Trigger Points Research Articles

Ultrasound-assisted Trigger Point Injection for Cutaneous Nerve Entrapment Syndrome.

Ultrasound-assisted Trigger Point Injection for Cutaneous Nerve Entrapment Syndrome.

Ultrasound-guided ınjections of 2 internal rotators with one needle: Trigger point treatment for shoulder pain.

Ultrasound-guided ınjections of 2 internal rotators with one needle: Trigger point treatment for shoulder pain.

Three Subtypes of Cutaneous Nerve Entrapment Syndrome: A Narrative Review.

Anterior, lateral, and posterior cutaneous nerve entrapment syndromes have been proposed as etiologies of trunk pain. However, while these syndromes are analogous, comprehensive reports contrasting the three subtypes are lacking. We therefore reviewed the literature on anterior, lateral, and posterior cutaneous nerve entrapment syndrome. We searched the PubMed and Cochrane Library databases twice for relevant articles published between March and September 2022. In addition to 16 letters, technical reports, and review articles, a further 62, 6, and 3 articles concerning anterior, lateral, and posterior cutaneous nerve entrapment syndromes, respectively, were included. These syndromes are usually diagnosed based solely on unique history and examination findings; however, the diagnostic process may be prolonged, and multiple re-evaluations are required. The most common first-line treatment is trigger point injection; however, the management of refractory cases remains unclear. Awareness of this disease should be expanded to medical departments other than general medicine.

Effects of Trigger Point Dry needling Brachioradialis on Type Writing Speed and Pain

Effects of Trigger Point Dry needling Brachioradialis on Type Writing Speed and Pain

Impact of needle warming moxibustion combined with trigger point massage on shoulder function and stress responses in elderly patients with frozen shoulder.

To explore the therapeutic effects of needle warming moxibustion (NWM) combined with trigger point massage on shoulder function and stress responses in elderly patients with frozen shoulder (FS), providing clinical guidance. A retrospective analysis was conducted on 116 patients with FS treated at the Guangdong Work Injury Rehabilitation Hospital from October 2022 to October 2023. The study included 61 patients who received NWM combined with trigger point massage (research group) and 55 patients who received conventional treatment (control group). Shoulder function and pain were assessed using the Constant-Murley Score (CMS) and the Short-Form McGill Pain Questionnaire (SF-MPQ). Additionally, the time to resume normal daily activities, time to achieve no self-perceived pain, and adverse reactions were documented. Post-treatment stress response indicators and inflammatory factors; adrenaline (ADR), cortisol (Cor), adrenocorticotropic hormone (ACTH), C-reactive protein (CRP), nitric oxide (NO), and prostaglandin E2 (PGE2), were measured. A 3-month follow-up was conducted to record prognostic recurrence. After treatment, the research group showed significantly better shoulder function, reduced pain, and shorter times to resume daily activities and to achieve no self-perceived pain compared to the control group (all P<0.05). Post-treatment levels of ADR, Cor, ACTH, CRP, NO, and PGE2 were also lower in the research group (all P<0.05). The incidence of adverse reactions did not significantly differ between groups (P>0.05); however, the recurrence rate was lower in the research group compared with the control group (P<0.05). NWM combined with trigger point massage effectively improves shoulder function and reduces inflammation and stress responses in elderly patients with FS, supporting its clinical application.

Precision Trigger Point Injections: An Anatomically Guided Approach for Anterior Cutaneous Nerve Entrapment Syndrome Treatment.

Precision Trigger Point Injections: An Anatomically Guided Approach for Anterior Cutaneous Nerve Entrapment Syndrome Treatment.

Fluid jets and polar domains, on the relationship between electromechanical instability and topology in ferroelectric nematic liquid crystal droplets.

Ferroelectric nematic liquid crystals are a class of recently discovered fluid materials formed by highly polar molecules that spontaneously align along a common direction, giving rise to a macroscopic polarization P. Since the polarization vector is locally collinear to the optical axis n, the study of the spatial patterns of n enables deducing the structure of P. We have carried on such topological study on ferroelectric nematic droplets confined between two solid ferroelectric substrates both when the droplet is in equilibrium and during a jet-emission phase that takes place when the solid surfaces become sufficiently charged. We find that in equilibrium the droplet splits in striped domains in which P has alternating directions. When these domains extend close to the droplets' perimeter, P adopts a π-twisted structure to minimize accumulation of polarization charges. As the substrate surface charge is increased above threshold, fluid jets are emitted with a quasi-periodic pattern, a behaviour suggesting that their location is governed by an electrofluidic instability on the droplets' rim, in turn indicating the absence of specific trigger points. Soon after their emission, the jet periodicity is lost; some jets retract while other markedly grow. In this second regime, jets that grow are those that more easily connect to polar domains with P along the jet axis. Occasionally, ejection of isolated spikes also occurs, revealing locations where polarization charges have accumulated because of topological patterns extending on length scales smaller than the typical domain size.

Treatment of fibromyalgia among patients with mastalgia and fibromyalgia improved mastalgia.

The aim of this study is to examine the effect of fibromyalgia (FM) treatment on mastalgia by performing fibromyalgia screening in patients who applied for mastalgia and whose underlying cause could not be found. Patients who applied to Kocaeli University General Surgery Outpatient Clinic between November 2017 and November 2020 with breast pain were included (n=120). Patients without cancer, systemic disease, previous breast surgery, and breast mass larger than 3 cm (n=30) were referred to the Physical Therapy and Rehabilitation Outpatient Clinic. A total of 13 patients (43%) were diagnosed with FMS. Twelve of them were given selective serotonin-noradrenaline reuptake inhibitor (duloxetine) treatment for 3 months. Turkish version of the Short Form - 36 (SF-36) quality of life scores, Visual Analog Scale (VAS), Cardiff breast pain score before and after treatment were compared. The remaining 17 patients were followed as only mastalgia. Patients with fibromyalgia and mastalgia had similar demographic results. At the end of the 3rd month, the complaints of breast pain completely regressed in all of the patients. Statistically significant changes were detected in VAS score, the number of trigger points, and SF-36 quality of life scores, Cardiff breast pain score after duloxetine treatment. In the presence of unexplained mastalgia, fibromyalgia should be kept in mind. Duloxetine treatment improved the breast pain and quality of life in patients with mastalgia and fibromyalgia.

Impact of Extracorporeal Shockwave Therapy on Quadratus Lumborum Trigger Point Associated with Chronic Low Back Pain: A Scoping Review

Impact of Extracorporeal Shockwave Therapy on Quadratus Lumborum Trigger Point Associated with Chronic Low Back Pain: A Scoping Review

Physiatry for Treating Hip, Knee, and Back Pain.

Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.

The Use of Exercise Prescription in Australian Osteopathy Practice: Secondary Analysis of a Nationally Representative Sample of the Profession.

Exercise is beneficial for improving general health, wellbeing, and specific medical conditions. In musculoskeletal conditions such as chronic low back and neck pain, prescribed exercise has been found to be moderately effective in decreasing pain and improving function. Osteopaths are primary contact health professionals who manage predominantly musculoskeletal complaints. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and profiles the characteristics of osteopaths who often use exercise prescription in patient care. Methodology. Secondary analysis of a cross-sectional survey of 992 osteopaths was registered with the Osteopathy Research and Innovation Network, an Australian practice-based research network. Demographics, practice, and treatment characteristics of Australian osteopaths who "often" use exercise prescription in patient care were examined. Seven-hundred and thirty-three Australian osteopaths (74%) indicated that they use exercise prescription "often" in patient care. Australian osteopaths who often use exercise prescription are more likely to be colocated with another osteopath (ORa 1.54) and send referrals to an exercise physiologist (ORa 1.94) and a specialist medical practitioner (ORa 1.72). Those osteopaths who often used exercise prescription were also more likely to discuss physical activity (ORa 5.61) and nutrition (ORa 1.90). Australian osteopaths who use exercise prescription often were more likely to treat patients with sports injuries (ORa 2.43) and use soft tissue techniques (ORa 1.92), trigger point techniques (ORa 2.72), and sports taping (ORa 1.78). Osteopaths who utilise exercise prescription were more likely to discuss physical activity, diet, and nutrition and utilise referral networks with specialist medical practitioners and exercise physiologists. Australian osteopaths who often use exercise prescriptions were also more likely to treat patients with sport injury. The results suggest that most Australian osteopaths use exercise prescription and have referral networks with other health professionals for patient management. Further work is required to explore the type of exercise prescription used and for what conditions.

The cooperation between physiotherapist and dentist in treatment of patient with functional disorders of the masticatory system – questionnaire survey

Introduction. The experience gained by dentists and physiotherapists in the field of masticatory organ dysfunctions in relation to the body as a whole confirms the belief that the issue of disorders of the masticatory organ motor system is not a local problem. Therefore, the treatment of this type of diseases should not be limited only to the reconstruction of static and dynamic occlusion using conservative, orthodontic or prosthetic methods, neglecting the appropriate mobilization of the musculoskeletal, fascial, osteoarticular chains associated with the cervical section and further sections of the spine. Limiting the diagnosis and therapy of functional disorders only to elements of the stomatognathic system may generate even greater ailments and diseases in the patient. A wide range of symptoms related to the stomatognathic system, causing unpleasant pain and emotional disorders, determines patients to seek help from many specialists, including: otolaryngologist, neurologist or physiotherapist. The patient has a chance to cure these health problems, provided that the entire rehabilitation team works: a dentist, a physiotherapist, a psychologist and a speech therapist specializing in masticatory system dysfunctions. Aim of study. The aim of the study was to determine the needs for establishing cooperation between a physiotherapist and dentist in the treatment of patients with functional disorders of the masticatory system. Material and methods. The research was conducted among 28 physiotherapists from the West Pomeranian Voivodeship. The diagnostic tool used was an interview questionnaire, containing a number of questions regarding the conditions and quality of establishing cooperation with a dentist in the management of patients referred for physiotherapy treatments for the treatment of disorders in the stomatognathic system. Conclusions. Existing physiotherapeutic methods shorten the duration of the disease, e.g. through massages, manual therapy (trigger point therapy, mobilization, post-isometric muscle relaxation), physical treatments (ultrasounds, biostimulation laser, cryotherapy, light therapy, magnetic field) and exercises (relaxation, stabilization, proprioception), which the patient performs under the supervision of a therapist and then alone at home. Achieving positive effects in the treatment of patients with stomatognathic disorders requires constant cooperation between a dentist and a physiotherapist. Only a comprehensive, holistic diagnostic and therapeutic approach is a condition for effective treatment.

Hybrid Warfare: Strategies and Counterstrategies in the India-Pakistan Rivalry

Hybrid Warfare represents a sophisticated amalgamation of diverse warfare strategies, seamlessly blending both conventional and non-conventional techniques. This nuanced approach encompasses an array of tactics, incorporating elements from fake news to cybercrimes, civil unrest to economic warfare, and diplomacy to separatist movements. Also recognized as asymmetrical or new-generation warfare, its primary objective is not confrontation but to meticulously identify and exploit the fault lines, vulnerabilities, and trigger points within the targeted nation. Pakistan has been subject to hybrid security threats from its historic rival India since the day of independence. The paper sheds light on Indian hybrid warfare against Pakistan which broadly encompasses political and diplomatic support to the separatist movements, targeted campaigns on social media, and hindering the timely completion of CPEC and other developmental projects. Given the intensity of hybrid security threats and their fall-flanged impact on the peace, development, and security of the state, the article has attempted to provide comprehensive policy options for Pakistan to effectively counter the hybrid threats.

Efficacy of cervical mobilization with post-isometric relaxation in managing mechanical neck pain, ROM, and functional limitations associated with myofascial trigger points

Background: Sedentary lifestyle, age-related degenerative changes or traumatic injuries leads to cervical spine structural mal-alignment, which results in neck pain and other symptoms. Various therapeutic exercises and manual techniques have been proven to be beneficial in terms of managing these symptoms. This study aimed to determine the combined effects of cervical mobilization and post-isometric relaxation (PIR) technique on managing neck pain, cervical side flexion range of motion, and functional limitation in participants with mechanical neck pain linked with myofascial trigger points. Methods: This study followed a 2-arm, parallel-group, pretest-posttest randomized comparative design. Thirty participants with mechanical neck pain associated with myofascial trigger points aged 30.87 ± 4.45 years were randomly allocated to Groups 1 and 2. Group 1 received conventional intervention, PIR, and cervical mobilization techniques while Group 2 received conventional intervention and PIR technique only. Neck pain, muscle tenderness, cervical range of motion, and functional limitations were assessed using a visual analog scale, pressure pain threshold (PPT), goniometer, and neck disability index (NDI) questionnaire, respectively at baseline on day 1 and post-intervention on day 7, 14, and 21. Wilcoxon signed-rank test and the Mann–Whitney U test evaluated within-group and between-group analyses, respectively. Statistical significance was established at a 95% confidence interval, indicated by P &lt; .05. Results: Significant differences (95% confidence interval [CI], P &lt; .05) were observed within each group for all the outcomes scores when compared to the baselines across multiple time points. Significant variations were observed between the groups when comparing visual analog scale and NDI scores at weeks 1, 2, and 3 post-interventions. In contrast, insignificant differences (95% CI, P &gt; .05) were observed for side flexion range of motion and PPT compared at weeks 1, 2, and 3 post-interventions except for PPT at week 3 post-intervention (95% CI, P &lt; .05). Additionally, Cohen d test revealed the superiority of group 1 over group 2 in reducing pain and functional limitations and improving cervical side flexion range of motion and PPT. Conclusion: The combination of cervical mobilization and Post-isometric relaxation techniques was discovered to effectively alleviate neck pain and enhance functional abilities when contrasted with the application of post-isometric relaxation alone in patients with mechanical neck pain linked with myofascial trigger points.

Association between myofascial trigger point therapy and conditioned pain modulation

IntroductionMyofascial trigger point therapy (MTrP) is a widely used therapeutic approach, although the underlying mechanisms remain unclear. Mechanisms discussed include peripheral involvement of muscles as well as central pain modulating processes such as the conditioned pain modulation (CPM). The aim of this study was to investigate whether the analgesic response of MTrP and the analgesic response of CPM correlate in asymptomatic participants in order to identify shared underlying mechanisms of MTrP and CPM. MethodBoth, CPM and MTrP protocols consisted of heat-based test stimuli (heat pain thresholds before and after the intervention) and pressure-based (conditioning) stimuli. Asymptomatic participants (n = 94) were randomly assigned to receive either mild, intense or no pressure stimuli (between-group design) to both the fingernail and the MTrP of the infraspinatus muscle (within-group design). Pressure stimuli at both locations (fingernail, MTrP) were applied with a pressure algometer for 120 s and continuously adjusted to maintain a constant pain intensity of mild or intense pain. All thermal stimuli were applied on the lower leg with a thermal stimulator. ResultsA significant correlation was shown between the analgesic effect of CPM and MTrP therapy for mild (r = 0.53, p = 0.002) and intensive stimuli (r = 0.73, p < 0.001). 17.3% of the variance of the MTrP effect were explained by CPM after mild stimulation, and 47.1% after intense stimulation. Pain-related characteristics did not explain the variance within the analgesic response using a regression analysis. ConclusionsBetween the analgesic responses following MTrP and CPM paradigms, a moderate to strong correlation was observed, suggesting shared underlying mechanisms.

Патогенез, ангиогенез диабетического макулярного отека и общая характеристика его лечения (Обзор литературы. Часть I)

Currently, the increase in the prevalence of diabetes mellitus is in the nature of a pandemic. Diabetic macular edema is a vision-threatening complication of diabetic retinopathy, the pathogenesis of which is multifactorial and includes hyperglycemia, endothelial dysfunction, leukostasis and inflammation, vasoconstriction and occlusion, oxidative stress and ischemia, neovascularization, which leads to the accumulation of exudative fluid, thickening of the central zone of the retina and irreversible processes of photoreceptors neurodegeneration with a significant decrease in visual functions. The article presents up-to-date information on the epidemiology, patho- and angiogenesis of this condition as well as the general characteristics of the DMO therapy. It consists of primary treatment of diabetes, laser photocoagulation and anti-angiogenic therapy. Intravitreal drug therapy based on VEGF inhibitors is currently the standard first-line treatment for DMO. The authors emphasize the necessity for further study of trigger points in the pathogenesis of diabetic retinopathy and the development of diabetic macular edema in order to find new drugs and work out a more individualized approach to patients. Key words:: diabetic retinopathy, diabetic macular edema, vascular endothelial growth factor, VEGF-therapy

Drivers of MSME loan defaults using survival analysis: implications for lenders and policy planners

PurposeThe authors analyse the determinants of loan defaults in micro, small and medium enterprises (MSME) loans in India from the survival duration perspective to draw inferences that have implications for lenders and policymakers.Design/methodology/approachThe authors use the Kaplan–Meier survivor function and the Cox Proportional Hazard model to analyse 4.29 lakhs MSME loan account data originated by a large bank having a national presence from 1st January 2016 to 31st December 2020.FindingsThe estimated Kaplan–Meier survival function by various categories of loan and socio-demographic characteristics reflects heterogeneity and identifies the trigger points for actions. The authors identify the key identified default drivers. The authors find that the subsidy amount is more effective at the lower level and its effectiveness diminishes significantly beyond an optimum level. The simulated values show that the effects of rising interest rates on survival rates vary across industries and types of loans.Practical implicationsThe identified points of inflection in the default dynamics would help banks to initiate actions to prevent loan defaults. The default drivers identified would foster more nuanced lending decisions. The study estimation of the survival rate based on the simulated values of interest rate and subsidy provides insight for policymakers.Originality/valueThis study is the first to investigate default drivers in MSME loans in India using micro-data. The study findings will act as signposts for the planners to guide the direction of the interest rate to be charged by banks in MSME loans, interest subvention and tailoring subsidy levels to foster sustainable growth.

Trigger points and high growth firms: the vital role of founder “sensing” and “seizing” capabilities

PurposeResearch on high growth firms is booming yet a strong conceptual understanding of how these firms obtain (and sustain) rapid growth remains (at best) partial. The main purpose of this paper is to explore the role founders play in enabling episodes of rapid growth and how they help navigate this process.Design/methodology/approachThis paper reports the findings from a qualitative study involving in-depth interviews with entrepreneurs enlisted onto a publicly funded high growth business accelerator programme in Wales. These interviews explored the causes of the firms rapid growth, their key growth trigger points and the organisational consequences of rapid growth.FindingsThe research reveals that periods of high growth are intrinsically and inextricably inter-linked with the entrepreneurial traits and capabilities of their founders coupled with their ability to “sense” and “seize” pivotal growth opportunities. It also demonstrates founder-level dynamic capabilities enable firms to capitalise on pivotal “trigger points” thereby enabling their progression to a new “dynamic state” in a firm’s temporal evolution.Originality/valueThe novel approach towards theory building deployed herein is the use of theoretical elaboration as means of extending important existing theoretical constructs such as growth “trigger points” and founder dynamic capabilities. To capitalise on these trigger points, founders have to undergo a process of “temporal transitioning” to effectively manage and execute the growth process in firms. The work also has important policy implications, underlining the need for more relational forms of support for entrepreneurial founders.

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.

Hyperexcitability of muscle spindle afferents in jaw-closing muscles in experimental myalgia: Evidence for large primary afferents involvement in chronic pain.

The goals of this review are to improve understanding of the aetiology of chronic muscle pain and identify new targets for treatments. Muscle pain is usually associated with trigger points in syndromes such as fibromyalgia and myofascial syndrome, and with small spots associated with spontaneous electrical activity that seems to emanate from fibers inside muscle spindles in EMG studies. These observations, added to the reports that large-diameter primary afferents, such as those innervating muscle spindles, become hyperexcitable and develop spontaneous ectopic firing in conditions leading to neuropathic pain, suggest that changes in excitability of these afferents might make an important contribution to the development of pathological pain. Here, we review evidence that the muscle spindle afferents (MSAs) of the jaw-closing muscles become hyperexcitable in a model of chronic orofacial myalgia. In these afferents, as in other large-diameter primary afferents in dorsal root ganglia, firing emerges from fast membrane potential oscillations that are supported by a persistent sodium current (INaP ) mediated by Na+ channels containing the α-subunit NaV 1.6. The current flowing through NaV 1.6 channels increases when the extracellular Ca2+ concentration decreases, and studies have shown that INaP -driven firing is increased by S100β, an astrocytic protein that chelates Ca2+ when released in the extracellular space. We review evidence of how astrocytes, which are known to be activated in pain conditions, might, through their regulation of extracellular Ca2+ , contribute to the generation of ectopic firing in MSAs. To explain how ectopic firing in MSAs might cause pain, we review evidence supporting the hypothesis that cross-talk between proprioceptive and nociceptive pathways might occur in the periphery, within the spindle capsule.