Effects of trigger point pressure release on pain modulation and associated movement impairments in a patient with severe acute myofascial pain syndrome: a case report

Abstract

Background: Upper trapezius myofascial pain syndrome (MPS) is one of most common musculoskeletal impairments. To treat this upper trapezius MPS, various conventional therapeutic exercises along with physical modalities or injection including the trigger point release technique (TPRT) or ischaemic compression, ultrasonography, a combination of ischaemic compression and massage and a combination of lidocaine or Botox (BTX-A) injection, and stretching exercise have been widely used. However, outcome studies produced variable temporary results along with side-effects in lidocaine and BTX-A injections including pain at the injection site, malaise, local weakness or nerve damage. Of these interventional approaches, manual TPRT, (a non-invasive, safe, and commonly used technique) was thought to reduce MPS by means of providing a localised pressure on the target. However, more convincing evidence of the long-term treatment effect is required although empirical evidence has shown some favourable short-term effects of TPRT in pain modulation. Objective: To investigate the long-term effects of the TPRT on pain modulation and associated movement impairments in a patient diagnosed with severe acute upper trapezius MPS. Methods: We have used quantitative measurements (muscle length and force) using the computer aided design (CAD) and the Biodex 3.0 Pro isokinetic equipment to determine the intervention-related changes in muscle length and strength. Case report: The therapeutic effect of TPRT in a 24-year-old male patient with severe, acute MPS of the upper trapezius muscle and associated movement dysfunction is presented. On initial evaluation, the patient complained of severe acute pain on the upper trapezius muscle and associated movement impairments including postural malalignment (protracted neck), limited cervical spine range of motion (ROM), muscle shortening and weakness. TPRT was applied on the taut band of upper trapezius and followed by added self-stretching, 20 min/day, 6 days a week for 3 weeks. After intervention, the patient's neck pain was completely resolved and associated movement impairments were restored to almost normal levels: normal ROM without pain, postural alignment, muscle length, and muscle strength in cervical and shoulder musculatures.