Ischemic Compression Research Articles

Trigger Point Therapy Techniques as an Effective Unconventional Method of Treating Tension Headaches: A Systematic Review.

Background/Objectives The main aim of the literature review was to determine whether different trigger point therapy techniques are effective in decreasing the intensity, frequency, and duration of tension-type headaches. An additional aim was to assess the impact of trigger point therapy on other physical and psychological variables in tension-type headaches. Methods This literature review was conducted in accordance with PRISMA guidelines, and the inclusion and exclusion criteria were developed using the PICO(s) strategy. Searches were carried out in four databases: PubMed, Science Direct, Cochrane Library, and PEDro. Results Of the 9 included studies with 370 participants, 6 studies were randomised controlled trials, 2 were pilot studies, and 1 was a case report. Conclusions Trigger point therapy has reduced the duration, intensity, and frequency of headaches. Dry needling, ischaemic compression, Positional Relaxation Techniques, and massage protocols focused on deactivating trigger points are effective methods of unconventional treatment of tension-type headaches.

Myofascial pain syndrome in patients with cancer: a narrative review.

Myofascial pain syndrome (MPS) is a chronic musculoskeletal pain syndrome. The purpose of this review is to describe the epidemiological and treatment evidence and to address the future research agenda in patients with cancer. A narrative review of previous reports investigating the prevalence and treatment of MPS in the oncology field is presented. The target population is patients with cancer and cancer survivors. There have been three prospective and two retrospective studies investigating the prevalence of MPS. MPS is as high as 38%-45% in patients with advanced or incurable cancer and 11.9%-44.8% in cancer survivors. A total of nine reports investigated the efficacy of the following interventions: trigger point injection (TPI), myofascial techniques and ischaemic compression. TPI has been reported to be effective in four observational studies. One randomised study reported the efficacy of myofascial techniques, but two randomised studies reported no added beneficial effects of it in breast cancer survivors. Two randomised studies investigated the efficacy of ischaemic compression, but the obtained results were contradictory. MPS is highly prevalent. We should know that non-cancer pain is also common in both patients with cancer and survivors. In treating such pain, careful physical examination is essential. Then, non-pharmacological treatment should be considered as well as pharmacotherapy. As evidence regarding MPS in the oncology field is scarce, further research is warranted.

Comparison of Ischemic Compression Combined With Muscle Energy Technique Versus Ischemic Compression Alone on Myofascial Trigger Points of Upper Trapezius in Breast Cancer Survivors

Background: A hyperirritable region, typically located within a taut band of skeletal muscle, is known as a myofascial trigger point. It can cause discomfort upon compression, as well as the typical referred pain, motor dysfunction, and autonomic abnormalities. TrPs may be associated with breast cancer. Symptoms of upper body dysfunction and pain are typical among breast cancer survivors. Noninvasive techniques including massage, spray and stretch, physical therapy, and transcutaneous electrical stimulation can all help reduce trigger points. Ischemic compression and Muscle energy technique (MET) is an intriguing non-invasive treatment that has showed more effect on myofascial trigger points Objectives: Aims and objective of this study was to compare the effect of ischemic compression combined with muscle energy technique and ischemic compression alone on myofascial trigger points in breast cancer survivors. To see improvement in range of cervical flexion, cervical extension and cervical lateral flexion. Method: This was Quasi-experimental study in which convenient sampling was done from breast cancer patient from breast cancer ward of PINUM and Allied hospital Faisalabad for 6 months after meeting inclusion and exclusion criteria. 20 individuals with Myofascial Trigger points were assigned into two groups: Group 1 and Group 2. Group 1 received ischemic compression combined with Muscle Energy Technique for 3 weeks and Group 2 received ischemic compression alone for 3 weeks. Evaluation of pain, range of cervical flexion, cervical extension and cervical lateral flexion was done by Numeric Pain Rating Scale, Goniometer and Neck Pain Disability Index respectively. Results: wilcoxon and Mann whitney tests were applied and results showed p value <0.01. Conclusion: According to data analysis and after applying Mann-whitney test we found that ischemic compression combined with muscle energy technique has more effect on myofascial trigger points in improving pain and range of motion than ischemic compression alone. Keywords: Breast cancer, Goniometer, Ischemic compression, Myofascial Trigger Points, ,Muscle Energy Technique, ROM

SHORT-TERM OUTCOMES OF HOME-BASED AND OUTPATIENT PROGRAMS OF PHYSICAL THERAPY IN PATIENTS WITH FROZEN SHOULDER AND MYOFASCIAL PAIN SYNDROME

The aim: is to compare short-term results of home-based and outpatient programs of physical therapy among patients with frozen shoulder and concomitant thoracic myofascial pain syndrome.
 Materials and methods. The study involved 80 patients. The range of motion in the shoulder joint affected by capsulitis was assessed. A numerical pain scale was used to assess pain sensations when pressing on trigger points. Functional limitations in the shoulder were measured by means of the Oxford Shoulder Score (before and 1.5 months after the end of the physical therapy). Participants were divided into two groups: home-based group (HG) and outpatient group (ОG). All the patients were consulted by a physical therapist. ОG patients received end-range mobilization with the assistance of a physical therapist 5 times a week to improve shoulder joint mobility. Most of ОG participants received 15 procedures (3 weeks). Patients HG performed therapeutic exercises without any assistance at home. (twice a day, 3 weeks). In terms of trigger points therapy, the patients performed ischemic compression without any assistance.
 Results. Patients of both groups demonstrated positive dynamics of the studied indicators. Comparison of the short-term results of the therapy according to range of motion and pain showed better indicators in the ОG. Comparison of the initial results of the groups in Oxford Shoulder Score items did not reveal any significant differences. Total score was 18.2±6.5 points in ОG and 17.6±7.5 points in HG (p=0.715). Me (25%; 75%) values were 17.5 (12.5; 23.8) and 18 (13; 23.5) points, respectively. Comparison of the final results of the groups in Oxford Shoulder Score items revealed significant differences. Total score was 47 (47; 48) points in ОG and 33 (31; 35.75) points in HG (p<0.001). x̅±SD values were 46.5±2.6 and 32.8±4.4 points, respectively.
 Conclusions. Short-term results of the outpatient program in terms of pain indicators, mobility of the shoulder joint and functional limitations were better as compared to the home-based program of physical therapy in patients with frozen shoulder and concomitant thoracic myofascial pain syndrome.

Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial.

Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.

To Compare the Effect of Ischemic Compression versus Dynamic Stretching Exercises on Pain in Subjects with Upper Trapezitis

Background: The most prevalent musculoskeletal ailment is trapezitis, which primarily affects the upper trapeziusmuscle due to overuse or strain.Purpose: The purpose of this study is to find out the effect of ischemic compression and dynamic stretchingexercises on pain in subjects with upper trapezitis.Materials and Methods: A total of 40 subjects were chosen from Neha Clinic and assigned to two groups, namelythe ischemic compression group along with Transcutaneous Electrical Nerve Stimulation (TENS) (n=20) and thedynamic stretching exercises group along with TENS (n=20), based on inclusion and exclusion criteria. Visualanalog scale (VAS) and cervical range of motion (CROM) were used as outcome measures. The entire process wasperformed from November 2022 to April 2023.Result: The mean value of ischemic compression at the post-test was found to be higher than the mean value ofdynamic stretching exercises, with a p-value of less than 0.0001Conclusion: The findings of this study suggest that ischemic compression is more effective than dynamic stretchingexercises in reducing pain associated with upper trapezitis.

Dynamics of disability and pain indicators under the influence of physical therapy for adhesives capsulitis and myofascial pain syndrome.

Aim: To compare the effectiveness of end-range mobilization and therapeutic exercises, used in combination with ischemic compression, on disability and pain indicators among patients with adhesive capsulitis of the shoulder joint and thoracic myofascial pain syndrome. Materials and Methods: The study involved 68 patients. Goniometry of the shoulder joint, assessment of pain in myofascial trigger points, and the Shoulder Pain and Disability Index questionnaire were used before and after physical therapy. The duration of physical therapy comprised 3 weeks. Physical therapy of the first group of patients consisted of end-range mobilization and ischemic compression. Patients of the second group performed therapeutic exercises and ischemic compression. Results: Both groups demonstrated positive dynamics of shoulder joint mobility, Shoulder Pain and Disability Index and pain in trigger points. However, the final results of the studied indicators were better in the first group of patients. Conclusions: Physical therapy based on the combination of end-range mobilization and ischemic compression had a more positive impact on disability and pain indicators for adhesive capsulitis of the shoulder joint and myofascial pain syndrome as compared to the combination of therapeutic exercises and ischemic compression.

Blood pressure cuff–induced radial nerve palsy following minimally invasive lateral microdiscectomy: illustrative case

BACKGROUND The authors describe a rare case of transient postoperative wrist and finger drop following a prone position minimally invasive surgery (MIS) lateral microdiscectomy. OBSERVATIONS Hand and wrist drop is an unusual complication following spine surgery, especially in prone positioning. The authors’ multidisciplinary team assessed a patient with this complication following MIS lateral microdiscectomy. The broad differential diagnosis included radial nerve palsy, C7 radiculopathy, stroke, and spinal cord injury. Given the patient’s supinator weakness, intact pronation and wrist flexion, and transient recovery within 4 weeks, the most likely diagnosis was radial nerve neuropraxia secondary to ischemic compression. After careful consideration of the operative environment and anatomical constraints, the patient’s blood pressure cuff was found to be the most probable source of compression. LESSONS Blood pressure cuff–induced peripheral nerve injury may be a source of postoperative radial nerve neuropraxia in patients undergoing spine surgery. Careful considerations must be given to the blood pressure cuff location, which should not be placed at the distal end of the humerus due to higher susceptibility of peripheral nerve compression. Spine surgeons should be aware of and appropriately localize postoperative deficits along the neuroaxis, including central versus proximal or distal peripheral injuries, in order to guide appropriate postoperative management.

Immediate Effect of Ischemic Compression Therapy to Release Suboccipital Trigger Points in Tension-Type Headache among Adult Population of GCUF

Tension-type headache is a nervous illness and characterized by pain, causes stretch on both sides and stiffness which feels like a band or pressure leads to disruption in daily activities. Objective: To see the immediate effects of ischemic compression therapy to release sub-occipital trigger points in tension type headache. Methods: It was a quasi-experimental study. Study population was students and faculty members of GC University, Faisalabad from age between 25 to 35 years. Sample size of the study was 35. A convenient sampling technique was used to select individuals according to the defined inclusion criteria. Trigger points were evaluated by palpating the occipital region. Data collection tools including visual analogue scale (VAS) and HIT-6 was used to measure intensity of pain and tension-type headache. SPSS version 25.0 was used to analyze the data. Results: Post-treatment values of VAS showed the reduction in pain intensity (mean=0.57) as compared to the pre-intervention values (mean = 5.03). A notable reduction in HIT-6 impact from (mean = 65.13) to (mean = 40.40) was observed. Paired sample t-test showed a p-value below 0.05 for both VAS and HIT-6, highlighting the positive effects of ischemic compression therapy to release sub-occipital trigger points in tension type headache. Conclusions: There was a notable reduction of pain intensity immediately after the treatment session. Ischemic compression therapy was significantly effective to release sub-occipital trigger points in patients with tension type headache.

Effectiveness of Dry Needling and Ischaemic Trigger Point Compression of the Levator Scapulae in Patients with Chronic Neck Pain: A Short-Term Randomized Clinical Trial.

Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN. A randomized clinical trial is conducted with 80 participants in two groups: the DN group (n = 40) and IC group (n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment. Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group (p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group. In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy.

Metabolic Tissue Swelling and Local Microcirculation in Splanchnic Artery Occlusion Shock: Implications for Critical Illness.

Trauma is a leading cause of death in the United States. Advancements in shock resuscitation have been disappointing because the correct upstream mechanisms of injury are not being targeted. Recently, significant advancements have been shown using new cell-impermeant molecules that work by transferring metabolic water from swollen ischemic cells to the capillary, which restores tissue perfusion by microcirculatory decompression. The rapid normalization of oxygen transfer improves resuscitation outcomes. Since poor resuscitation and perfusion of trauma patients also causes critical illness and sepsis and can be mimicked by ischemia-reperfusion of splanchnic tissues, we hypothesized that inadequate oxygenation of the gut during trauma drives development of later shock and critical illness. We further hypothesized that this is caused by ischemia-induced water shifts causing compression no-reflow. To test this, the superior mesenteric artery of juvenile anesthetized swine was occluded for 30 minutes followed by 8 hours of reperfusion to induce mild splanchnic artery occlusion (SAO) shock. One group received the impermeant polyethylene glycol 20,000 Da (PEG-20k) that prevents metabolic cell swelling, and the other received a lactated Ringer's vehicle. Survival doubled in PEG-20k-treated swine along with improved macrohemodynamics and intestinal mucosal perfusion. Villus morphometry and plasma inflammatory cytokines normalized with impermeants. Plasma endotoxin rose over time after reperfusion, and impermeants abolished the rise. Inert osmotically active cell impermeants like PEG-20k improve intestinal reperfusion injury, SAO shock, and early signs of sepsis, which may be due to early restoration of mucosal perfusion and preservation of the septic barrier by reversal of ischemic compression no-reflow. SIGNIFICANCE STATEMENT: Significant advancements in treating shock and ischemia have been disappointing because the correct upstream causes have not been targeted. This study supports that poor tissue perfusion after intestinal ischemia from shock is caused by capillary compression no-reflow secondary to metabolic cell and tissue swelling since selectively targeting this issue with novel polyethylene glycol 20,000 Da-based cell-impermeant intravenous solutions reduces splanchnic artery occlusion shock, doubles survival time, restores tissue microperfusion, and preserves gut barrier function.

Electrical dry needling versus a non-invasive multicomponent intervention in the treatment of myofascial trigger points in patients with chronic low back pain: A randomised clinical trial

Objective To compare the effects of electrical dry needling with a non-invasive multi-component intervention in patients with chronic low back pain. Design A randomised single-blind clinical trial. Setting Outpatient Physiotherapy Clinic; home. Participants Sixty-four patients with chronic low back pain aged 30–65 years. Interventions Six-week electrical dry needling on myofascial trigger points, and a non-invasive multicomponent intervention (home exercise programme, stretching and ischemic compression). Main measures Pain (Visual Analogue Scale), disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), kinesiophobia (Tampa Scale of Kinesiophobia), quality of life and sleep (Short Form 36-item Health Survey and Pittsburgh Sleep Quality Index), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion (finger-to-floor distance), and pressure pain threshold (algometer) were assessed at baseline, after 6 weeks, and after 2 months. Results ANOVA showed statistically significant differences in group-by-time interaction for most pain pressure thresholds of myofascial trigger points (P < 0.05), for disability (Roland-Morris Disability Questionnaire: F = 6.14, P = 0.016; and Oswestry Disability Index: F = 7.36, P = 0.009), for trunk anteflexion (F = 10.03, P = 0.002) and for habitual sleep efficacy (F = 6.65, P = 0.012), use of hypnotics (F = 4.77, P = 0.033) and total score of quality of sleep (F = 8.23, P = 0.006). Conclusions In comparison to a non-invasive multicomponent intervention, electrical dry needling has more positive effects on disability, pain intensity, kinesiophobia, and reducing patients’ sensitivity to myofascial trigger points pressure, at post-treatment and at 2 months. Clinical Trial Registration number NCT04804228. Registered on May 28th, 2021. Available at https://clinicaltrials.gov/ct2/show/NCT04804228

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

ObjectiveThe objective of this study was to verify which are the additional effects of the ischemic compression (IC) technique associated with joint mobilization techniques on pain, morphological aspects of myofascial trigger points (MTrPs), function, and psychological aspects in individuals with rotator cuff-related shoulder pain (RCRSP). MethodsSixty individuals with RCRSP were randomly allocated intervention sessions the Mobilization Group (MG, n = 20), only joint mobilizations of the shoulder complex; intervention sessions Compression Group (CG, n = 20), with the same mobilizations associated with the IC over MTrPs; and Placebo Group (PG, n = 20), with the same mobilizations associated with placebo of IC. All interventions performed 2 per week, for 6-weeks. Pain was assessed by Visual Analogue Scale and function by the Disabilities of the Arm, Shoulder and Hand questionnaire. The kinesiophobia, pain catastrophizing, perception of improvement, mobility, pain threshold and area the MTrPs were also evaluated at baseline (week-0), after 6-weeks and after 10-weeks. ResultsThere were no between-group difference in pain: CG-MG 0.8 (95% CI 0.4 to 1.2), CG-PG 0.5 (95% CI 0.0 to 0.9), MG-PG -0.3 (95% CI -0.8 to 0.1) after 6-weeks and CG-MG 0.1 (95% CI -0.2 to 0.5), CG-PG -0.7 (95% CI -0.9 to −0,4), MG-PG -0,8 (95% CI -1.07 to 0.5) at 10-weeks. Similar effects were observed on function, characteristics of MTrPs and psychological aspects. ConclusionThe IC technique on the MTrPs of the upper trapezius muscle associated with joint mobilization techniques has no additional effect on pain in individuals with RCRSP. Trial registrationRBR-44v8y7.

Comparative Analysis of the Impact of Positional Release Technique (PRT) and Ischemic Compression (IC) on Headache Disability and Pain in Cervicogenic Headache (CGH) Patients

Headache originating from the bony structures or soft tissues of the neck is commonly known as cervicogenic headache. This study was conducted to determine the effects of the positional release technique (PRT) and ischemic compression (IC) on pain and headache disability among patients with cervicogenic headache (CGH). For this purpose, a randomized clinical trial was conducted. Data was collected from the Physiotherapy Department of Sharif Medical Complex, Lahore. A total of 36 CGH patients were assigned into two groups, randomly. The first group was treated with PRT and the other with IC. Both groups were given 12 sessions of therapy over a span of 4-weeks. HDI (Headache Disability Index) and NPRS (Numeric Pain Rating Scale) were used to measure the treatment effect on pain and headache disability before and after treatment. Among the participants (N = 36), the mean age of Group A and Group B was 26.22 ± 2.90 and 24.55 ± 2.55, respectively. A significant difference was found between the mean values of pre- and post-HDI and NPRS, with p-values 0.025 and 0.031, respectively and after treatment p value was 0.001 &amp; 0.00 respectively. The results favoured the use of PRT because there was more variation in the mean values of PRT as compared to IC. Also, the mean values of pre- and post-HDI and NPRS scores varied significantly. Notably, a significant difference was not found between the mean values of both techniques at the beginning of treatment (pre-treatment). However, a significant difference was observed between the mean values of both techniques following treatment (post-treatment) in favour of PRT, since the mean values of PRT varied more than those of IC.

EVALUATION OF THE THERAPEUTIC ALLIANCE IN PATIENTS WITH ADHESIVES CAPSULITIS AND MYOFASCIAL PAIN SYNDROME AFTER PHYSICAL THERAPY

Abstract. The purpose of the study: to investigate the therapeutic alliance that is formed during physical therapy based on therapeutic exercises and ischemic compression in patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region.&#x0D; Materials and methods. 20 patients participated in the study. None of the patients had a history of intra-articular corticosteroid injections prior to the orthopedic physician's consultation, while 7 (35%) patients received the injection after the physician's consultation prior to physical therapy. Physical therapy began after an examination and consultation with an orthopedic traumatologist. Patients received a physical therapist's consultation, during which they were given information about the specifics of performing therapeutic exercises and ischemic compression of trigger points at home through instruction, demonstration, and trial performance. The patient also received an information booklet. Later, exercises and ischemic compression were performed at home independently. The complex of therapeutic exercises included pendulum exercises and stretching exercises, which were aimed at the shoulder joint and did not aim to move the scapulothoracic joint. Planned counseling of patients by a physical therapist also took place at the beginning of the 2nd and 3rd week of therapy, and the final one at the end of the 3rd week. At all consultations, in addition to providing and clarifying information about physical therapy, information was also received from the patient about the presence of questions, thoughts and feelings related to physical therapy to prevent the existence of unanswered questions and unexpressed thoughts.&#x0D; Goniometry of the shoulder joint and assessment of pain on a numerical scale at trigger points (when applying pressure of 2.5 kg×cm-2) were used before the intervention and after three weeks of physical therapy. The first assessment of the therapeutic alliance was conducted after three weeks of physical therapy, and the second 1.5 months after the first questionnaire.&#x0D; Results. In the course of physical therapy, the indicators of movement amplitudes improved and pain in trigger points decreased statistically. The first assessment of the therapeutic alliance established that the Mе (25%; 75%) indicators of the goal domain were 16 (15; 17) points, the task domain was 15 (14; 17) points, the relationship domain was 16 (15; 17) points, and re-evaluation did not establish changes in key indicators in the distant period. The goals domain scores decreased slightly, while the task and relationship domains increased slightly. Statistical differences were established only in the eighth (in favor of the first questionnaire), ninth and twelfth points of the questionnaire (in favor of the second questionnaire).&#x0D; Conclusions. Physical therapy, which consisted of a series of consultations and independent performance of therapeutic exercises and ischemic compression, had a positive effect on the range of motion in the shoulder joint and pain in trigger points. During the three-week participation in the physical therapy program, a therapeutic alliance was formed, which the patients rated at the level of 47 (46; 48) points, and the remote assessment did not establish its changes over time.

Effectiveness of ischemic compression on myofascial trigger points in relieving neck pain: A systematic review and meta-analysis.

Ischemic compression is widely used to clinically treat neck pain. However, no meta-analysis has been conducted to evaluate the effects of this process on neck pain. This study aimed to evaluate the effects of ischemic compression on the myofascial trigger points for improving neck pain-related symptoms (mainly pain, joint mobility limitation and function limitation) and to compare ischemic compression with other therapies. Electronic searches were conducted in PubMed, OVID, Web of Science, EBSCO, SCOUPS, Cochrane Library, PEDro, Wanfang, CNKI and Chinese VIP Database in June 2021. Only randomised controlled trials on the effects of ischemic compression on neck pain were included. The major outcomes were pain intensity, pressure pain threshold, pain-related disability and range of motion. Fifteen studies involving 725 participants were included. Significant differences were observed between ischemic compression and sham/no treatment group in pain intensity, pressure pain threshold and range of motion immediately and in the short term. Significant effect sizes of dry needling were observed over ischemic compression in terms of improving pain intensity (SMD = 0.62; 95% CI: 0.08 to 1.16; P= 0.02), pain-related disability (SMD = 0.68; 95% CI: 0.19 to 1.17; P= 0.007) and range of motion (MD =-2.12; 95% CI: -2.59 to -1.65; P< 0.001) immediately after treatment. Dry needling also showed a significant small effect size for the short-term reduction of pain (SMD = 0.44; 95% CI: 0.04 to 0.85; P= 0.03). Ischemic compression can be recommended in the immediate and short-term pain relief and increase in the pressure pain threshold and range of motion. Dry needling is superior to ischemic compression in relieving pain and improving pain-related disability and range of motion immediately after treatment.

The Effect of the Ischemic Compression Technique Applied to Upper Trapezius Muscle on the EMG Activity of the Serratus Anterior and Upper Trapezius during Wall Slide Exercise

The Effect of the Ischemic Compression Technique Applied to Upper Trapezius Muscle on the EMG Activity of the Serratus Anterior and Upper Trapezius during Wall Slide Exercise

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

BackgroundRotator cuff dysfunction is the main cause of shoulder pain. The shoulder and the diaphragm have an important relationship through the myofascial system and through its innervation. ObjectivesTo analyse the effect of diaphragm manual therapy on the symptoms of patients with rotator cuff injury compared to manual treatment on shoulder muscles. DesignA randomized, controlled, single-blind trial of 45 participants diagnosed with rotator cuff injury. MethodThe sample were divided into 3 groups of treatment.1. Manual treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (Control/Shoulder group -SG-).2. Diaphragm manual therapy techniques (Diaphragm group -DG-).3. Active diaphragm mobilization by hypopressive gymnastic exercise (Breathing group -BG-).Shoulder pain using a numerical rating scale (NRS), shoulder range of motion (ROM), and pressure pain threshold (PPT) were evaluated, and compared between groups. ResultsBoth the SG and DG showed a clinically significant improvement, as well as a significant effect size, on the NRS in shoulder flexion and abduction movements. Regarding ROM improvement, only the SG obtained a significant effect size (abduction and external rotation). The PPT at the xiphoid process of the sternum showed a clinically significant improvement in the DG. ConclusionIndirect treatment of the shoulder through a protocol of manual therapy techniques on the diaphragm and intervention on MTP of the rotator cuff have been clinically effective in reducing pain on the NRS immediately, in flexion and abduction movements of the shoulder, and more effective compared to the intervention in the breathing group. Clinical trial registration numberNCT03293329.

The Role of Manual Therapies in the Treatment of Headache Disorders.

A comprehensive headache treatment plan typically requires both medication and non-medication treatment strategies. Manual therapies offer another therapeutic approach to headache treatment. This article reviews the evidence for manual therapies in the treatment of headache disorders. Current evidence shows potential benefit from myofascial trigger point injections, myofascial release, and massage for the treatment of various headache types. There is also evidence for strain counterstrain technique, ischemic compression, and spinal manipulative therapies for cervicogenic headache. Although larger randomized clinical trials are necessary for many of these modalities, recent findings show that manual therapies could be an important tool for the treatment of some headache disorders.

THE INFLUENCE OF MOBILIZATION AND ISCHEMIC COMPRESSION ON PAIN AND DISABILITY IN ADHESIVE CAPSULITIS AND MYOFASCIAL PAIN SYNDROME

The purpose of the study: to investigate the effect of end-range mobilization and ischemic compression on pain and disability scores among patients with adhesive capsulitis of the shoulder joint and myofascial pain syndrome in the thoracic region.&#x0D; Materials and methods. Goniometry of the shoulder joint, assessment of pain at the end points of the range of motion and trigger points (when applying a pressure of 2.5 kg×cm-2), as well as the Shoulder Pain and Disability Index questionnaire were used before the intervention and after physical therapy.&#x0D; Physical therapy began after an examination and consultation with an orthopedic traumatologist. The majority of patients received 15 planned procedures of end-range mobilization performed by a physical therapist within 3 weeks, only two patients received 14 and 16 procedures. Mobilization from I to V degrees of intensity according to the Maitland classification was used. The patient performed ischemic compression independently after instruction (determination of the localization of trigger points, formation of their map, training in exposure techniques). Compression was performed with an average level of pain or more than average; duration of 30 seconds for each point.&#x0D; Results. The proportion of male patients was 20.8%. In the examined group of patients, the values of Me (25%; 75%) for age were 53.5 (48.25; 58.5) years, and for the duration of symptoms 4 (2; 5.5) months. Localization of adhesive capsulitis on the right side was observed in 9 patients (37.5%), and on the dominant upper limb in 8 (33.3%) patients. In five patients, the lesion was on the dominant right limb. The evaluation of the transfer of end-range mobilization procedures at the end of the first, sixth, eleventh and last procedure established that the maximum pain on a 10-point scale during mobilization was, respectively: 10 (9; 10) points, 8 (7.25; 9) points, 7 (5 ; 8) points and 4 (3; 5) points. In the course of physical therapy, the indicators of amplitudes of movements and pain at maximum amplitude, as well as at trigger points, improved statistically. The median value for active abduction increased by 74.5° and for active flexion increased by 116.5°. The median value for active internal rotation increased by 77.5°, and for active external rotation, flexion increased by 75°. The median value of pain when reaching the maximum amplitude of active abduction decreased by 6 points, and for active flexion, internal and external rotation, the median dynamics indicator was similar. It should be noted that the pain index at the trigeminal point at the first assessment was 9 (9; 9) points, and at the final assessment it statistically improved and was 4 (3; 4) points (Z = -4.340; p&lt;0.001). All items of the Shoulder Pain and Disability Index questionnaire improved statistically, leading to improvements in domain values and the index itself. Іndicators Me (25%; 75%) of the pain domain decreased from 93 (63; 100) points to 16 (6.5; 20) points (Z = -4.287; p&lt;0.001), and the disability domain from 83.8 (56.9; 91.6) points to 5.6 (3.8; 10.9) points (Z = -4.286; p&lt;0.001). Тhe median indicator of the pain domain decreased by 77 points, and the disability domain by 78.2 points. The index decreased from 88.7 (54.1; 94.4) points to 10.5 (4.2; 15.4) points. (Z = -4.286; p&lt;0.001).&#x0D; Conclusions. The use of a combination of end-range mobilization and ischemic compression was effective in reducing the index of shoulder pain and disability among the examined patients.