overall pain pattern. The distribution of TrPs was not significantly different between groups. Clinicians should examine for the presence of muscle TrPs in blue-collar and white-collar workers.

Immediate Effects of Ischemic Compression on Neck Function in Patients With Cervicogenic Cephalic Syndrome

Article

May 2012

Cervicogenic cephalic syndrome (CCS), a group of diseases, consists of cervicogenic headache and dizziness. These symptoms may cause loss of physical function compared with other headache and dizziness disorders. The purpose of this case-control study was to assess the clinical effects of ischemic compression (IC) in patients with CCS. Twenty-seven subjects with chronic neck pain (persisting for >3 months) and 26 healthy volunteers were examined. Subjects with organic lesion of the ear, nose, throat, eye, or central nervous system were excluded. The CCS group received IC over the maximal tender points of the origin of the posterior nuchal muscle. Sensory organization test (SOT) scores, cervical range of motion (ROM), and isometric strength of neck were measured before IC and after IC. The ROM of the cervical spine increased in all directions after IC (P < .0083) in the CCS group, and isometric strength in the CCS group rose in all directions after IC (P = .000). There was a significant difference in ankle strategy score under the sway-referenced vision and fixed support condition (P = .003) between the control group and CCS before IC. The ankle strategy score of the CCS group improved substantially after IC under eyes closed and sway-referenced support conditions (P = .003). The visual and vestibular ratios in the CCS group also increased after IC (P = .006 and P = .002, respectively). The findings of this study showed that ROM of the cervical spine and isometric strength increased in all directions, and the SOT scores showed increased postural stability under conditions with swayed reference support after IC in the CCS group. The ratios for vestibular and visual function also increased after IC in the CCS group.

Changes in muscle activity determine progression of clinical symptoms in patients with chronic spine-related muscle pain. A complex clinical and neurophysiological approach

Article

Jul 2011
FUNCT NEUROL

Spine-related muscle pain can affect muscle strength and motor unit activity. This study was undertaken to investigate whether surface electromyographic (sEMG) recordings performed during relaxation and maximal contraction reveal differences in the activity of muscles with or without trigger points (TRPs). We also analyzed the possible coexistence of characteristic spontaneous activity in needle electromyographic (eEMG) recordings with the presence of TRPs. Thirty patients with non-specific cervical and back pain were evaluated using clinical, neuroimaging and electroneurographic examinations. Muscle pain was measured using a visual analog scale (VAS), and strength using Lovett's scale; trigger points were detected by palpation. EMG was used to examine motor unit activity. Trigger points were found mainly in the trapezius muscles in thirteen patients. Their presence was accompanied by increased pain intensity, decreased muscle strength, increased resting sEMG amplitude, and decreased sEMG amplitude during muscle contraction. eEMG revealed characteristic asynchronous discharges in TRPs. The results of EMG examinations point to a complexity of muscle pain that depends on progression of the myofascial syndrome.

The Effects of Pressure Release, Phonophoresis of Hydrocortisone, and Ultrasound on Upper Trapezius Latent Myofascial Trigger Point

Article

Jan 2012

To compare the effects of pressure release (PR), phonophoresis of hydrocortisone (PhH) 1%, and ultrasonic therapy (UT) in patients with an upper trapezius latent myofascial trigger point (MTP). Repeated-measure design. A pain control medical clinic. Subjects (N=60; mean±SD age, 21.78±1.76y) with a diagnosis of upper trapezius MTP participated in this study. Subjects were randomly divided into 4 groups: PR, PhH, UT, and control (15 in each group). All patients had a latent MTP in the upper trapezius muscle. PR, PhH, UT. Subjective pain intensity, pain pressure threshold (PPT), and active cervical lateral flexion range of motion were assessed in 6 sessions. All 3 treatment groups showed decreases in pain and PPT and an increase in cervical lateral flexion range of motion (P<.001) compared with the control group. Both PhH and PR techniques showed more significant therapeutic effects than UT (P<.001). Our results indicate that all 3 treatments used in this study were effective for treating MTP. According to this study, PhH is suggested as a new method effective for the treatment of MTP.

The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: A randomized controlled trial

Article

Mar 2010

Currently, large levels of practice variability exist regarding the clinical deactivation of trigger points. Manual physical therapy has been identified as a potential means of resolving active trigger points; however, to date the ideal treatment approach has yet to be elucidated. The purpose of this clinical trial was to compare the effects of two manual treatment regimens on individuals with upper trapezius trigger points. Sixty patients, 19-38 years of age with non-specific neck pain and upper trapezius trigger points, were randomized into one of two, 4 week physical therapy programs. One group received muscle energy techniques while the second group received an integrated neuromuscular inhibition technique (INIT) consisting of muscle energy techniques, ischemic compression, and strain-counterstrain (SCS). Outcomes including a visual analog pain scale (VAS), the neck disability index (NDI), and lateral cervical flexion range of motion (ROM) were collected at baseline, 2 and 4 weeks after the initiation of therapy. Results revealed large pre-post-effect sizes within the INIT group (Cohen's d = 0.97, 0.94 and 0.97). Additionally, significantly greater improvements in pain and neck disability and lateral cervical flexion ROM were detected in favor of the INIT group (0.29-0.57, 0.57-1.12 and 0.29-0.57) at a 95% CI respectively. The findings of this study indicate the potential benefit of an integrated approach in deactivating upper trapezius trigger points. Further research should be performed to investigate the long-term benefits of the current treatment approach.

The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: A pilot randomised controlled trial

Article

Jan 2011

The primary aim of this study was to investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of trigger point (TrP) pressure release on latent soleus myofascial trigger points (MTrPs). The secondary aim was to assess aspects of the methodological design quality, identify limitations and propose areas for improvement in future research. A pilot randomised control trial. Twenty healthy volunteers (5 men and 15 women; mean age 21.7±2.1 years) with a restricted active ankle joint dorsiflexion. Participants underwent a screening process to establish both a restriction in active ankle dorsiflexion and the presence of active and latent MTrPs in the soleus muscle. Participants were then randomly allocated to an intervention group (TrP pressure release) or control group (no therapy). The results showed a statistically significant (p=0.03) increase of ankle ROM in the intervention compared to the control group. This study identified an immediate significant improvement in ankle ROM after a single intervention of TrP pressure release on latent soleus MTrPS. These findings are clinically relevant, although the treatment effect on ankle ROM is smaller than a clinical significant ROM (5°). Suggestions for methodological improvements may inform future MTrP research and ultimately benefit clinical practice in this under investigated area.

The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain

Article

Dec 2010

Extensive computer use amongst office workers has lead to an increase in work-related neck pain. Aberrant activity within the three portions of the trapezius muscle and associated changes in scapular posture have been identified as potential contributing factors. This study compared the activity (surface electromyography) of the three portions of the trapezius in healthy controls (n = 20) to a neck pain group with poor scapular posture (n = 18) during the performance of a functional typing task. A scapular postural correction strategy was used to correct scapular orientation in the neck pain group and electromyographic recordings were repeated. During the typing task, the neck pain group generated greater activity in the middle trapezius (MT) (p = 0.02) and less activity in the lower trapezius (LT) (p = 0.03) than the control group. Following correction of the scapula, activity recorded by the neck pain group was similar to the control group for the middle and lower portions (p = 0.09; p = 0.91). These findings indicate that a scapular postural correction exercise may be effective in altering the distribution of activity in the trapezius to better reflect that displayed by healthy individuals.

Grieve's Modern Manual Therapy : The Vertebral Column

Article

Myofascial Pain and Dysfunction: The Trigger Point Manual

Article

Jan 1983

Immediate Effect of Ultrasound and Ischemic Compression Techniques for the Treatment of Trapezius Latent Myofascial Trigger Points in Healthy Subjects: A Randomized Controlled Study

Article

Sep 2009

The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle. Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm(2) of pressure using a pressure analog algometer. The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained. In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.

Reliability of different thresholds for defining muscular rest of the trapezius muscles in computer office workers

Article

Aug 2009

This study aimed at documenting the reliability of different thresholds used for defining the muscular rest of the trapezius muscles of 27 computer office workers, using surface electromyography (EMG) signals collected in the field. Measurement strategies for increasing the reliability of the results were also explored. Ten different thresholds to define muscular rest were compared: 1) five normalised (individualised) thresholds; 2) three absolute thresholds (in muV); 3) two absolute but individualised thresholds. The reliability was assessed using both a 15-min standardised computer task and 45 min of regular computer work. The main findings were: 1) overall, in a repeated measures study design, muscular rest variables were more reliable with the use of absolute thresholds when compared to normalised and individualised thresholds; 2) excellent reliability (index of dependability >0.75) can be reached when averaging the scores over 2 days; 3) using a standardised task instead of regular work does not necessarily lead to more reliable results.

Myofascial Pain and Dysfunction: The Trigger Point Manual

Article

Jan 1983
J Can Chiropract Assoc

John CP Henderson

Work-induced pain, trapezius blood flux, and muscle activity in workers with chronic shoulder and neck pain

Article

May 2009
PAIN

Pain, trapezius microcirculation, and electromyography (EMG) were recorded during 90 min of simulated office work with time pressure and hand precision demands in 24 full-time working subjects with chronic shoulder and neck pain. The responses were compared with those of a reference group of 28 healthy subjects without pain. Pain intensity was rated on a visual analogue scale. Intramuscular blood flux was measured by laser-Doppler flowmetry (LDF) and muscle activity by surface EMG bilaterally in the upper trapezius. Pain increased during the work task, and the increase was larger in women than in men and in the reference group. Muscle activity was low: <4% of EMG during maximal voluntary contraction. LDF showed elevated intramuscular blood flux above baseline throughout the work task in both groups and during recovery in the pain group. Pain in the active side correlated positively with blood flux in the pain-afflicted subjects and negatively in the reference group. In conclusion, office work induced pain, and trapezius vasodilation that did not return to resting values during recovery. These data show that pain is associated with trapezius vasodilation but not with muscle activity. Interaction between blood vessels and nociceptors may be important in the activation of muscle nociceptors in people with chronic shoulder and neck pain. Pain-afflicted people may benefit from breaks spaced at shorter intervals than those needed by pain-free subjects when working under time pressure.

Chiropractic Management of Myofascial Trigger Points and Myofascial Pain Syndrome: A Systematic Review of the Literature

Article

Feb 2009

Myofascial pain syndrome (MPS) and myofascial trigger points (MTrPs) are important aspects of musculoskeletal medicine, including chiropractic. The purpose of this study was to review the most commonly used treatment procedures in chiropractic for MPS and MTrPs. The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and databases for systematic reviews and clinical guidelines were searched. Separate searches were conducted for (1) manual palpation and algometry, (2) chiropractic and other manual therapies, and (3) other conservative and complementary/alternative therapies. Studies were screened for relevance and rated using the Oxford Scale and Scottish Intercollegiate Guidelines Network rating system. A total of 112 articles were identified. Review of these articles resulted in the following recommendations regarding treatment: Moderately strong evidence supports manipulation and ischemic pressure for immediate pain relief at MTrPs, but only limited evidence exists for long-term pain relief at MTrPs. Evidence supports laser therapy (strong), transcutaneous electrical nerve stimulation, acupuncture, and magnet therapy (all moderate) for MTrPs and MPS, although the duration of relief varies among therapies. Limited evidence supports electrical muscle stimulation, high-voltage galvanic stimulation, interferential current, and frequency modulated neural stimulation in the treatment of MTrPs and MPS. Evidence is weak for ultrasound therapy. Manual-type therapies and some physiologic therapeutic modalities have acceptable evidentiary support in the treatment of MPS and TrPs.

Effect of a desk attachment board on posture and muscle activity in women during computer work

Article

Dec 2008

Working at a computer is part of a large number of jobs and has been associated with upper extremity musculoskeletal disorders and back pain. The study evaluated the effects of a board attachment on upper extremity and back. The findings are mixed in that the board may have a positive effect in preventing back pain, but may be detrimental to upper extremities. Effect of a desk attachment board on upper extremity and trunk posture, and muscle activity was assessed in women video display terminal users. Participants completed a standard 20-min computer task under two conditions: 1) using a standard desk; 2) using a desk attachment board designed to support the forearms. Bilateral electromyography of the trapezius, multifidus and longissimus muscles and the right anterior deltoid and forearm extensor muscles was recorded. 3-D trunk and upper extremity posture was monitored. Participants were tested before and after 2 weeks of familiarisation with the board in their workplace. Perceived tension and discomfort were recorded before and after use of the board. Use of the board tended to increase muscle activity in the right trapezius and forearm extensor and to decrease muscle activity in the back. Perceived tension in the low back decreased slightly with the board. The board may be useful in reducing tension in the low back during computer work, but may adversely affect the upper extremities.

Myofascial trigger points

Article

Oct 1989
J Clin Orthod

G J Murphy

Effectiveness of a Home Program of Ischemic Pressure Followed by Sustained Stretch for Treatment of Myofascial Trigger Points

Article

Nov 2000

Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Dutch Musculoskeletal Questionnaire: description and basic qualities

Article

Nov 2001

A questionnaire ('Dutch Musculoskeletal Questionnaire', DMQ) for the analysis of musculoskeletal workload and associated potential hazardous working conditions as well as musculoskeletal symptoms in worker populations is described and its qualities are explored using a database of 1575 workers in various occupations who completed the questionnaire. The 63 questions on musculoskeletal workload and associated potentially hazardous working conditions can be categorized into seven indices (force, dynamic and static load, repetitive load, climatic factors, vibration and ergonomic environmental factors). Together with four separate questions on standing, sitting, walking and uncomfortable postures, the indices constitute a brief overview of the main findings on musculoskeletal workload and associated potentially hazardous working conditions. Homogeneity of the indices is satisfactory. The divergent validity of the indices is fair when compared with an index of psychosocial working conditions and discomfort during exposure to physical loads. Worker groups with contrasting musculoskeletal loads can be differentiated on the basis of the indices and other factors. With respect to the concurrent validity, it appears that most indices and factors show significant associations with low back and/or neck-shoulder symptoms. This questionnaire can be used as a simple and quick inventory for occupational health services to identify worker groups in which a more thorough ergonomic analysis is indicated.

Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity

Article

Oct 2002
ARCH PHYS MED REHAB

To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle. Randomized controlled trial. Institutional practice. One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs). Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release). The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect. In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05). Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM.

A prospective study of the relationship between musculoskeletal or psychological complaints and muscular responses to standardized cognitive and motor tasks in a working population

Article

Jul 2005

The present study sought to determine the relationship between musculoskeletal or psychological complaints and muscular responses to standardized cognitive and motor tasks. The prospective study design examined (i) whether complaint severity predicts muscular responses during standardized tasks and (ii) whether the muscular responses predict changes in complaint severity over one year. Musculoskeletal and psychological complaints were recorded by monthly reports the four months preceding and 12 months succeeding a work session in the laboratory; complaint-severity indices were computed from complaint-severity scores (intensity scorexduration score). Surface electromyography (EMG) was recorded bilaterally from the upper trapezius, middle deltoid, and forearm extensor muscles in 45 post-office workers (30 women) during two identical task series. Between the series, exhausting submaximal muscle contractions (25% of peak torque) were performed. In adjusted regression models, no relations between musculoskeletal complaints the last four months and muscle activity during the task series were found. However, psychological complaints the last four months predicted higher muscle activity levels and a steeper rise in muscle activity in the muscles not engaged in motor task performance. Sleep disturbance was the strongest individual predictor of increased muscle responses. In contrast, psychological complaints the last four months predicted lower EMG levels in the task-engaged muscle during the complex-choice-reaction-time tasks. None of the muscle-activity responses to the standardized tasks predicted changes in severity of musculoskeletal or psychological complaints over the subsequent one-year period. In conclusion, psychological complaints predict different responses in task-engaged and non-involved muscles during cognitive and motor tasks. Musculoskeletal complaints did not predict responses to the tasks.

Comparison of three computer office workstations offering forearm support: Impact on upper limb posture and muscle activation

Article

Mar 2006

The aims of the study were: 1) to determine whether resting the forearms on the work surface, as compared to chair armrests, reduces muscular activation; 2) to compare the sensitivity of different electromyographic (EMG) summary parameters. Eighteen healthy subjects performed computer work (with keyboard and mouse alternately) for 20 min while resting their forearms on a work surface adjustable in height (Workstation A), on the chair's armrests with an adjustable workstation (Workstation B) or on their chair's armrests with a non-adjustable workstation (Workstation C). The EMG amplitude of the trapezius and deltoid muscles was little influenced by the workstations, whereas their EMG variability increased with Workstation A, which was interpreted as a positive effect. However, the EMG amplitude of the mouse-side extensor digitorum muscle was higher with Workstation A. Alternating between resting the forearms on the work surface and on the chairs' armrests could solicit different muscles during computer work, and could be considered as a strategy for preventing musculoskeletal disorders. The new exposure variation analysis summary parameters used were sensitive to small workstation changes, thus supporting their use in future studies.

The reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal and external rotator musculature using a stabilization device

Article

Mar 2007

Although hand-held dynamometry is considered an objective method of measuring strength, the reliability of the procedure can be compromised by inadequate tester strength and insufficient stabilization of the dynamometer and subject. The purpose of this study was to investigate the test-retest reliability of a hand-held dynamometer with the use of a portable stabilization device while testing the shoulder internal and external rotator musculature. The isometric strength of the shoulder rotator musculature was tested twice in 30 asymptomatic adult volunteers (15 male and 15 female) between 18 and 63 years of age by using an intrasession design. Consistency of the testing protocol was maintained through the use of an arm stabilization apparatus, which fixed the arm in 30 degrees of the scapular plane and a portable dynamometer stabilization device. Intraclass correlation coefficients (ICC's) were high, ranging from ICC (3,1) = 0.971-0.972 for the test-retest trials of internal and external rotation. There was no significant difference between sessions one and two for maximum internal rotation (p = 0.431) and maximum external rotation strength (p = 0.780). The results indicate that the testing protocol with stabilization device is a reliable method for measuring strength of the internal and external rotator shoulder musculature.

Myofascial Trigger Points

Article

Jan 2008

Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Trigger points may be relieved through noninvasive measures, such as spray and stretch, transcutaneous electrical stimulation, physical therapy, and massage. Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.

LD Data collection/processing (responsible for experiments, patient management, organization, or reporting data LD Analysis/interpretation (responsible for statistical analy sis, evaluation, and presentation of the results)

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Design (planned the methods to generate the results): BC, VD, IC, JV, AC, LD Supervision(providedoversight,responsiblefororganization and implementation, writing of the manuscript): BC, VD, IC, JV, AC, LD Data collection/processing (responsible for experiments, patient management, organization, or reporting data): BC, VD, IC, JV, AC, LD Analysis/interpretation (responsible for statistical analy sis, evaluation, and presentation of the results): BC, VD, IC, JV, AC, LD Literature search (performed the literature search): BC, VD, IC, JV, AC, LD Writing (responsible for writing a substantive part of the manuscript): BC, VD, IC, JV, AC, LD Critical review (revised manuscript for intellectual content, this does not relate to spelling and grammar checking): BC, VD, IC, JV, AC, LD REFERENCES

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Jm Richter
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Hp Slijper
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Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks.

Jan 2009
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Szeto GPY
Straker LM
OÆSullivan PB

Szeto GPY, Straker LM, OAESullivan PB. Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks. Eur J Appl Physiol 2009;106: 243-51.

Effect of Ischemic Compression on Trigger Points in the Neck and Shoulder Muscles in Office Workers: A Cohort Study

Abstract

No full-text available

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