Proof-of-concept: Differentiating upper trapezius muscle with myofascial trigger point using deep learning model on a small prospective sEMG dataset.

The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature

Needling Therapy for Myofascial Pain Control

Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome

Background: Myofascial pain syndrome is a common multifactorial condition that presents with key manifestations and comorbid with many systemic diseases and regional pain syndromes. Objective: This study aims to concisely review clinical, diagnostic and integrative therapeutic aspects of myofascial pain syndrome.
 Methods: E-searches (2000-2019) using keywords and Boolean operators were made and using exclusion and inclusion criteria, 50 full articles that focused on myofascial pain syndrome were retained for this review.
 Results: Myofascial pain syndrome is a multidimensional musculoskeletal disorder with ill-understood etiopathogenesis and pathophysiology and characterized by tender taut muscle with myofascial trigger points, muscle twitch response, specific pattern of referred pain and autonomic symptoms. A variety of pharmacological and nonpharmacological therapies with variable efficacy are used in myofascial pain syndrome, the latter modalities such as education, stretching and exercises, moist hot and cold packs, dry needling and myofascial massage or myofascial trigger point massage are used as first line options.
 Conclusion: Myofascial pain syndrome and trigger points initiated by repeated strains and injuries co-occur with diverse physical diseases and regional pain syndromes, which need comprehensive diagnostic evaluation using multiple methods. Several interventions are used in patients with myofascial pain syndrome who effectively respond to myofascial massage. This study calls for exploring etiopathogenesis and basic pathophysiological mechanisms underlying myofascial pain syndrome in future.

Myofascial pain syndrome is a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this critical review will summarize recent findings concerning the clinical evaluation and the treatment of myofascial trigger points. The clinical features of myofascial trigger points and their contribution to the patient pain and disability have been detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to identify MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments have been proposed and positive effects on pain and function demonstrated. The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to consider the contribution of myofascial trigger points to the patient's pain and disability through a careful medical history and a specific manual examination. Patients with myofascial trigger points will benefit from a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved.

BackgroundMyofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius.MethodsWe screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject’s trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants.ResultsNo significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 ± 5.8 mm.ConclusionsAccording to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.

A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points

Trigger points are irritable, hard “knots” within a muscle that may cause pain over a large area, leading to difficulty performing everyday tasks. When a person has painful muscles and trigger points, it is sometimes called myofascial pain syndrome. Common locations for these problems are the arm and neck. Dry needling is a treatment that involves a very thin needle being pushed through the skin to stimulate a trigger point. Dry needling may release the tight muscle bands associated with trigger points and lead to decreased pain and improved function. In a study published in the September 2013 issue of JOSPT, a group of researchers analyzed the results of the best clinical studies that have been conducted thus far to determine if dry needling helps to reduce neck and arm pain. J Orthop Sports Phys Ther 2013;43(9):635. doi:10.2519/jospt.2013.0505

This presentation will specialise in two muscle pain syndromes, myofascial pain and fibromyalgia. It will specialise in the etiology which remains in debate and therefore the evaluation necessary to form the diagnosis. Both syndromes will be discussed from the point of view what these have in common and how they are dissimilar. The new ARA classification of fibromyalgia are going to be discussed. A significant amount of time will be spent on the evaluation of both history and physical exam, which is necessary to make the diagnosis. Treatment are going to be presented that covers pharmaceutical, physiotherapy , and psychological intervention necessary to manage these two syndromes. Emphasis are going to be placed on pain reduction and physical rehabilitation . The presentation will conclude with a discussion of outcomes that can be expected. Introduction- Myofascial pain syndromes arise from acute and chronic musculoskeletal pain and sometimes have a referred neuropathic component. It affects more than three quarters of the world's population and is one of the most important and overlooked causes of disability. The origins of pain are thought to reside anywhere between the motor end plate and the fibrous outer covering of the muscle, with involvement of microvasculature and neurotransmitters at the cellular level. Diagnosis is formed by clinical examination for the presence of myofascial trigger points, though some ancillary tests may provide supportive evidence. Keywords: chronic pain; dry needling; sensitization; trigger point. Purpose of review: Myofascial pain syndrome may be a chronic pain condition characterized by the presence of myofascial trigger point, a hyperirritable painful spot involving a limited number of muscle fibers. The literature suggest that myofascial trigger points should be considered peripheral pain generators and this review will summarize recent findings concerning the clinical evaluation and therefore the treatment of myofascial trigger points. Recent findings: The clinical features of myofascial trigger points and their contribution to the patient pain and disability are detailed in several recent studies, which support the clinical relevance of the condition. Recent studies reported that manual palpation to spot MTrPs has good reliability, although some limitations are intrinsic to the diagnostic criteria. During the last decade, a plethora of treatments are proposed and positive effects on pain and performance demonstrated. Summary: The myofascial trigger point phenomenon has good face validity and is clinically relevant. Clinicians are encouraged to think about the contribution of myofascial trigger points to the patient's pain and disability through a careful medical record and a selected manual examination. Patients with myofascial trigger points will enjoy a multimodal treatment plan including dry needling and manual therapy techniques. Internal and external validity of research within the field must be improved Methods: Forty-eight patients with chronic myofascial pain enrolled during a prospective interventional trial of three weekly dry-needling treatments for active myofascial trigger points. Trigger points were evaluated at baseline and at treatment completion using palpation, the pressure-pain threshold, and therefore the mechanical heterogeneity index. Thirty patients were reevaluated at 8 weeks. Trigger points that changed to tissue that was not spontaneously painful, with or without the presence of a palpable nodule. Trigger points that changed to tissue without a palpable nodule. The mechanical heterogeneity index was defined because the proportion of the upper trapezius that appeared mechanically stiffer on elastography. Statistical significance for comparisons decided at P < .05. Results: Following 3 dry needle treatments, the mechanical heterogeneity index decreased significantly for the 38 myofascial trigger points (79% of 48) that skilled treatment. Among these, the baseline mechanical heterogeneity index was significantly lower for the 13 trigger points (27% of 38) that resolved, but the decrease after 3 dry needle treatments did not reach significance. The pressure-pain threshold improved significantly for both groups. At 8 weeks, the mechanical heterogeneity index decreased significantly for the 22 trigger points (73% of 30) that responded and for the ten (45% of 22) that resolved. The pressure-pain threshold improvement was significant for trigger points that responded but didn't reach significance for resolved trigger points Conclusions: The mechanical heterogeneity index identifies changes in muscle tissue properties that correlate with changes within the myofascial trigger point status after dry needling.The myofascial trigger point irritability might be suppressed after a remote acupuncture treatment. It appears that needling to the remote AcP points with multiple needle insertions of modified AcP technique may be a better technique than simple needling insertion of straightforward needling technique in terms of the decrease in pain intensity and prevalence of endplate noise and therefore the increase in pressure absolute threshold within 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. References- 1.Handwerker H, Arendt-Nielsen L. Pain Model: Translational Relevance and Applications. Seattle: IASP Press; 2013. 2.Simons DG, Travell JG, Simons L. Myofascial Pain and Dysfunction. The Trigger Point Manual. 3th ed. Philadelphia: Wolters Kluwer; 2019. 3.Fernandez-de-Las-Penas C, Dommerholt J. International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: a Delphi study. Pain Med. 2018;19:142–150. doi:10.1093/pm/pnx207 4.Palacios-Cena M, Castaldo M, Wang K, et al. Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine. 2017;96:e6548. doi:10.1097/MD.0000000000006548 5.Ferracini GN, Florencio LL, Dach F, et al. Myofascial trigger points and migraine-related disability in women with episodic and chronic migraine. Clin J Pain.

Myofascial Trigger Point Identification in B-Mode Ultrasound: Texture Analysis Versus a Convolutional Neural Network Approach.

This study aimed to assess the relationship between the occurrence of cervical myofascial pain with active myofascial trigger points (MTrPs) within the upper trapezius muscle and the electromyographic asymmetry index (AsI) of masticatory muscles: temporalis anterior (TA), superficial part of the masseter muscle (MM), and anterior belly of the digastric muscle (DA). The study group comprised 100 subjects (80 women and 20 men) aged 18 to 30 years (mean 23 ± 2.6 years) reporting pain in the neck muscles, diagnosed with myofascial pain with active MTrPs only within the upper trapezius muscle. The control group comprised 60 healthy, pain-free subjects (42 women and 18 men) aged 20 to 30 years (mean 22.8 ± 2.6 years) without MTrPs in the upper trapezius muscle. The palpation measurement, based on the diagnostic criteria of Travell and Simons, was used to diagnose active MTrPs. The masticatory muscle activity was recorded using an 8-channel device for surface electromyography—BioEMG IIITM. Significant differences in electromyographic patterns between the group with MTrPs in the right side of upper trapezius muscle and the control group were observed within resting activity for the AsI TA (MTrPs: 8.64 vs. controls: −3.22; p = 0.001) and AsI MM (MTrPs: 7.05 vs. controls: −2.09; p = 0.018). Controls presented different electromyographic patterns during maximum voluntary clenching with cotton rolls between teeth within masseter muscle compared to the MTrPs group (MTrPs: 9.27 vs. controls: −0.43 vs. p = 0.041). Participants with MTrPs in the left side of upper trapezius muscle presented predomination of left-sided electromyographic patterns at rest within temporalis anterior in comparison to controls (MTrPs: −19.22 vs. controls: −3.22; p = 0.001). MTrPs within the trapezius muscle may be related to asymmetry within the masticatory muscle activity, suggesting that the presence of myofascial pain within the cervical muscles plays a role in the imbalance of the stomatognathic system. A unilateral active MTrPs within the trapezius muscle may increase the sEMG activity on the same side of the temporalis anterior and masseter muscles.

BackgroundMyofascial pain syndrome (MPS) has a high global prevalence and is associated with myofascial trigger points (MTrPs) in taut bands or nodules. Little is known about the aetiology. The current study assessed the pathophysiological characteristics of MTrPs in MPS patients.MethodsBiopsies of the trapezius muscle were collected from the MTrPs of MPS patients (MTrP group; n = 29) and from healthy controls (control group; n = 24), and their morphologies were analysed via haematoxylin‐eosin (H&E) and Masson staining. A protein microarray was used to detect the receptor tyrosine kinase (RTK) family proteins. mRNA and long non‐coding RNA (lncRNA) sequencing and analysis were conducted, and immunohistochemistry and Western blotting were used to examine the expression of EphB and Rho family proteins.ResultsAbnormally contracted sarcomeres showed enlarged, round fibres without inflammation or fibrosis. An lncRNA‐mRNA network analysis revealed activation of muscle contraction signalling pathways in MTrP regions. Among RTK family proteins, 15 exhibited increased phosphorylation, and two exhibited decreased phosphorylation in the MTrP regions relative to control levels. In particular, EphB1/EphB2 phosphorylation was increased on the muscle cell membranes of abnormal sarcomeres. RhoA and Rac1, but not cell division control protein 42 (Cdc42), were activated in the abnormal sarcomeres.ConclusionsEphB1/EphB2 and RhoA/Rac1 might play roles in the aetiology of abnormally contracted sarcomeres in MTrPs without inflammatory cell infiltration and fibrotic adhesion.SignificanceContracted sarcomeres were found in MTrP regions, which is consistent with the MTrP formation hypothesis. EphB1/EphB2 and RhoA/Rac1 might play roles in the sarcomere contractile sites of MTrPs, which may be promising therapeutic targets.

Background:Myofascial trigger points (MTrPs) for abnormal skeletal muscle contraction are the cause of myofascial pain. The G protein-coupled receptor family and tyrosine kinase receptor family regulate the contraction of vascular smooth muscle through the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) pathway. Phosphorylated myosin light chain (p-MLC) is associated with skeletal muscle contraction. The aim of the current study was to explore the effect and mechanism of the PI3K/AKT/MLC signalling pathway on myofascial pain in rats.Methods:A rat model of myofascial pain was established by a blunt strike to the gastrocnemius muscle combined with centrifugal exercise for 8 weeks, followed by recovery for 4 weeks. Different concentrations of the PI3K inhibitor LY294002 (0.01, 0.1, or 1 mg/ml) were subsequently injected into the MTrPs of rats with myofascial pain to observe the effects on the mechanical tenderness threshold at the MTrPs.Results:LY294002 (0.1 mg/ml) inhibited myofascial pain at 0.5, 1 and 2 h after injection, and LY294002 (1 mg/ml) inhibited myofascial pain at 0.5, 1, 2 and 4 h after injection. The expression of PI3K increased on the enlarged muscle fibre membrane at MTrPs. LY294002 (1 mg/ml) inhibited the expression of PI3K, p-AKT, and p-MLC and the abnormal contraction of muscle fibres at MTrPs and alleviated nerve fibre compression at MTrPs. Moreover, LY294002 inhibited the expression of Fos in the spinal dorsal horn of rats with myofascial pain.Conclusions:These findings suggested that the increased expression of PI3K/p-AKT/p-MLC was related to myofascial pain in rats and that the PI3K inhibitor LY294002 might alleviate myofascial pain in rats by inhibiting abnormal contraction at MTrPs.

EMG changes in myofascial trigger point after type A botulinum toxin

Background: Myofascial pain syndrome is a common pain condition characterized by a key symptoms and signs, determined by multiple etiologies, comorbid with a variety of systemic diseases and regional pain syndromes and managed by diverse therapies with variable outcomes.&#x0D; Objective: This study aimed to concisely report 11 cases of myofascial pain syndrome managed by myofascial trigger point therapy.&#x0D; Methods: The relevant information about 11 cases was collected prospectively using a semistructured proforma. All patients were diagnosed mainly by detailed history and gold standard palpation method that helps identify taut muscles, tender myofascial trigger points, local twitch response and autonomic manifestations.&#x0D; Results: Most of the patients with variable age and profession presented in emergency room with acute pain, limited motion, weakness, referred pain of specific pattern and associated autonomic signs and symptoms. Myofascial trigger point therapy alone with a timeline of about 30-60 minutes of 1-3sessions brought about good results in all 11 patients (100%) who remained stable at two to three months followup.&#x0D; Conclusion: Myofascial pain syndrome linked with latent or active myofascial trigger points developed due to repeated strains and injuries needs to be diagnosed by history and palpation method, systemic evaluation and laboratory investigations. Though several interventions are used in myofascial pain syndrome, myofascial trigger point massage therapy alone is found to be reasonably effective with excellent results. This clinical case series is calling for double-blind randomized controlled trials among patients with myofascial pain syndrome not only in Saudi Arabia but also in other Middle East countries in future.