Latent Myofascial Trigger Points Research Articles

Effects of transcutaneous radiofrequency diathermy versus ultrasound on latent myofascial trigger points in the upper trapezius: A randomized crossover trial.

Currently, the use of radiofrequency diathermy for the treatment of neck pain is booming. This study aimed to evaluate the clinical efficacy of Digital Capacitive Diathermy (DCD®) on stiffness, pain, cervical range of motion, and cervical disability and to compare it with ultrasound (US) in patients with latent myofascial trigger point (MTrP) in the upper trapezius. Nineteen participants with latent MTrPs in the upper trapezius were included in the assessor-masked, randomized, clinical crossover trial. Subjects were exposed to both interventions: US and DCD® and treatment effectiveness was measured by myotonometric variables, pressure pain threshold (PPT), visual analog scale (VAS), cervical side-bending flexion ranges, and the neck disability index scale (NDI). There were no significant differences between US and DCD® interventions regarding changes in outcome measures. The US group achieved a statistically significant difference of 2.16 to 1.13 points (p= 0.005; r= 0.646) for the VAS. The DCD® intervention showed a statistically significant improvement of 1.11 points for the NDI at 1-week following intervention (95% CI 0.14-2.07; p= 0.27; d= 0.217). Our findings suggest that DCD® and US can both be considered effective modalities for the treatment of latent MTrPs, having a longer duration of action with DCD® therapy.

Phonophoresis in Physiotherapy: Mechanisms, Applications, and Emerging Trends for Enhanced Drug Delivery and Therapeutic Efficacy

Phonophoresis, a widely utilized treatment in physiotherapy, combines topically applied gel or cream-based medications with ultrasonic therapy to enhance percutaneous absorption of pharmacological agents. The procedure employs ultrasound frequencies of 0.7 to 1.1 MHz with intensities ranging from 0.0 to 3.0 Watts per cm². Indications for phonophoresis span various inflammatory, deformative, dermatological, and rheumatic/neurological conditions. Recent studies suggest its clinical efficacy in pain relief and improved function, especially in conditions like lateral epicondylitis and osteoarthritis. The mechanism of action involves both thermal and non-thermal effects, with cavitation playing a key role in enhancing transdermal transport. Phonophoresis offers a non-invasive alternative for drug delivery, bypassing hepatic metabolism and minimizing systemic side effects. Various medicinal gels, particularly diclofenac, are used for transdermal drug delivery through phonophoresis. Low frequency phonophoresis has gained attention for enhancing transdermal transport, especially for macromolecules. Its applications extend beyond physiotherapy to include ocular drug delivery, nail therapy, gene therapy, and sports sciences. Clinical studies demonstrate the effectiveness of phonophoresis in conditions like anterior knee pain, tuberculous lymphadenitis, acute low back pain, and latent myofascial trigger points. Dosage considerations emphasize optimizing thermal effects without causing tissue damage. Studies highlight the potential of phonophoresis in relieving pain and improving function, particularly in knee osteoarthritis. Additionally, phonophoresis with Phyllanthus amarus nanoparticle gel shows promise in reducing pain and enhancing functional capacity in symptomatic knee osteoarthritis. In summary, phonophoresis stands as a valuable modality in physiotherapy, showcasing diverse applications and demonstrating clinical efficacy in various musculoskeletal and inflammatory conditions. Further research is warranted to explore its full potential and optimize treatment protocols.

Identification of Myofascial Trigger Point Using the Combination of Texture Analysis in B-Mode Ultrasound with Machine Learning Classifiers.

Myofascial pain syndrome is a chronic pain disorder characterized by myofascial trigger points (MTrPs). Quantitative ultrasound (US) techniques can be used to discriminate MTrPs from healthy muscle. In this study, 90 B-mode US images of upper trapezius muscles were collected from 63 participants (left and/or right side(s)). Four texture feature approaches (individually and a combination of them) were employed that focused on identifying spots, and edges were used to explore the discrimination between the three groups: active MTrPs (n = 30), latent MTrPs (n = 30), and healthy muscle (n = 30). Machine learning (ML) and one-way analysis of variance were used to investigate the discrimination ability of the different approaches. Statistically significant results were seen in almost all examined features for each texture feature approach, but, in contrast, ML techniques struggled to produce robust discrimination. The ML techniques showed that two texture features (i.e., correlation and mean) within the combination of texture features were most important in classifying the three groups. This discrepancy between traditional statistical analysis and ML techniques prompts the need for further investigation of texture-based approaches in US for the discrimination of MTrPs.

Determine the Occurrence of Latent Myofascial Trigger Points Through Binary Logistic Regression Model in Sportsmen

This study aimed to ascertain the prevalence of latent myofascial trigger points (L-MTrPs) among male athletes. Ninety participants were randomly included in the study. The presence of L-MTrPs was identified based on Simon’s criteria, leading to the categorization of participants into two groups: L-MTrPs (n=45) and non-myofascial trigger points (N-MTrPs) (n=45). Pain pressure thresholds (PPT) of muscles were quantified using a pressure algometer, while force production was measured with HUMAC NORM isokinetic. The range of motion (ROM) for knee flexors and extensors was determined using Kinovea software. These parameters were treated as independent variables, whereas L-MTrPs and N-TrPs were considered dependent variables. Binary Logistic Regression (Enter Method) was employed for data analysis. Model fitness was evaluated through standard error computation, Wald’s χ2, and odds ratios with a 95% confidence interval. Model adequacy was assessed via the likelihood ratio, Cox & Snell (R2), Nagelkerke (R2), and Hosmer and Lemeshow tests. The results effectively predicted L-MTrPs and N-MTrPs, revealing that force production, PPT, and ROM were the most significant predictive variables for L-MTrPs. In conclusion, reduced force production, lower PPT, and restricted ROM were indicative of L-MTrPs. Consequently, regular evaluation of muscular strength, PPT, and ROM are recommended for athletes to prevent the development of L-MTrPs.

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

Myofascial pain syndrome (MPS) is one of the most common causes of chronic pain and affects a large portion of patients seen in specialty pain centers as well as primary care clinics. Diagnosis of MPS relies heavily on a clinician's ability to identify the presence of a myofascial trigger point (MTrP). Ultrasound can help, but requires the user to be experienced in ultrasound. Thus, this study investigates the use of texture features and deep learning strategies for the automatic identification of muscle with MTrPs (i.e., active and latent MTrPs) from normal (i.e., no MTrP) muscle. Participants (n=201) were recruited from Toronto Rehabilitation Institute, and ultrasound videos of their trapezius muscles were acquired. This new data set consists of 1344 images (248 active, 120 latent, 976 normal) collected from these videos. For texture analysis, several features were investigated with varying parameters (i.e., region of interest size, feature type and pixel pair relationships). Convolutional neural networks (CNN) were also applied to observe the performance of deep learning approaches. Performance was evaluated based on the classification accuracy, micro F1-score, sensitivity, specificity, positive predictive value and negative predictive value. The best CNN approach was able to differentiate between muscles with and without MTrPs better than the best texture feature approach, with F1-scores of 0.7299 and 0.7135, respectively. The results of this study reveal the challenges associated with MTrP identification and the potential and shortcomings of CNN and radiomics approaches in detail.

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.

Effects of Myofascial Induction Therapy on Ankle Range of Motion and Pressure Pain Threshold in Trigger Points of the Gastrocnemius-A Clinical Trial.

The myofascial induction technique (MIT) has been shown to increase shoulder range of motion (ROM) in breast cancer survivors and decrease pain pressure threshold over the radial nerve in patients with epicondylalgia. To the authors' best knowledge, no study on trigger points and MIT has been published to date. The effect on ROM of latent trigger points is also unknown. A total of 20 twins with one latent trigger point of the gastrocnemius muscle were evaluated pre- and post-MIT in the calf. We measured static footprint variables in a pre-post study. We found differences in PPT (p = 0.001) and no differences in ROM with knee flexed (p = 0.420) or stretched (p = 0.069). After Calf MIT, latent myofascial trigger points improve PPT but no change in ankle dorsiflexion with knee bent or knee flexed were found in non-restriction healthy subjects.

Ischemic pressure vs. post-isometric relaxation for treatment of rhomboid latent myofascial trigger point: a systemic review.

This systematic review was carried out to review ischemic pressure and post-isometric relaxation for treatment of rhomboid latent myofascial trigger point. This systematic review was organized using PRISMA and Cochrane standards. This meta-analysis compares ischemic pressure to post-isometric relaxation for rhomboid latent myofascial trigger point. Search terms included: myofascial pain, trigger point, ischemia pressure, post-isometric relaxation, and electric stimulation. We first searched MEDLINE (including ePub, Ahead of Print, InProgress, and Other Non-Indexed Citations) and then EMBASE and the Cochrane CENTRAL Register of Controlled Trials. Searches were conducted from the databases' inception through August 2022. The RCT review followed PRISMA criteria. PubMed, Embase, PSYCHInfo, and the Cochrane Library were searched from their origin without language constraints to locate all RCTs linked to ischemic pressure vs. post-isometric relaxation for therapy of rhomboid latent myofascial trigger point. 463 duplicates were removed. 140 of 174 citations were removed. Seven high-quality full-text papers out of 34 were included. Conservative and noninvasive treatments can only raise pain tolerance. Compared to standard treatment, ischemia pressure and post-isometric relaxation reduced shoulder and neck pain and PPT discomfort. This study suggests that ischemia compression may be more effective than post-isometric relaxation for treating rhomboid latent myofascial trigger points (MTP). Future progress in the field will depend on multi-subject RCTs.

The Relationship Between Latent Myofascial Trigger Point and Range of Motion of Knee Flexor and Extensor Muscles

The study purpose was to assess the relationship between Latent Myofascial Trigger Point and range of motion in the lower limb of athletes. A lower Pain pressure threshold (< 25 lbs/cm2) in muscles indicates the presence of a latent myofascial trigger point. Materials and methods. Initially, the study involved 46 male Athletes (aged 20-23 years) as participants. The pain pressure threshold was measured by the pressure algometer (FPX 25 Wagner Instruments, Greenwich, CT, USA) to detect latent myofascial trigger points on the hamstring and quadriceps muscles. Out of 46 participants, 23 tested positive with a latent myofascial trigger point, and rest of them tested negative with a latent myofascial trigger point. All the participants measured knee flexor and extensor range of motion with the Kinovea software (version 0.9.5). In descriptive statistics, mean and standard deviation were used, and Pearson correlation was used to determine the relationship between the variables. The level of significance was set at 0.05. Results. A significant correlation was found between Latent Myofascial Trigger Points and lower limb range of motion (p < 0.05), and it was also observed that the magnitude of correlation coefficient was very large (0.7–0.9). Conclusions. Latent Myofascial Trigger Points impair sports performance by decreasing the range of motion of knee flexors and extensors. In light of this, Latent Myofascial Trigger Point should be considered a serious musculoskeletal disorder, and appropriate preventative measures should be taken by health professionals.

The beneficial effects of traditional Thai massage on young patients with latent myofascial trigger points in the wrist extensor muscles: A randomized controlled trial

BackgroundThe purpose of the study was to assess the effects of traditional Thai massage (TTM) on pressure pain threshold (PPT), pain intensity, wrist flexion and grip strength in young patients with latent myofascial trigger points in the wrist extensor muscles. MethodsSixty-two participants were randomly assigned to received three 20-min sessions per week of either TTM (mean age = 20.9 ± 1.40 years, body mass index (BMI) = 21.61 ± 3.46 kg/m2) or sham ultrasound therapy (SUS) (mean age = 20.71 ± 1.90 years, BMI = 23.06 ± 5.17 kg/m2) for 9 sessions. PPT, pain intensity, wrist flexion and grip strength were assessed at baseline, weeks 3, and 5. ResultsIn both groups, significant improvement in PPT, pain intensity and wrist flexion were observed after the intervention period and at two weeks after the intervention period (P < .05) except for the PPT in the SUS group (P > .05). The TTM group showed a significantly greater improvement in PPT, pain intensity and wrist flexion than the SUS group at weeks 3 and 5 (P < .05). ConclusionTTM can improve the PPT, pain intensity and wrist flexion in this patient population. Trial registrationClinicalTrials.gov Identifier: NCT02067624.

Latent myofascial trigger points injection therapy for adult cough variant asthma: A randomized controlled trial.

Cough variant asthma (CVA) is a chronic inflammatory airway disease characterized by airway hyper-responsiveness (AHR), of which cough is the only symptom. The cough is a result of the contraction of the vocal cords, diaphragm, sternocleidomastoid muscle, and other respiratory related muscles caused by the AHR. Long-term chronic coughing can lead to repetitive contraction and chronic strain of the muscles involved in the head and neck, ultimately contributing to the formation of latent myofascial trigger points (MTrPs). In turn, latent MTrPs can also irritate or compress the nerves around them, triggering cough. The date indicated that latent MTrPs can induce autonomic phenomena and are effective in allergic rhinitis. But their roles in asthma are unclear. In this article, the efficacy and safety of latent MTrPs injection therapy in CVA were investigated. This randomized controlled trial was conducted with 110 patients. Patients were assigned to the intervention or control group in a 1:1.5 ratio. Intervention group (n = 44): single injection therapy with latent MTrPs. Control group (n = 66): budesonide-formoterol plus montelukast for 8 weeks. During the 36-week follow up period, the recurrence rate at week 36, cough visual analog scale (VAS), ACT (asthma control test)-scores, ACQ5 (asthma control questionnaire)-scores, AQLQ (asthma quality of life questionnaire)-scores, proportion of using rescue medication, and adverse events were evaluated. The recurrence rate at week 36 was lower in the intervention group than in the control group (36 weeks, 5.0 vs. 34.55%, p = 0.001). There were significant differences between groups in change from baseline to 36 weeks in VAS [36 weeks, 1.70 (1.49) vs. 3.18 (2.04), p < 0.001]; ACT-score [36 weeks, 21.38 (2.65) vs. 18.53 (3.00), p < 0.001]; ACQ5-score [36 weeks, 0.85 (0.55) vs. 1.52 (0.62), p < 0.001]; AQLQ-score [36w, 174.40 (18.22) vs. 151.69 (24.04), p < 0.001]; proportion of using rescue medication (36 weeks, 5.0 vs. 29.1%, p = 0.003). Fewer adverse events occurred in the two groups. Latent myofascial trigger points injection therapy provided long-acting, practical, short treatment duration and safety methods for CVA. http://www.chictr.org.cn/index.aspx, Chinese Clinical Trial Registry Center, ChiCTR2100044079.

Effectiveness of Manual Trigger Point Therapy in Patients with Myofascial Trigger Points in the Orofacial Region-A Systematic Review.

The objective was to compile, synthetize, and evaluate the quality of the evidence from randomized controlled trials (RCTs) regarding the effectiveness of manual trigger point therapy in the orofacial area in patients with or without orofacial pain. This project was registered in PROSPERO and follows the PRISMA guidelines. Searches (20 April 2021) were conducted in six databases for RCTs involving adults with active or latent myofascial trigger points (mTrPs) in the orofacial area. The data were extracted by two independent assessors. Four studies were included. According to the GRADE approach, the overall quality/certainty of the evidence was very low due to the high risk of bias of the studies included. Manual trigger point therapy showed no clear advantage over other conservative treatments. However, it was found to be an equally effective and safe therapy for individuals with myofascial trigger points in the orofacial region and better than control groups. This systematic review revealed a limited number of RCTs conducted with patients with mTrPs in the orofacial area and the methodological limitations of those RCTs. Rigorous, well-designed RCTs are still needed in this field.

Dry needling on latent and active myofascial trigger points versus oral diclofenac in patients with knee osteoarthritis: a randomized controlled trial

BackgroundLatent and active myofascial trigger points (MTrPs) in knee-associated muscles may play a key role in pain management among patients with knee osteoarthritis (KOA). The aim of this study was to investigate the effect of dry needling treatment on pain intensity, disability, and range of motion (ROM) in patients with KOA.MethodsThis randomized, single-blinded, clinical trial was carried out for 6 weeks of treatment and 6-month follow-up. A total of 98 patients met the entry criteria and were randomly assigned to the dry needling latent and active myofascial trigger point (MTrPs) with the stretching group or the oral diclofenacwith the stretching group. Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM were statistically analyzed before and after treatment and at the 6-month follow-up.ResultsA total of 42 patients in the dry needling group (DNG) and 35 patients in the diclofenac group (DG), respectively, completed the study, and there was no significant difference in the general data between the two groups. After treatments, both the groups showed a good effect in knee pain, function, and ROM, However, the DNG showed a significantly better result than the DG. Especially in the results of the 6-month follow-up, the DNG showed much better results than the DG.ConclusionsDry needling on latent and active MTrPs combined with stretching and oral diclofenac combined with stretching can effectively relieve pain, improve function, and restore knee ROM affected by KOA. However, the effects of dry needling and stretching are better and longer lasting than those of oral diclofenac and stretching for at least 6 months.Trial registrationRegistered in the Chinese Clinical Trial Registry (www.chictr.org.cn) in 17/11/2017 with the following code: ChiCTR-INR-17013432.

Effects of the Upper Trapezius Taping on Shoulder Pain, Muscle Activity, Strength, Scapular Elevation in Subjects with Latent Myofascial Trigger Points

Background Patients who have latent myofascial trigger points commonly over-compensate with the upper trapezius (UT) due to insufficient shoulder flexion strength. Previous studies have suggested that taping is an effective way to restrict unwanted joint movements along the direction of the tape. However, few studies have been conducted to investigate how taping affects shoulder compensation movements in individuals with MTPs. Objectives We investigated the effects of taping on pain, activation of the UT, anterior deltoid (AD), serratus anterior (SA), shoulder flexion strength, and the angle of scapular elevation in subjects with MTPs. Methods In total, 30 subjects with latent MTPs were recruited. The subjects were randomly assigned to two groups (inhibition taping group, n=15; sham taping group, n=15). Subjects were evaluated for pain, activation of the UT, AD, and SA, shoulder flexion strength, and scapular elevation angle during maximum isometric shoulder flexion pre and immediately post-the-taping intervention. Two-way repeated ANOVA was performed to analyze group (inhibitory vs. sham) and time (pre vs. post-taping values) main and interaction effects. Results Statistically significant main effect for time was found in UT (p < 0.001), AD (p < 0.001), shoulder flexion strength (p < 0,001), and scapular elevation angle (p < 0,001) after inhibition taping. Additionally, the inhibition taping group showed significantly greater changes in UT (p = 0.020), AD (p = 0.048) EMG activity, shoulder elevation angle (p = 0.005), and scapular elevation angle (p = 0.049). Conclusions These results suggest that when performing shoulder rehabilitation exercises in a clinical setting, restricting scapular elevation via taping is an effective way to correct compensatory scapular movement and alter the recruitment pattern of UT and AD activation in patients with MTPs.

Comparison of High Power Pain Threshold Ultrasound and Ischemic Compression Techniques for the Treatment of Latent Myofascial Trigger Points: A Randomized Controlled Study

Abstract Objective Myofascial trigger points (MTrPs) have been defined as discrete and hyperirritable areas located within a taut band of skeletal muscle or fascia, which when compressed produce pain, tenderness, dysfunction and autonomic phenomena. The treatment techniques aimed to return the fiber groups to their optimum length and end plates to their optimum function. Ischemic Compression (IC) and of High Power Pain Threshold Ultrasound (HPPT-US) are among the treatment techniques used for MTrPs. The aim of the current study is to compare the efficacy of IC and HTTP-US which was applied in different ways on MTrPs treatment. Patients and Methods This is a randomized prospective study conducted with 153 participants have at least three latent trigger points. Participants received HPPT-US technique in which the intensity is kept constant at the pain level, HPPT-US technique in which the intensity is kept constant at half the pain level or IC. Outcome measures were the Visual Analog Scale, Beck Depression Inventory, Neck Pain and Disability Scale, number of deactivated MTrPs and Pain Pressure Threshold (PPT). Results Pain, psychological status and disability improved in each group; there was no significant difference between the groups (p&gt;0.05). PPT increased in each group; a significant difference was found between the groups (p&lt;0.05). IC was slightly more effective than HPPT-US. Conclusion Our results have shown that HPPT-US which was applied in different ways and IC were effective therapies for latent trigger points.

Effectiveness of Dry Needling and Ischemic Trigger Point Compression in the Gluteus Medius in Patients with Non-Specific Low Back Pain: A Randomized Short-Term Clinical Trial.

Background: The presence of latent myofascial trigger points (MTrPs) in the gluteus medius is one of the possible causes of non-specific low back pain. Dry needling (DN) and ischemic compression (IC) techniques may be useful for the treatment of these MTrPs. Methods: For this study, 80 participants were randomly divided into two groups: the dry needling group, who received a single session of DN to the gluteus medius muscle plus hyperalgesia (n = 40), and the IC group, who received a single session of IC to the gluteus medius muscle plus hyperalgesia (n = 40). Pain intensity, the pressure pain threshold (PPT), range of motion (ROM), and quality of life were assessed at baseline, immediately after treatment, after 48 h, and one week after treatment. Results: Statistically significant differences were shown between the two groups immediately after the intervention, showing a decrease in PPT (p < 0.05) in the DN group and an increase in PPT in the IC group. These values increased more and were better maintained at 48 h and after one week of treatment in the DN group than in the IC group. Quality of life improved in both groups, with greater improvement in the DN group than in the IC group. Conclusions: IC could be more advisable than DN with respect to UDP and pain intensity in the most hyperalgesic latent MTrPs of the gluteus medius muscle in subjects with non-specific low back pain, immediately after treatment. DN may be more effective than IC in terms of PPT, pain intensity, and quality of life in treating latent plus hyperalgesic gluteus medius muscle MTrPs in subjects with non-specific low back pain after 48 h and after one week of treatment.

Altered Brain Activity and Effective Connectivity within the Nonsensory Cortex during Stimulation of a Latent Myofascial Trigger Point.

Myofascial trigger point (MTrP), an iconic characteristic of myofascial pain syndrome (MPS), can induce cerebral cortex changes including altered cortical excitability and connectivity. The corresponding characteristically reactive cortex is still ambiguous. Seventeen participants with latent MTrPs underwent functional near-infrared spectroscopy (fNIRS) to collect cerebral oxygenation hemoglobin (Δ[oxy-Hb]) signals. The Δ[oxy-Hb] signals of the left/right prefrontal cortex (L/R PFC), left/right motor cortex (L/R MC), and left/right occipital lobe (L/R OL) of the subjects were measured using functional near-infrared spectroscopy (fNIRS) in the resting state, nonmyofascial trigger point (NMTrP), state and MTrP state. The data investigated the latent MTrP-induced changes in brain activity and effective connectivity (EC) within the nonsensory cortex. The parameter wavelet amplitude (WA) was used to describe cortical activation, EC to show brain network connectivity, and main coupling direction (mCD) to exhibit the dominant connectivity direction in different frequency bands. An increasing trend of WA and a decreasing trend of EC values were observed in the PFC. The interregional mCD was primarily shifted from a unidirectional to bidirectional connection, especially from PFC to MC or OL, when responding to manual stimulation during the MTrP state compared with resting state and NMTrP state in the intervals III, IV, and V. This study demonstrates that the nonsensory cortex PFC, MC, and OL can participate in the cortical reactions induced by stimulation of a latent MTrP. Additionally, the PFC shows nonnegligible higher activation and weakened regulation than other brain regions. Thus, the PFC may be responsible for the central cortical regulation of a latent MTrP. This trial is registered with ChiCTR2100048433.

Myotonometric Evaluation of Latent Myofascial Trigger Points and Taut Band in Elite Athletes

Purpose: Our aim was to identify the mechanical properties of the latent myofascial trigger points (MTrPs), the taut band and the non-taut band (surrounding muscle) within the gastrocnemius muscle using the myotonometric evaluation method. Methods: Thirty-one asymptomatic elite rugby players (23.0±4.16 y, 97.5±22.1 kg, 183.5±7.6 cm) with a latent MTrP in lateral gastrocnemius muscle included in this study. Muscle stiffness, decrement and muscle tone of latent MTrPs, taut band and the non-taut band were measured using a myotonometer (MyotonPRO, Myoton AS, Tallinn, Estonia). One-way ANOVA was conducted to determine the differences between the three measurement points. After pairwise comparisons, Cohen’s d effect sizes were calculated to determine the magnitude of differences between the measurement points. Results: Although the stiffness of the MTrPs was lower than its taut band, one-way ANOVA revealed that there was no difference between the MTrPs vs the taut band and the non-taut band for frequency, stiffness and decrement parameters (p&amp;gt;0.05). However, there is a difference between the taut band non-taut band for muscle tone (P= 0.016), for stiffness (P=0.035) and for decrement (P=0.012) and effect sizes are as d=0.64, d=0.69 and d=0.62 for stiffness, muscle tone and decrement respectively. Conclusion: The MTrPs and the taut bands showed an increase in muscle stiffness and muscle tone compared to the surrounding muscle. The taut band could be easily identified from the surrounding muscle using the myotonometer. Therefore, myotonometric measurement is a potentially valuable method for the identification of the taut band in elite athletes.

Electrical dry needling versus conventional physiotherapy in the treatment of active and latent myofascial trigger points in patients with nonspecific chronic low back pain

BackgroundChronic low back pain is considered to be one of the main causes of absenteeism from work and primary and specialized consultations. The symptoms of nonspecific chronic low back pain may be accompanied by the activation of myofascial trigger points in the muscles, together with local and/or referred pain. Electrical dry needling is increasingly used in the treatment of lumbar myofascial pain. Conventional physiotherapy, however, is a popular approach to chronic pathologies, and there is evidence of different modalities of physiotherapy being used in the treatment of chronic low back pain. The aim of this study has been to determine the effectiveness of electrical dry needling versus conventional physiotherapy when applied to active and latent myofascial trigger points in patients with nonspecific chronic low back pain.MethodsThis is a controlled, randomized, two-arm, double-blind study. A total of 92 patients with chronic low back pain (time to onset ≥ 3 months, Roland Morris Disability Questionnaire score ≥ 4) will be recruited from the University of Almería. Participants will be divided into two study groups (n = 40) to receive treatment of low back pain with electrical dry needling and conventional physiotherapy (ischaemic compression, analytic stretching and postural education training dossier). A total of 6 sessions will be administered once a week for 6 weeks. Pain intensity, disability, fear of movement, quality of life, quality of sleep, anxiety and depression, pressure pain threshold, abdominal strength and lumbar mobility will be recorded at 6 weeks (post-immediate) and 2 months after the end of treatment.DiscussionWe believe that an approach including electrical dry needling to chronic low back pain dysfunction will be more effective in these patients. The results of this study will inform clinicians on which type of treatment is more beneficial for patients with chronic low back pain.Trial registrationClinicalTrials.gov NCT04804228. Registered on 14 January 2021

Dry needling in active or latent trigger point in patients with neck pain: a randomized clinical trial

The purpose was to determine the efficacy of deep dry needling (DDN) applied on an active myofascial trigger point (MTrP) versus a latent-MTrP versus a non-MTrP location, on pain reduction and cervical disability, in patients with chronic neck pain. A randomized, double-blind clinical trial design was used. A sample of 65 patients was divided into non-MTrP-DDN, active-MTrP-DDN and latent-MTrP-DDN groups. The visual analog scale (VAS), reproduction of the patient’s pain, number of local twitch responses, pressure pain threshold (PPT) and Neck Disability Index (NDI) were assessed before, during and after the intervention and up to 1 month post-intervention. The active-MTrP-DDN-group reduced pain intensity more than non-MTrP-DDN-group after a week and a month (P < 0.01), as well as showing the greatest improvement in tibialis muscle PPT. The treatment of both Active and Latent MTrPs was associated with the reproduction of the patient’s pain. The application of DDN on an active-MTrP in the upper trapezius muscle shows greater improvements in pain intensity after 1 week and 1 month post-intervention, compared to DDN applied in latent-MTrPs or outside of MTrPs in patients with neck pain.