[Show abstract][Hide abstract] ABSTRACT: Evidence strongly supports that low-level laser therapy (LLLT) is an effective physical modality for the treatment of pain associated with myofascial trigger points (MTrP). However, the effect of laser fluence (energy intensity in J/cm(2)) on biochemical regulation related to pain is unclear. To better understand the biochemical mechanisms modulated by high- and low-fluence LLLT at myofascial trigger spots (MTrSs; similar to human MTrPs) in skeletal muscles of rabbits, the levels of β-endorphin (β-ep), substance P (SP), tumor necrosis factor-α (TNF-α), and cyclooxygenase-2 (COX-2) were investigated in this study. New Zealand rabbits (2.5-3.0 kg in weight) were used in this study. High-fluence LLLT (27 J/cm(2)), low-fluence LLLT (4.5 J/cm(2)), or sham operations were applied on MTrSs of biceps femoris of rabbits for five sessions (one session per day). Effects of LLLT at two different fluences on biceps femoris, dorsal root ganglion (DRG), and serum were determined by β-ep, SP, TNF-α, and COX-2 immunoassays. LLLT irradiation with fluences of 4.5 and 27 J/cm(2) at MTrSs can significantly reduce SP level in DRG. LLLT with lower fluence of 4.5 J/cm(2) exerted lower levels of TNF-α and COX-2 expression in laser-treated muscle, but LLLT with higher fluence of 27 J/cm(2) elevated the levels of β-ep in serum, DRG, and muscle. This study demonstrated fluence-dependent biochemical effects of LLLT in an animal model on management of myofascial pain. The findings can contribute to the development of dosage guideline for LLLT for treating MTrP-induced pain.
Lasers in Medical Science 09/2014; · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nerve inflammation plays an important role in the development and progression of neuropathic pain after chronic constrictive injury (CCI). Recent studies have indicated that hypoxia-inducible factor 1α (HIF-1α) is crucial in inflammation. Low-level laser therapy has been used in treating musculoskeletal pain, but rare data directly support its use for neuropathic pain. We investigated the effects of low-level laser on the accumulation of HIF-1α, tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) in controlling neuropathic pain, as well as on the activation of vascular endothelial growth factor (VEGF) and nerve growth factor (NGF) in promoting functional recovery in a rat CCI model. CCI was induced by placing four loose ligatures around the sciatic nerve of rats. Treatments of low-level laser (660 nm, 9 J/cm(2)) or sham irradiation (0 J/cm(2)) were performed at the CCI sites for 7 consecutive days. The effects of laser in animals with CCI were determined by measuring the mechanical paw withdrawal threshold, as well as the sciatic, tibial, and peroneal function indices. Histopathological and immunoassay analyses were also performed. Low-level laser therapy significantly improved paw withdrawal threshold and the sciatic, tibial, and peroneal functional indices after CCI. The therapy also significantly reduced the overexpressions of HIF-1α, TNF-α, and IL-1β, and increased the amounts of VEGF, NGF, and S100 proteins. In conclusion, a low-level laser could modulate HIF-1α activity. Moreover, it may also be used as a novel and clinically applicable therapeutic approach for the improvement of tissue hypoxia/ischemia and inflammation in nerve entrapment neuropathy, as well as for the promotion of nerve regeneration. These findings might lead to a sufficient morphological and functional recovery of the peripheral nerve.
The Journal of Comparative Neurology 02/2012; 520(13):2903-16. · 3.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is still unclear when latent myofascial trigger points (MTrPs) develop during early life. This study is designed to investigate the mechanical pain sensitivity of deep tissues in children in order to see the possible timing of the development of latent MTrPs and attachment trigger points (A-TrPs) in school children.
Five hundreds and five healthy school children (age 4- 11 years) were investigated. A pressure algometer was used to measure the pressure pain threshold (PPT) at three different sites in the brachioradialis muscle: the lateral epicondyle at elbow (site A, assumed to be the A-TrP site), the mid-point of the muscle belly (site B, assumed to be the MTrP site), and the muscle-tendon junction as a control site (site C).
The results showed that, for all children in this study, the mean PPT values was significantly lower (p < 0.05) at the assumed A-TrP site (site A) than at the other two sites, and was significantly lower (p < 0.05) at the assumed MTrP site (site B) than at the control site (site C). These findings are consistent if the data is analyzed for different genders, different dominant sides, and different activity levels.
It is concluded that a child had increased sensitivity at the tendon attachment site and the muscle belly (endplate zone) after age of 4 years. Therefore, it is likely that a child may develop an A-Trp and a latent MTrP at the brachioradialis muscle after the age of 4 years. The changes in sensitivity, or the development for these trigger points, may not be related to the activity level of children aged 7-11 years. Further investigation is still required to identify the exact timing of the initial occurrence of a-Trps and latent MTrPs.
[Show abstract][Hide abstract] ABSTRACT: Background and Purpose. Dry needling is an effective therapy for the treatment of pain associated with myofascial trigger point (MTrP). However, the biochemical effects of dry needling that are associated with pain, inflammation, and hypoxia are unclear. This study investigated the activities of β-endorphin, substance P, TNF-α, COX-2, HIF-1α, iNOS, and VEGF after different dosages of dry needling at the myofascial trigger spots (MTrSs) of a skeletal muscle in rabbit. Materials and Methods. Dry needling was performed either with one dosage (1D) or five dosages (5D) into the biceps femoris with MTrSs in New Zealand rabbits. Biceps femoris, serum, and dorsal root ganglion (DRG) were sampled immediately and 5 d after dry needling for β-endorphin, substance P, TNF-α, COX-2, HIF-1α, iNOS, and VEGF immunoassays. Results. The 1D treatment enhanced the β-endorphin levels in the biceps femoris and serum and reduced substance P in the biceps femoris and DRG. The 5D treatment reversed these effects and was accompanied by increase of TNF-α, COX-2, HIF-1α, iNOS, and VEGF production in the biceps femoris. Moreover, the higher levels of these biochemicals were still maintained 5 d after treatment. Conclusion. Dry needling at the MTrSs modulates various biochemicals associated with pain, inflammation, and hypoxia in a dose-dependent manner.
Evidence-based Complementary and Alternative Medicine 01/2012; 2012:342165. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. To obtain electrophysiological effects of Fu's subcutaneous needling (FSN) on needling distance by assessment of endplate noise (EPN) recorded from the myofascial trigger spots (MTrSs) in rabbit skeletal muscle. Method. Eighteen New Zealand rabbits weighing 2.5-3.0 kg were randomly divided into two groups as follows: proximal needling (PN) group and distal needling (DN) group. The needling procedure followed the instructions described by the inventor of FSN, including needling insertion and swaying movement. The amplitudes of EPN on the MTrS region of BF muscle were recorded as an index of MTrS irritability. Random sampling of EPN tracings were taken for further analyses before, during, and after FSN treatment. Results. In PN and DN groups, the trends of EPN amplitude alterations were similar at conditions before, during, and after FSN treatment. The degree of reduction in the EPN amplitude in PN group was significantly higher than that in DN group. There were no significant changes in EPN amplitudes in the MTrS of contralateral BF without FSN intervention either in DN or PN group. Conclusion. The irritability of proximal MTrSs could be modulated after ipsilateral FSNs. The placement of FSN may affect the effectiveness of suppression of irritability of MTrSs.
Evidence-based Complementary and Alternative Medicine 01/2012; 2012:353916. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Incomplete bladder emptying (IBE) is defined as having a postvoid residual (PVR) urine volume greater than 100 mL for 2 consecutive days. IBE is common in stroke patients and could necessitate indwelling or intermittent catheterization. The condition is correlated with urinary tract infections, which could impede rehabilitation progress and increase medical costs. Treatment for patients with IBE includes bladder retraining, biofeedback, medication, and botulinum toxin injection, but none of these interventions are completely effective. METHODS: All patients with acute stroke who were admitted to the rehabilitation ward between August 2010 and April 2011 were included in the study and their PVR urine volume was checked. Electroacupuncture (EA; 1 Hz, 15 minutes) was performed on the acupoints Sanyinjiao (SP6), Ciliao (BL32), and Pangguangshu (BL28) of stroke patients with IBE for a total of ten treatments (five times a week for 2 weeks). Bladder diaries, which included the spontaneous voiding and PVR urine volumes, were recorded during the course of treatment. RESULTS: The presence of IBE was not related to sex, history of diabetes mellitus, stroke type (hemorrhagic or ischemic), or stroke location (P > 0.05). Among the 49 patients in the study, nine (18%) had IBE, and seven of the stroke patients with IBE were treated with EA. Increased spontaneous voiding volume and decreased PVR urine volume were noted after ten sessions of EA. CONCLUSION: EA may have beneficial effects on stroke survivors with IBE, thereby making it a potential safe modality with which to improve urinary function.
Clinical Interventions in Aging 01/2012; 7:469-474. · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate the remote effect of acupuncture (AcP) on the pain intensity and the irritability of the myofascial trigger point in the upper trapezius muscle.
Forty-five patients were equally divided into three groups: patients in the placebo control group received sham AcP, those in the simple needling group were treated using simple needling, and those in the modified AcP received AcP with the rapid "screwed in and out" into multiple sites to elicit local twitch responses. The acupoints of Wai-guan and Qu-chi were treated. The outcome assessments included changes in subjective pain intensity, pressure pain threshold, range of motion, and mean amplitude of endplate noise in the myofascial trigger point region.
Immediately after acupuncture, all measured parameters improved significantly in the simple needling and modified AcP groups, but not in the placebo control group. There were significantly larger changes in all parameters in the modified AcP group than that in the simple needling group.
The myofascial trigger point irritability could be suppressed after a remote acupuncture treatment. It appears that needling to the remote AcP points with multiple needle insertions of modified AcP technique is a better technique than simple needling insertion of simple needling technique in terms of the decrease in pain intensity and prevalence of endplate noise and the increase in pressure pain threshold in the needling sites (represented either AcP points and or myofascial trigger points). We have further confirmed that the reduction in endplate noise showed good correlation with a decreased in pain.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 12/2011; 90(12):1036-49. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hypoxia is a feature of the inflamed synovium in rheumatoid arthritis (RA). Intra-articular injection of hyaluronan (HA) may be considered a potential way to treat RA. However, the exact molecular mechanism of HA on decreased cellular responses to hypoxic environment is unclear. The present study has been designed to use the adjuvant-induced arthritis model to examine the effects of HA on the changes of immunohistochemical expressions of hypoxia-inducible factor-1alpha (HIF-1alpha), inducible nitric oxide synthase (iNOS), and matrix metalloproteinase-3 (MMP3) in the synovial tissues at the early phase of arthritic inflammation.
Monoarthritis was induced in adult male Sprague-Dawley (250-300 g) via intraarticular injection of complete Freund's adjuvant (CFA) into the tibiotarsal joint. The CFA-induction arthritis animals were divided into three groups: treatment (intraarticular injection of HA), placebo (intraarticular injection of saline) and controls (no treatments). Functional evaluations of edema and pain behavior, histology, and HIF-1alpha, iNOS, and MMP3 immunohistochemistry were performed before, after the first injection, three injections, and on the follow-up injection of the treatments.
Intra-articular injection of HA also significantly suppressed the mechanical allodynia (p < 0.001) and overexpressions of HIF-1alpha (p < 0.001), iNOS (p = 0.004) and MMP3 (p < 0.001) immunoreactivity in synovium.
This study demonstrated that early intervention of HA is an effective protection against accumulation of inflammation-induced HIF-1alpha, iNOS, and MMP3 to limit erosive damage in CFA-induced model of arthritis.
Arthritis research & therapy 06/2011; 13(3):R90. · 4.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To elucidate the neural mechanisms underlying the remote effects produced by dry needling rabbit skeletal muscle myofascial trigger spots (MTrSs) via analyses of their endplate noise (EPN) recordings.
Experimental animal controlled trial.
An animal laboratory of a university.
Male New Zealand rabbits (N=96) (body weight, 2.5-3.0kg; age, 16-20wk).
Animals received no intervention for neural interruption in group I, transection of the tibial nerve in group II, transection of L5 and L6 spinal cord in group III, and transection of the T1 and T2 spinal cord in group IV. Each group was further divided into 4 subgroups: animals received ipsilateral dry needling, contralateral dry needling, ipsilateral sham needling, or contralateral sham needling of gastrocnemius MTrSs.
EPN amplitudes of biceps femoris (BF) MTrSs.
BF MTrS mean EPN amplitudes significantly increased (P<.05) initially after gastrocnemius verum needling but reduced to a level significantly lower (P<.05) than the preneedling level in groups I and IV with ipsilateral dry needling or contralateral dry needling, and in group II with contralateral dry needling (but not ipsilateral dry needling). No significant EPN amplitude changes were observed in BF MTrS in group III or in the control animals receiving superficial needling (sham).
This remote effect of dry needling depends on an intact afferent pathway from the stimulating site to the spinal cord and a normal spinal cord function at the levels corresponding to the innervation of the proximally affected muscle.
Archives of physical medicine and rehabilitation 04/2011; 92(7):1098-105. · 2.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Objective: To evaluate the effect of low-level laser treatment with different dosages on the irritability of myofascial trigger spots [MTrS] in rabbit skeletal muscles. Methods: Twenty rabbits were equally divided into a low dose group and a high dose group. In each rabbit, the MTrS on the experimental side was irradiated with 660-nm continuous-wave gallium-aluminum-arsenate laser daily for six sessions. The energy per session was 27 J/cm2 [low dose group] and 72 J/cm2 [high dose group]. The MTrS on the other side received sham treatment. The MTrS irritability was assessed with the prevalence of endplate noise [EPN] at baseline after the first and after the last treatments. Results: After the first laser treatment, the EPN prevalence was significantly decreased in both groups. The percentage change in the high dose group was greater than that in the low dose group. The EPN prevalence after the last laser treatment was lower than that after the first laser treatment in the low dose group, but not in the high dose group. Conclusions: In the present study, a dose-dependent effect of laser treatment on the MTrS irritability was demonstrated. A cumulative effect was only observed in low dose treatments. It appears that a ceiling effect may have occurred in relatively high dose laser treatment.
[Show abstract][Hide abstract] ABSTRACT: The present study examined whether transplantation of mesenchymal stem cells (MSCs) in combination with exercise would have synergistic effects leading to functional recovery that is greater than exercise alone. Sprague-Dawley rats received a sciatic nerve transection and were divided into four groups: denervated (control), denervated + exercise (control+Ex), denervated + MSC transplantation (MSC), and denervated + MSC transplantation + exercise (MSC+Ex). A volume of 1 x 105 of MSCs was injected into the lesion site in the MSC-treated groups, and culture medium in the control animals. Twelve hours after surgery, a swimming exercise regime was begun: 30 minutes/day for seven days in the MSC+Ex and control+Ex groups. Functional assessments including sciatic function index (SFI), vertical locomotor activity (VA), ankle activity (AA), and electrophysiological studies were performed to monitor the functional recovery. Histological analysis was performed to assess nerve continuity and myelination. No significant differences in SFI, VA, AA and electrophysiological studies were found between the MSC+Ex and control+Ex groups. Also, a morphological study revealed prominent axonal degeneration in the injured nerves of all animals. The results revealed that any synergistic effect of MSC transplantation on functional recovery of swimming exercise-treated transected nerve that may have existed was negligible.
[Show abstract][Hide abstract] ABSTRACT: To investigate the remote effect of acupuncture on the pain intensity and the endplate noise (EPN) recorded from a myofascial trigger point (MTrP) of the upper trapezius muscle.
Randomized controlled trial.
Patients (N=20) with active MTrPs in upper trapezius muscles and no experience in acupuncture therapy.
Patients were divided into 2 groups. Those in the control group received sham acupuncture, and those in the acupuncture group received modified acupuncture therapy with needle insertion into multiple loci to elicit local twitch responses. The acupuncture points of Wai-guan and Qu-chi were treated.
Subjective pain intensity (numerical pain rating scale) and mean EPN amplitude in the MTrP of the upper trapezius muscle.
The pain intensity in the MTrP was significantly reduced after remote acupuncture (from 7.4+/-0.8 to 3.3+/-1.1; P<.001), but not after sham acupuncture (from 7.4+/-0.8 to 7.1+/-0.9; P>.05). The mean EPN amplitude was significantly lower than the pretreatment level after acupuncture treatment (from 21.3+/-9.5 microV to 9.5+/-3.5 microV; P<.01), but not after sham acupuncture treatment (from 19.6+/-7.6 microV to 19.3+/-7.8 microV; P>.05). The change in the pain intensity was significantly correlated with the change of EPN amplitude (r=0.685).
Both subjective changes in the pain intensity and objective changes of the EPN amplitude in the MTrP region of the upper trapezius muscle were found during and after acupuncture treatment at the remote ipsilateral acupuncture points. This study may further clarify the physiological basis of the remote effectiveness of acupuncture therapy for pain control.
Archives of physical medicine and rehabilitation 06/2009; 90(6):905-12. · 2.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To better understand the mechanisms of therapeutic lasers for treating human myofascial trigger points, we designed a blinded controlled study of the effects of a therapeutic laser on the prevalence of endplate noise (EPN) recorded from the myofascial trigger spot (MTrS) of rabbit skeletal muscle.
In eight rabbits, one MTrS in each biceps femoris muscle was irradiated with a 660-nm, continuous-wave, gallium-aluminum-arsenate (GaAlAs) laser, at 9 J/cm2. The contralateral side of muscle was treated with a sham laser. Each rabbit received six treatments. The immediate and cumulative effects were assessed by the prevalence of EPN with electromyographic (EMG) recordings after the first and last treatments.
Compared with pretreatment values, the percentages of EPN prevalence in the experimental side after the first and last treatments were significantly reduced (P < 0.01 for both). The change in EPN prevalence in the experimental side was significantly greater than in the control side immediately after the first and last treatments (P < 0.05). However, no significant differences were noted between the first and last treatments (P > 0.05).
In our study, immediate and cumulative effects of a GaAlAs laser applied on MTrS were demonstrated on the basis of the assessment of EPN prevalence. It seems that laser irradiation may inhibit the irritability of an MTrS in rabbit skeletal muscle. This effect may be a possible mechanism for myofascial pain relief with laser therapy.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 07/2008; 87(12):1006-14. · 1.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was to investigate the behavioral specificities of spontaneously hypertensive rats (SHR) and compare them with Wistar-Kyoto (WKY) controls using a 1-year longitudinal study of locomotor activity. Rat locomotor activity was examined every week at 4-12 weeks of age and every month at 4-12 months of age using an Automated Digiscan Activity Monitor system. Six behavioral variables were collected and analyzed: horizontal activity (HA), total distance (TD), movement time (MT), vertical activity (VA), stereotypy count (SC), and margin time (MGT). In general, a significant weekly and monthly age-dependent change (p<0.01) in SHR was shown in the HA, TD, VA, SC and MT variables, whereas MGT showed no significant differences (p>0.05). However, except for the first observations, SHR was significantly hyperactive relative to WKY for HA, VA, TD, MT and SC (p<0.01) before 6 months of age. MGT in SHR were significantly lower than those of WKY (p<0.01) before 3 months of age. Only for VA, SHR was more hyperactive than WKY (p<0.01) and sustained for 12 months in age. From the present results, by extending the observations of locomotor activity testing from 4 weeks to 12 months of life, we were able to observe an interesting strain difference between SHR and WKY in the development pattern of spontaneous activity levels.
[Show abstract][Hide abstract] ABSTRACT: To investigate the changes in pressure pain threshold of the secondary (satellite) myofascial trigger points (MTrPs) after dry needling of a primary (key) active MTrP.
Single blinded within-subject design, with the same subjects serving as their own controls (randomized). Fourteen patients with bilateral shoulder pain and active MTrPs in bilateral infraspinatus muscles were involved. An MTrP in the infraspinatus muscle on a randomly selected side was dry needled, and the MTrP on the contralateral side was not (control). Shoulder pain intensity, range of motion (ROM) of shoulder internal rotation, and pressure pain threshold of the MTrPs in the infraspinatus, anterior deltoid, and extensor carpi radialis longus muscles were measured in both sides before and immediately after dry needling.
Both active and passive ROM of shoulder internal rotation, and the pressure pain threshold of MTrPs on the treated side, were significantly increased (P < 0.01), and the pain intensity of the treated shoulder was significantly reduced (P < 0.001) after dry needling. However, there were no significant changes in all parameters in the control (untreated) side. Percent changes in the data after needling were also analyzed. For every parameter, the percent change was significantly higher in the treated side than in the control side.
This study provides evidence that dry needle-evoked inactivation of a primary (key) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral. This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon.
American Journal of Physical Medicine & Rehabilitation 05/2007; 86(5):397-403. · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether latent myofascial trigger points (MTPs) can be identified in healthy infants and in healthy adult subjects.
A convenience sample of 60 healthy adults and 60 infants (age range, 0-12mo).
An algometer was used to measure the pressure pain threshold (PPT) on 3 different sites, including a midpoint (assumed to be the MTP site) in the brachioradialis muscle.
The mean PPT values at the MTP site were significantly lower than the other sites in the adult muscles. However, no significant differences in PPT values among these 3 sites were found in the infants. Taut bands were found in all the adult muscles but none in the infants.
In the adult subjects, the midpoint of brachioradialis muscle was significantly more irritable than other sites and the midpoint was probably a latent MTP. However, in the infants younger than 1 year old, such a phenomenon could not be observed in this study. It is very likely that the latent MTPs might not exist in early life, but develop in later life.
Archives of Physical Medicine and Rehabilitation 03/2007; 88(2):251-4. · 2.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to investigate the correlation between the irritability of the myofascial trigger point (MTrP) and the prevalence of endplate noise (EPN) in the MTrP region of human skeletal muscle.
Twenty normal subjects with latent MTrPs and 12 patients with active MTrPs in the upper trapezius muscles were recruited for this study. The patients reported the subjective pain intensity of the active MTrP (0-10). The MTrP and an adjacent non-MTrP site were confirmed and marked for the measurement of pressure pain threshold (with a pressure algometer) and the prevalence of EPN (with electromyographic recordings).
The prevalence of EPN in the MTrP regions was significantly higher (P < 0.01) in the active MTrPs than in the latent ones. However, no EPN could be found in the non-MTrP region near either the active or the latent MTrPs. The pain intensity and the pressure pain threshold were highly correlated with the prevalence of EPN in the MTrP region (r = 0.742 and -0.716, respectively).
The irritability of an MTrP is highly correlated with the prevalence of EPN in the MTrP region of the upper trapezius muscle. The assessment of EPN prevalence in an MTrP region may be applied to evaluate the irritability of that MTrP.
American Journal of Physical Medicine & Rehabilitation 03/2007; 86(3):183-9. · 1.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to assess the occurrence of end plate noise (EPN) in an acupuncture point (AcP).
Ten male and 10 female normal volunteers were included in this study. For each subject, mapping of the distribution of EPN loci in an AcP region of Stomach-36 in one leg selected randomly, and also in a nearby non-AcP region in the other leg as a control, was performed with electromyographic recordings.
There were significantly more EPN loci in the AcP region of Stomach-36 than in the non-AcP region near this AcP. Whenever the searching needle approached an EPN locus, the subjects always felt pain, soreness, or an unpleasant sensation. This feeling was rarely reported when no EPN was recorded from any site in either an AcP region or a non-AcP region. After electromyographic study, every AcP was confirmed as a myofascial trigger point.
Similar to the distribution of EPN loci in an MTrP region, significantly more EPN loci can be identified in an AcP region of Stomach-36 than in a nearby non-AcP site. This study provides additional support to the hypothesis that some AcPs are also myofascial trigger points.
American Journal of Physical Medicine & Rehabilitation 06/2006; 85(5):443-8. · 1.73 Impact Factor