Manual therapies in myofascial trigger point treatment: a systematic review

Abstract

Background and purpose: Myofascial pain syndrome (MPS) is thought by some authors the main cause of headache and neck pain. MPS is characterized by Myofascial Trigger Points (MTrPs). However, there are not many controlled studies that have analyzed the effects of the manual therapies in their treatment. The aim of this systematic review is to establish whether manual therapies have specific efficacy in the management of MPS, based on published studies. Methods: Data sources: PubMed (from 1975), Ovid MEDLINE (from 1975), Ovid EMBASE (from 1975), the Cochrane Database of Systematic Reviews, AMED (Alternative Medicine), Science Direct and PEDRO (Physiotherapy Evidence Database), databases were used to the searches. Study selection: Clinical or Controlled trials in which some form of manual therapy treatment was used to treat MTrPs. Data extraction: Two blinded reviewers independently extracted data concerning trial methods, quality and outcomes. Quality assessment: Physiotherapy Evidence Database (PEDRO) quality score method was used in this review. Results: Data synthesis. 7 studies were included in this review. One manual therapy treatment was investigated in 4 studies (one of them included a group treated with manual therapy combined with other physical medicine modalities); a combination of various manual therapies was investigated in 2 studies, and manual therapy combined with other physical medicine modality was investigated in 2 trials. Quality of the included studies: Two papers obtained 6 points, another two scored 5 points, one scored 3 points, one scored 2 point and the remaining one scored 1 point. Discussion: Results did not produce any rigorous evidence that some manual therapies have an effect beyond placebo in treatment of MPS. Some of the studies reviewed confirmed that MTrP treatment is effective in reducing the pressure pain threshold, and scores on visual analogue scales. Pressure pain threshold and visual analogue scale were the outcome measures most used in the analyzed studies. MPS is characterized by restricted range of motion (ROM), which suggests the need to include ROM measurements in future studies. Conclusions: The principal conclusion of this review is that there have been very few randomized controlled trials that analyse treatment of MPS using manual therapy. The second conclusion is that the hypothesis that manual therapies have specific efficacy, beyond placebo, in the management of MPS is neither supported nor refuted by research to date. Controlled trials are needed to investigate whether manual therapy has an effect beyond placebo on MTrP management.