Trigger Points Research Articles

Comparison of Development of Upper Trapezius Trigger Point in Computer Operators with or without Fore arm support

Background:Computer work often involves both physical and mental demands. The physical demands are characterizedby low-force exertions and static postures that are sustained for long durations. Elevated shoulder postures,prolonged static contractions and the task duration have been identified as computer-related risk factorsfor neck and shoulderproblems, so this is responsible for development of trigger points particularly in the uppertrapezius muscles in forearm-unsupported computer operators as compared to forearm-supported.The uppertrapezius (UT)is designated as a postural muscle and is highly suspected ofoveruse because it works constantlyagainst gravity to maintain an erect head and neck position. This studyaims to identify upper trapezius triggerpoints (TrPs) developed with or without forearm support (FS) in computer operators.Materials and Methods: The study took place in the worksite of computer operators in Nagpur,Maharashtra for1.5 year. With a power of 90 and significance error of 1%, a total of 40 patients were taken according to the convenientsampling and divided into two categories computer operators Group A: with FS and Group B: without FS,following signs and symptoms like Trigger point, posterolateral neck and upper back pain most common in which group assessed by using, VAS (Visual Analogue Scale) for measuring pain intensity, Trigger Point Rating Scale is used for myofascial screening. Neck Disability Index for assessing the neck-related disability due to pain taken.Result: The study was conducted on 40 people, in which 20 people with forearm support and 20 people withforearm unsupported. The result is that forearm support reduces the load on the UTand also reduces the risk ofdevelopment of upper trapezius TrPs as compared to the forearm unsupported.Conclusion: Based on the results of these studies, it has been concluded that the development of UT TrPsincomputer operators without FS is more common as compared to FS.

P-Wave Morphology From Common Nonpulmonary Vein Trigger Sites Following Pulmonary Vein and Posterior Wall Isolation

BackgroundNon-pulmonary vein (PV) triggers are increasingly targeted during atrial fibrillation (AF) ablation. P-wave morphology (PWM) can be useful because point mapping of AF triggers is challenging. The impact of prior ablation on PWM is yet to be determined. ObjectivesThis study sought to report PWM before and after left atrial (LA) ablation and construct a P-wave algorithm of common non-PV trigger locations. MethodsThis multicenter, prospective, observational study analyzed the paced PWM of 30 patients with persistent AF undergoing pulmonary vein isolation (PVI) and posterior wall isolation (PWI). Pace mapping was performed at the SVC, crista terminalis, inferior tricuspid annulus, coronary sinus ostium, left septum, left atrial appendage, Ligament of Marshall, and inferoposterior LA. The PWM was reported before PVI, then blinded comparisons were made post-PVI and post-PVI + PWI. A P-wave algorithm was constructed. ResultsA total of 8,352 paced P waves were prospectively recorded. No significant changes in the PWM were seen post-PVI alone in 2,775 of 2,784 (99.7%) and post-PWI in 2,715 of 2,784 (97.5%). Changes in PWM were predominantly at the IPLA (53 P waves) with a positive P-wave in leads V2 to V6 before biphasic post-PWI, LA appendage (9 P waves), coronary sinus ostium (6 P waves), and ligament of Marshall (3 P waves). A PWM algorithm was created before PVI and accurately predicted the location in 93% post-PVI + PWI. ConclusionsMinimal change was observed in PWM post-PV and PWI aside from the IPLA location. A P-wave algorithm created before and applied after PVI + PWI provided an accuracy of 93%. PWM provides a reliable tool to guide the localization of common non-PV trigger sites even after PV and PWI.

Autonomous handover parameter optimisation for 5G cellular networks using deep deterministic policy gradient

The ultra-dense network (UDN) is considered a vital technology for 5G mobile communications due to its ability to transmit high data rates in high-traffic environments. However, it also creates new challenges, such as increased interference and difficulty managing mobility. To ensure seamless base station connectivity and maintain a high quality of service, a reliable handover algorithm is necessary, especially in a UDN where the cell size is small. This paper proposes an optimisation method for handover parameters based on the Deep Deterministic Policy Gradient (DDPG) algorithm. It adjusts the handover margin (HOM) to determine the handover trigger points accurately and dynamically. Simulation results indicate that the system’s mobility performance has been greatly improved while maintaining high throughput and low latency at different speeds.

The key role of muscle spindles in the pathogenesis of myofascial trigger points according to ramp-and-hold stretch and drug intervention in a rat model.

This study investigated whether abnormal peak inversion spontaneous potentials (PISPs) recorded at resting myofascial trigger points (MTrPs) stem from the discharge of muscle spindles. Forty-eight male Sprague-Dawley rats were randomly divided into six groups. Five groups underwent MTrP modeling intervention, whereas one group did not receive intervention and was duly designated as the blank control. After model construction, five rat models were randomly subjected to ramp-and-hold stretch tests, succinylcholine injection, eperisone hydrochloride injection, saline injection, and blank drug intervention. By contrast, the rats in the blank control group were subjected to ramp-and-hold stretch tests as a control. Frequencies and amplitudes of PISPs were recorded pre- and post-interventions and compared with those of the blank group. Stretch tests showed that the depolarization time and amplitude of PISPs ranged from 0.4ms to 0.9ms and from 80 uV to 140μV, respectively. However, no PISPs were observed in the control rats. The frequency of PISPs in the ramp and hold phases and the first second after the hold phase was higher than that before stretching (p < 0.01). Succinylcholine and eperisone exerted excitatory and inhibitory effects on PISPs, respectively. In the group injected with 0.9% saline, no considerable differences of the PISPs were observed during the entire observation period. In conclusion, PISPs recorded at resting MTrPs are closely related to muscle spindles. The formation of MTrPs may be an important factor that regulate dysfunctional muscle spindles.

A Comparison of Myofascial Release and Positional Release in Conjunction with Static Stretching for Treatment of Upper Trapezius Trigger Points among University Students: A Pilot Study

Introduction: Myofascial trigger points are considered to be a major cause of neck pain and shoulder muscle tenderness among the working population. Aim: To investigate the efficacy of combining Myofascial Release Therapy (MFR) and Positional Release Therapy (PRT) on pain intensity and pain tolerance for managing neck pain caused by Myofascial Trigger Points (MTrPs) of the upper trapezius muscle. Materials and Methods: A pilot study was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India on a total of 16 participants were randomly assigned to Group A (MFR) and Group B (PRT), receiving treatment 3 days a week for two weeks. Both groups also received conventional treatment (such as static stretching of the upper trapezius along with a cold pack). The Numeric Pain Rating Scale (NPRS) and the Pain Pressure Threshold (PPT) were employed to compare the pre- and postintervention assessment of the participants. Results: As the baseline data were normally distributed, the statistical analysis used independent t-tests for between-group comparisons and paired t-tests for within-group analysis. For within-group analysis, both groups revealed highly significant improvement (p&lt;0.05) in all the outcome measures such as (NPRS and PPT). However, upon comparing both groups, the between-group analysis showed significant improvement across all parameters (p&lt;0.05). Conclusion: Both PRT and MFR combined with static stretching were found to be effective in reducing pain and raising the pain threshold; however, comparing patients who received MFR combined with static stretching had more significant results.

Ab. No. 161 An Immediate Effect of Active Release Technique [ART] Versus Graston Technique [GT] on Neck Pain in Individuals Having Myofascial Trigger Point of Upper Trapezius

Introduction: Myofascial trigger points (MTrPs) are hyperirritable, palpable nodules found along taut bands of muscle fibers. It has been estimated that 85% of people who come to pain in clinics have trigger points in the neck, and they occur more often in women than in men. MTrPs are classified clinically into active and latent. latent trigger points produce pain when palpated and cause restriction of movement. ART can identify and reduce fibrous adhesions, microscopic tissue injury and inflammation. Graston technique is an Instrument assisted soft Tissue Mobilization method. It helps the healing process by intentional micro-trauma, breaking down collagen cross-linkage, increasing blood flow and cellular regeneration. The purpose is to compare the immediate Effect of Active Release Technique Methods: 30 participants age (18-34) years were included, 15 per group. Ethical approval was taken. Groups A received ART &amp; Group B - Graston technique. Pre and post evaluation was done using pain pressure threshold (PPT) and Visual Analogue Scale (VAS) for pain. Result: Within group analysis showed Group A PPT (p&gt;0.05), VAS (p&lt;0.05) and Group B PPT p&gt;0.05), VAS (&lt; 0.05). Between group showed statistical significance in PPT (p&lt;0.05) but did not in VAS (p&gt;0.05). Conclusion: Graston technique is more effective in increasing PPT. Implications: Graston technique can be used to get faster results.

The Ability of Injections Versus Needle Insertion to Decrease the Severity and Frequency of Symptoms for Patients With Chronic Headaches: A Critically Appraised Topic

Clinical Scenario: Headaches can be categorized as tension-type headaches, migraine, trigeminal autonomic cephalgia, and other primary headache disorders according to the Third International Classification of Headache Disorders. Headaches are one of the most common disorders within the nervous system and have a prevalence of &gt;48% within the general population. Nerve blocks are a type of nerve stimulation that is believed to help reduce the frequency and severity of headaches. The physiological effect of the greater occipital nerve block on headaches is thought to be due to the central nervous system connections of the greater occipital nerve and trigeminal and cervical afferent fibers, which is believed to be the prime origin of migraine headaches. Nerve blocks can contain a variety of drug regimens including steroids, local anesthetics, or a mixture of both. Trigger point injections (TPIs) are an invasive therapy where a needle is guided directly into a trigger point that has been previously identified upon examination. Botulinum toxin A is an alternative treatment modality that can be injected with TPIs. Botulinum toxin A is a potent naturally occurring toxin that causes dose-dependent muscular relaxation by inhibiting the release of acetylcholine at the neuromuscular junction. Summary of Key Findings: (1) Both greater occipital nerve blocks and TPIs have been shown to reduce headache frequency and severity in the short term; however, it appears to be due to the needle injected into the soft tissue structures and not due to the type of solution injected. (2) Ultrasound guidance allows for a more accurate and effective technique than a blind injection as it allows for accurate injection into the targeted muscles, thereby minimizing complications and increasing the chance of success. (3) Once symptoms have been alleviated, clinicians should evaluate the patient’s mechanics in the upper trunk to determine whether there are any mechanical abnormalities leading to the formation of myofascial pain and/or trigger points causing the headache symptoms. If identified and treated appropriately, this can allow for a long-term solution in correcting the cause rather than the symptoms alone. (4) Participants receiving a greater occipital nerve block or TPI, despite the drug regimen or dosage, experienced similar benefits with no statistical significance. In deciding which treatment approach to take, the clinician should speak with the patient to educate them on the available options and allow the patient to be part of the decision-making process to best meet their needs and include a rehabilitation plan with all the treatment approaches. Clinical Question: In patients who experience chronic headaches, was there a greater decrease in headache frequency and severity with a greater occipital nerve block or TPI? Clinical Bottom Line: Needles into the supraclavicular region for headaches lead to decreased severity and frequency of headaches in the short term but will not lead to headache resolution. Strength of Recommendation: B.

COMPARISON OF THE EFFECTIVENESS OF MYOFASCIAL PAIN REDUCTION USING LOW-INTENSITY LASER AND RED LED LIGHT THERAPY IN PATIENTS WITH TEMPORO¬MANDIBULAR JOINT DYSFUNCTION

Introduction: Today, there is a significant prevalence of temporomandibular joint (TMJ) dysfunction, which currently ranges from 21.5 % to 50.5 %. This disease can worsen the patient's quality of life due to the presence of pain, which is the main symptom of this pathology. To reduce the intensity of pain in patients with TMJ dysfunction, low-level laser and red LED light therapy is used. There are a significant number of studies proving clinical efficacy in alleviating the symptoms of TMJ dysfunction using various methods of light therapy, but the number of studies comparing the effectiveness of different light therapy options among themselves is quite limited. The aim of the study was to compare the effectiveness of pain relief and the number of trigger points in patients with TMJ dysfunction using a low-level laser and red LED light. Materials and methods: 60 patients were randomised into 2 groups. Randomisation for patient allocation was performed using Microsoft Excel 2016. Patients of group I received red LED light therapy, radiation sources were applied to the trigger points of the masticatory muscles extracorporeally for 5 minutes. Patients in group II received low-intensity laser therapy for 30 seconds on the trigger points of the masseter muscles extracorporeally. Patients in both study groups received therapy weekly for 4 weeks. The effectiveness of the treatment was assessed by filling out a visual analogue scale (VAS), the number of trigger points of the masticatory muscles and the force of contraction of the masticatory muscles at rest and during tooth contact in patients with temporomandibular joint dysfunction. Results: the VAS scores in group I decreased by 47.02 % from the start of treatment, in group II – by 53.7 %. The number of trigger points in the projection of the masticatory, temporal muscles and parotid region in group I decreased by 62.34 %, in group II – by 72.21 %. According to electromyography, in group I, the amplitude of bioelectrical impulses of the masticatory muscles at rest decreased by 20.58 % on average, and in the state of voluntary teeth clenching – by 22.89 %. In group II, the amplitude of bioelectrical impulses of the masticatory muscles at rest decreased by 25.58 % on average, and in the state of voluntary teeth clenching – by 28.37 %. Conclusions: red LED light therapy and low-level laser therapy reduces pain intensity and the number of trigger points in patients with myofascial pain. Comparison of the effectiveness of red LED light therapy and laser therapy in reducing pain syndrome showed a higher ability of laser therapy to reduce myofascial pain and the number of trigger points in patients with temporomandibular joint dysfunction (p&lt;0.01).

Prevalence of cervicogenic dizziness in patients with neck pain and effectiveness of cervicogenic dizziness rehabilitation

Objective: This study aims to determine the frequency of cervicogenic dizziness in patients suffering from neck pain and observe the efficacy of cervicogenic dizziness (CGD) rehabilitation. Material and Method: It was a retrospective study. The patients aged between 18 and 65 who attended the physical medicine and rehabilitation outpatient clinic and suffered from neck pain were included in the study. Pregnants and patients with a history of cervical surgery, missing data, or attending the rehabilitation program irregularly were excluded. Demographic data, treatment protocols, laboratory and radiology results, and Dizziness Handicap Inventory Scores in the 1st and 3rd month after rehabilitation were obtained from the health database. The frequency and reasons for cervicogenic dizziness and the efficacy of the rehabilitation program were observed. P &lt; 0.05 was considered statistically significant. Results: Totally, 443 patients were analyzed. 288 patients were female, and 155 were male. The mean age was 50.31 ± 14.06. Cervical disc herniation was determined in 40% (n = 178) of the patients, cervical spondylosis was observed in 11.5% (n = 51) of patients, 45.5% (n = 202) of patients had myofascial pain syndrome and 1.5% (n = 6) of patients defined trauma. Neck pain was associated with dizziness in 8.57% (n = 38). Cervicogenic dizziness was determined in 8.1% of the patients, and the most common reasons were myofascial trigger points and cervical disc hernia. Patients who accepted the cervicogenic rehabilitation program had a better Dizziness Handicap Inventory Score in the 1st and 3 rd month controls. Conclusion: Cervicogenic dizziness was determined in 8.1% of patients suffering from neck pain. It was detected that the most common reason was cervical pathologies, and the patients benefited from rehabilitation program.

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.

Efficacy of Integrated Neuromuscular Inhibition Technique on Pain and Range of Motion in Patients with Upper Trapezius Triggers Point: A Literature Review

Introduction: Myofascial Pain Syndrome (MPS) is current musculoskeletal pain disorder that affects the majority of chronic pain population. Myofascial Trigger Points (MTrPs) are hyperexcitable spots in a tight band within the skeletal muscle, which ache upon shortening, elongating and manifest referred pain. Integrated Neuromuscular Inhibition Technique (INIT) is a single coordinated technique, which is used to decrease the pain intensity, increase the function and range of motion due to the increased blood supply by intermittent pressure, muscle relaxation by strain-counter strain and tone reduction by muscle energy technique. Thus, the review of literature was suggested to explore the efficacy of techniques like INIT on pain and range of motion parameters. Aim: To evaluate the current literatures on the efficacy of INIT on pain and range of motion in patients with upper trapezius trigger point. Materials and Methods: A literature review was conducted from December 2023 to February 2024, using PubMed, the Cochrane Library, and PEDro databases to identify studies on the Integrated Neuromuscular Inhibition Technique (INIT) in patients with upper trapezius trigger points. Seven articles meeting inclusion criteria were selected for detailed analysis to evaluate INIT’s effects on pain and range of motion in this population. Results: From the initial search of PubMed, the Cochrane Library, and PEDro databases, seven articles met inclusion criteria for analysis. Among these, four studies reported positive outcomes for the Integrated Neuromuscular Inhibition Technique (INIT) in treating upper trapezius trigger points. INIT interventions consistently improved pain levels and range of motion, indicating its efficacy in managing myofascial pain syndromes in this muscle group. Conclusion: An integrated strategy, INIT is proved to be effective in reducing pain and improving quality of life in patients with non specific neck pain, stiffness, and enhancing functionality.

The relationship between myofascial trigger points sensitivity, cervical postural abnormality, and clinical tension-type headache parameters

ABSTRACT Background Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH. Objectives To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH). Methods A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured. Results Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (r = 0.32, P < 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males. Conclusions There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.

Resting muscle tension and trigger points in elite junior short-track athletes and healthy non-athletes: a cross-sectional examination.

Short-track speed skating (short track) is an Olympic sport characterized by a specific body position and counterclockwise movement on the track. Based on previous studies, we hypothesized that athlete body positions employed in this sport could lead to asymmetric overuse disorders of the left lower limb muscles. An increased number of latent trigger points (LTrPs) was confirmed in individual muscles of the overloaded left limb of short-track athletes. This study aimed to compare the number of LTrPs and the level of resting muscle tone between elite junior short-track athletes and healthy non-athletes. The experimental (EXP) group comprised 15 elite short-track junior athletes from the Polish national team and the control (CON) group comprised 15 healthy young volunteers. In both groups, the left leg was tested for (i) the presence of LTrPs and (ii) resting muscle tone (RMT), assessed using surface electromyography in six muscles. The EXP group showed a higher number of LTrPs in the left lower limb, compared with the CON group. The muscle that was most significantly affected in the athletes was the vastus lateralis obliquus [χ 2 (1, N = 30), p < 0.001, V Cramer = 0.71]. This muscle also differed significantly between the groups in terms of the RMT (p = 0.033, Cohen's d = 0.87). Elite short-track junior athletes presented with increased RMT and an increased number of LTrPs in the vastus lateralis oblique muscle, compared with healthy non-athletes.

Assessment of damage to the physiotherapist’s thumb when working on trigger points: an analysis of its performance and comparison to tool therapy

Aim: This study aims to assess the behaviour of the thumb when subjected to axial pressures, to estimate the risk of potential damage in the long term and to quantify the information obtained from clinical analyses. Materials and Methods: The study evaluated the effect of axial loading on the thumb based on an objective assessment during measurements on a strain gauge bench and compared it to hand loading during use of a fascial therapy tool. The study was supplemented by biomechanical analysis on an X-ray of a randomly selected physiotherapist. Results: The study highlighted a decrease in thumb performance during the course of successive soft tissue therapy techniques, despite guidelines stating the need for uniform action on the tissues, and confirmed that prolonged axial pressure/loading can lead to a range of functional impairments carrying the risk of permanent damage in the long term. Compared to thumb work, tool therapy scored slightly better, although also with a downward trend indicative of inadequate ergonomics resulting from the tool’s design. Conclusions: The thumb, as the most sensitive structure of the therapist’s hand, despite anatomical conditions providing it with high stability during use, can gradually acquire dysfunctions that limit its performance. Consequently, there is a need to search for substitutes that are as equally effective.

Dextrose neuroprolotherapy and occlusal splint treatment outcomes in occlusal trauma: Evaluation through ultrasound imaging.

Occlusal trauma has become a common phenomenon among individuals today. Its primary source is bruxism, which involves unusual activities such as clenching and grinding during the day or sleep. The hypothesis is that with 5% dextrose neuroprolotherapy, both the trigger points and affected nerves will be healed, and the muscle will be relieved by eliminating the pain. This study aimed to compare the short-term ultrasonographic results of patients treated with occlusal splint and 5% dextrose neuroprolotherapy for bruxism. Patients were divided into two groups: the dextrose neuroprolotherapy group and the occlusal splint group. In the first group, patients were administered 5% dextrose three times at one-week intervals using the dextrose neuroprolotherapy method. Impressions for both jaws were made using a high-viscosity irreversible hydrocolloid impression material in the second group. An occlusal splint was tailored to fit the upper jaw. Patients were assessed for masseter muscle thickness and strain ratio using ultrasonography before and 3 months after the treatment. No statistically significant differences were found between the two groups for all measures. Statistically significant differences were observed in the strain ratio of the left musculus massetericus in the resting position and the thickness of the left musculus massetericus in the contracted position exclusively in the neuroprolotherapy group (p=0.001, p=0.011, respectively). Differences in the strain ratio of both sides of the contracted musculus massetericus were demonstrated in both groups (neuroprolotherapy group: right side p<0.001, left side p=0.007, splint group: right side p=0.005, left side p=0.012). This study demonstrates that 5% dextrose neuroprolotherapy is an effective treatment comparable to an occlusal splint. Objectively visualizing changes in the masseter muscle through ultrasound provides clear results in the context of occlusal trauma and bruxism.

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.

Extracorporeal Shock Wave Treatment and Multimodal Pain Management for Tarsal Tunnel Syndrome

Introduction: Plantar fasciitis (PF) is an important cause of musculoskeletal pain and radial pressure waves (RPWs) can be used for patients not improving after 3 months of other non-operative measures. However, in refractory cases of PT, it is imperative to investigate possible differential diagnoses and one of its important differential diagnoses is tarsal tunnel syndrome (TTS). TTS is a rare but important condition which is regularly under diagnosed leading to a range of symptoms affecting the plantar aspect of the foot typically associated with a neuropathic pain pattern. Case Report: We report a case of PF with TTS and associated neuropathic components. At first, nortriptyline 50 mg and 5% lidocaine patch were used, which improved the neuropathic pattern. After that, three RPW sessions were conducted at weekly intervals, with energy between 2 and 3 bars, frequency between 5 and 7 hertz. In addition to the area of greatest pain in the plantar fascia, treatment was also applied to the myofascial trigger points of the triceps surae and posterior tibial muscles. Three months after the last RPW session, the patient reported a 90% improvement in pain intensity, without limitations in daily activities. Conclusion: This case highlights the importance of differential diagnoses of PF, especially before the indication of RPW in refractory cases. In addition to the neuropathic pattern associated with TTS, neuropathic pain associated with tendinopathies of the lower limbs is common (1/4 of cases) and needs to be identified and treated in conjunction with tendinopathy for a more effective result. Keywords: Chronic pain, Plantar fasciitis, Tarsal tunnel syndrome, Mixed pain, Neuropathic pain, Shockwaves

Effectiveness of palpation technique training and practice using a muscle-nodule-palpation simulator.

[Purpose] Extant techniques for palpating nodules, a diagnostic criterion of myofascial trigger points, lack high reliability. Therefore, this study aimed to investigate the effects of training and practice using a novel muscle-nodule-palpation simulator. [Participants and Methods] Sixteen university students (age range: 19-22 years) were randomly assigned to the training (n=8) and control (n=8) groups and used the muscle-nodule-palpation simulator to determine the position and orientation of the muscle nodule embedded in the model. During the experiment, only the participants in the training group were allowed to practice nodule detection while viewing the model through its transparent material. Subsequently, both groups underwent a performance evaluation. [Results] The training group exhibited greater improvement in performance than the control group. The means and standard errors of the improvement in the proportion of successful localization of the muscle nodule were 0.14 ± 0.06 for the control group and 0.42 ± 0.09 for the training group. [Conclusion] Training using the muscle-nodule-palpation simulator improved palpation technique for nodule localization.

Структура головных болей у пациентов молодого и среднего возраста с дисплазией соединительной ткани

The purpose — to study the structure of headaches in patients with connective tissue dysplasia (CTD). Material and methods. 100 patients of both sexes aged from 18 to 55 years old with clinical manifestations of CTD and headache were examined. The control group consisted of 30 patients with headache without CTD. Results. Patients with CTD have higher prevalence of chronic migraine, headache associated with temporomandibular joint dysfunction (TMJD). There is a trend towards a higher incidence of cervicogenic headache in combination with TMJD. Also, primary and secondary headaches in patients with CTD were accompanied by predominant blocking of the spinal motion segments of the cervical spine and the upper thoracic spine, against the background of instability and violation of the statics of the cervical spine. Also, a predominant localization of myofascial trigger points in the area of the trapezius and pericranial muscles was found. There is a trend towards higher scores on the central sensitization scale of patients with CTD.

整脊手法联合触发点疗法提高青少年特发性脊柱侧弯疗效的可行性分析

整脊手法联合触发点疗法提高青少年特发性脊柱侧弯疗效的可行性分析