Taut Band Research Articles

Quality of Life in Oral Submucous Fibrosis: A Systematic Review.

Oral submucous fibrosis (OSMF) is a chronic, insidious disease and is said to have a multifactorial origin with varied clinical manifestation of repeated oral ulcers, intolerance to spicy food, mucosal blanching resulting in stiffness of the oral mucosa and formation of taut bands leading to reduced mouth opening. We designed this study to systematically review the literature on QOL in OSMF and hope to make recommendations for future course of QOL assessment in OSMF. An electronic bibliographic search of studies was done from year 1900-2019 using specified keywords. The following databases were searched: PubMed, Ovid, Google Scholar and manual search were done from references of relevant articles. Of the screened 156 articles, finally 10 studies were included after screening for inclusion/exclusion criteria. Quality assessment of studies was completed using the Effective Public Health Practice Project (EPHPP) criteria for quantitative studies. Most instruments used in the studies were not disease specific for OSMF except one study. Six types of questionnaires were used. The heterogeneity in study population, study designs, QOL instruments and outcome measures made it difficult for a comparison. Therefore, a quantification analysis was not possible. Also pure OSMF data without the involvement of other lesions were less in number. OSMF not only physically debilitates a patient, it has its repercussions on the social, physical, psychological domains as well. Another aspect is that apart from trismus, which is the most common and evident symptom associated with OSMF, a substantial part of the suffering that ensues is also because of the ulcerations, burning sensation and worsening of dental health. Another focus was the association of worse QOL with a higher grade of disease, longer and higher tobacco abuse contact duration. This review is unable to give a confident answer to the evidence on QOL in OSMF but definitely showers light on the evident lack of robust data on the same. Robust Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation methodological and adequately powered studies on assessing QOL in OSMF using only a reliable disease specific questionnaire is the need of the hour. PROSPERO Registration: CRD42018102874.

Immediate effect of kinesio tapping V.S ischaemic compression on myofascial trigger points of trapezius muscle

Introduction: Myofascial pain syndrome is the most common cause of myofascial pain which is mainly due to myofascial trigger points. The myofascial trigger points are spots of hyperirritability located in the muscle as a taut band which on palpation or compression is tender and has referral pain. Some studies state that trigger points may form as a result from or be irritated by overuse, faulty posture, trauma, mechanical over load or psychological stress. We in our study have aimed to compare the immediate effect of Kinesio tapping with Ischaemic compression on trigger points in trapezius muscle. Materials and Methods: 30 subjects were included in the study, which were divided in Group A (Kinesio Taping) and Group B (Ischemic Compression). Outcome measure was assessed on the basis of NPRS and Cervical Spine ROM based on Pre and Post procedure readings according to the respective groups. Conclusion: Kinesio tapping and ischemic compression both treatment are effective individually to relive pain and increase lateral flexion range of cervical spine and work effectively on different individuals to get the same result.

Volume 3, Issue 1 (Continuously Updated 2020) Func Disabil J 2020, 3(1): 111-122 | Back to browse issues page ‎ 10.32598/fdj.3.16 XML Print Download citation: BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks Send citation to: Mendeley Zotero RefWorks Parandnia A, Yassin M, Sarrafzadeh J, Salehi R, Navaei F. Comparison of the Effects of

Background & Objectives: Myofascial Trigger Point (MTrP) is one of the most common musculoskeletal disorders. The MTrP includes highly sensitive points within a taut band, is painful to palpation, and causes pain in a specific pattern. The MTrP is more prevalent in the upper trapezius muscle because this muscle plays an important role in maintaining the posture of the head and neck. This study aimed to compare the effects of dry needling and high-intensity laser therapy on the clinical signs of females with active trigger points in the upper trapezius muscle. Methods: Thirty females with the active MTrP of the upper trapezius muscle were randomly assigned into two groups: high-intensity laser therapy group (n=15) and dry needling group (n=15); they received the interventions in five sessions for three weeks. The outcome measures included pain intensity and pain pressure threshold, which were assessed before and two days after the interventions. Results: In both study groups, the scores of the visual analogue scale of pain were significantly decreased, also, the pain pressure threshold was significantly increased (P=0.001), after the treatment. However, the two groups did not significantly differ in any of the outcome measures (P>0.05). Conclusion: Both high-intensity laser therapy and dry needling can be employed to treat the MTrP of the upper trapezius muscle. Considering the effectiveness of the two treatments, each of the methods can be alternatively selected for these patients.

Effect of Ischemic Compression and Infrared Radiations on Myofascial Trigger Point of Trapezius

Background and Objective: Trigger point is a hypersensitive spot in a taut band of skeletal muscles, it has intense pain while compression, producing movement and any alterations. Trapezius is the common muscle always develop trigger point, although various management exist in managing the trigger point still there are lot of scope in the research. So far, there are no studies on combining IRR with ischemic compression. The objective of the study was to identify the effect of ischemic compression and infrared radiation on myofascial trigger point of trapezius muscle with neck pain patients. Material and Methods: 60 patients were included for the study using experimental study design, they were recruited following due consideration of the selection criteria. First group is an experimental group, which receives IRR along with Ischemic compression therapy for 20 minutes. Second group is control group receives only IRR with gentle neck stretches for 20 minutes. All patient was advised to follow home advices and instructions given by the therapist through the period of the treatment. Written consent was obtained from every individual participant. The study duration was six months and the individual patient underwent 8 weeks. Study identifies two measures as an outcome, which are pain using numerical pain scale and trigger using pressure pain threshold. Results: Blinded assessor is used to identify the data’s collected from the patient during the initial visit and at the last visit by the participant. All the collected data were analyzed using SPSS 20.0. The result of the study shows that pain scale was 9.72 (p<0.001) and PPT was 12.25 (p<0.001). Conclusion: This study concluded that ischemic compression with infrared radiation therapy in myofascial trigger point of trapezius muscle in neck pain patients and it also significantly reduces the pain as well as the Pressure pain threshold.

Quantitative response of healthy muscle following the induction of capsaicin: an exploratory randomized controlled trial

BackgroundMyofascial pain syndrome (MPS) is a prevalent chronic pain disorder primarily characterized by myofascial trigger points (MTrPs). There is limited knowledge on the pathophysiology and mechanisms underlying MTrP and its development. Research has previously demonstrated the identification of MTrPs using ultrasound and vibration sonoelastography, although there is some contradictory evidence regarding if MTrPs present as hyper or hypoechoic regions. Electromyography (EMG) investigations of MTrP have demonstrated that MTrPs are usually located proximal to innervation zones where the peak surface EMG signals are obtained from. Central sensitization has been proposed as the primary mechanism underlying MTrP development. Central sensitization is associated with hyperexcitability of neuronal responses to normal or noxious stimuli. There is a need for a study that measures ultrasound image textural changes and motor unit activity responses in the muscle following sensitization. The purpose of this study is to determine whether sensitizing healthy muscle using capsaicin induces a regional change in image texture variables within the specific and surrounding muscles, as well as the motor unit frequency and amplitude changes that accompany them. This is an exploratory trial that aims to provide preliminary evidence on whether central sensitization is a direct cause of taut band and MTrP development.MethodsEthical approval was obtained from the University Health Network (UHN) Research Ethics Board. This proposed study is a single centered, factorial, randomized placebo-controlled trial with two independent variables, depth of capsaicin application and dose of capsaicin, for a total of six treatment arms and three control treatment groups.DiscussionThis will be the first study that assesses the B-mode ultrasound image texture of induced sensitized muscles and will provide more evidence on muscle motor unit activity and regional changes of central sensitization. Findings from this study may support one of few hypotheses proposed delineating the involvement of central sensitization in the development of trigger points.Trial registrationNational Institutes of Health ClinicalTrials.gov NCT03944889. Registered on May 07, 2019

Increased substance P-like immunoreactivities in parabrachial and amygdaloid nuclei in a rat model with masticatory myofascial pain.

This study explores the involvement of substance P (SP) in the parabrachial nucleus (PBN) and central amygdaloid nucleus (CeA) in the nociception-emotion link and of rats with masticatory myofascial pain (MMP) induced by chronic tetanic eccentric muscle contraction. A total of 18 rats were randomly and equally assigned for MMP (MMP group) and sham-MMP induction (sMMP group). MMP was induced by electrical-stimulated repetitive tetanic eccentric contraction of the masseter muscle for 14 consecutive days. Myofascial trigger points in the masseter muscle were identified by palpable taut bands, increased prevalence of endplate noise (EPN), focal hypoechoic nodules on ultrasound and restricted jaw opening. All animals were killed for morphological and SP immunohistochemical analyses. Chronic tetanic eccentric contraction induced significantly thicker masseter muscle confirmed by hypoechogenicity, increased prevalence and amplitudes of EPN, and limited jaw opening. Immunohistochemically, the SP-like positive neurons increased significantly in PBN and CeA of the MMP group. Our results suggested that MMP increases the SP protein levels in PBN and CeA, which play important roles in MMP-mediated chronic pain processing as well as MMP-related emotional processes.

The pathophysiological nature of sarcomeres in trigger points in patients with myofascial pain syndrome: A preliminary study.

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

No additional benefit of trigger point therapy in cervical spondylosis patients treated with physiotherapy

Abstract Introduction: Trigger points are defined as exquisitely tender spots in discrete taut bands of hardened muscle that produce symptoms. Trigger point therapy is increasingly accepted in the medical literature. Clinical and electrophysiological research has provided biological plausibility for the existence of trigger points. Aim: The main purpose of this study was to determine the additional benefit of trigger point therapy on cervical pain, mobility and functionality in cervical spondylosis patients treated with physiotherapy. Materials and methods: We conducted a 3-week interventional study on eighteen patients diagnosed with cervical spondylosis addressed to a physiotherapy clinic for treatment. After signing an informed consent, patients were randomly allocated into two groups: the study group - which had trigger point therapy added to the common physiotherapy treatment protocol and the control group - which benefited from common physiotherapy treatment only. All patients were evaluated using the Visual Analog Scale, Neck Disability Index and cervical mobility. All evaluations were made before treatment, after 2 weeks and 3 weeks of treatment. Results: Both the study and control groups had significantly improved in pain, cervical mobility and physical function. The pain and functionality comparison at the end of the study, did not find significant differences between groups. Conclusion: The study shows that adding trigger point therapy to common physiotherapeutic treatment is not followed by additional improvement in pain, mobility or physical function of patients with cervical spondylosis.

Assessment of Interleukin-6 in Young Swimmers Suffering from Myofascial Pain Syndrome Using LidocainePhonophoresis: A Randomized Controlled Trial

To investigate interleukin-6 in athletic children suffering from myofascial pain syndrome (MPS) using lidocaine phonophoresis. Myofascial pain syndrome is considered a major health dilemma affecting both adults and children due to overuse injuries. Moreover, it is one of the most common conditions of chronic musculoskeletal pain of patient’s in general medical practice. The exact cause of MPS is unidentiϑied. However, it could be diagnosed among physicians by the presence of hypersensitive nodules referred to as myofascial trigger points (MTrPs) within a taut bands of skeletal muscle. Forty ϑive young swimmers(boys) with MPS in the upper trapezius muscle (10 - 14 years old) participated in the study. Assessment of serum interleukine-6, functional activities and cervical range of motion were measured before and after treatment. They were randomly assigned to three groups (n=15 in each), ϑirst one kept as a control group (A) and allocated to special designed physical therapy program. The two study groups (B and C) were treated by pulsed ultrasound and lidocaine phonophoresis respectively. Equally, study groups received similar physical therapy program assumed to the control. Treatment submission was assembled as 40 minutes, 3 times / week for three consecutive months. After treatment there was a signiϑicant enhancement within the control and study groups. Group C revealed a higher degree of response to treatment. Both lidocaine phonophoresis and special designed physical therapy program simultaneously could provide very useful and interesting treatment of neck pain in youth athletes using IL-6 as a tool of diagnosis.

Spectral Analysis of Heart Rate Variability During Trigger-Point Acupuncture of Various Muscles.

Objective: The aim of this research was to clarify changes in cardiovascular autonomic nervous system function due to trigger-point (TP) acupuncture; the current author evaluated differences in responses among acupuncture at TPs of various muscles using spectral analysis of heart rate variability. Materials and Methods: Subjects were 48 healthy men. Before measurements began, subjects were assigned to a TP acupuncture or control group based on presence/absence of referred pain on applying pressure to a taut band within the right extensor digitorum muscle, tibialis anterior muscle, gluteus medius muscle, or masseter muscle. Measurements were conducted in a room with a temperature of 25°C, with subjects in a long sitting position after 10 minutes of rest. Acupuncture needles were retained for 10 minutes at 1 site on the right extensor digitorum muscle, tibialis anterior muscle, gluteus medius muscle, or masseter muscle. Electrocardiography was performed simultaneously with respiratory-cycle measurements. Based on the R-R interval on the electrocardiograms, frequency analysis was performed, low-frequency (LF) and high-frequency (HF) components were extracted, and the ratio of LF to HF components (LF/HF) was evaluated. Results: All subjects in the TP acupuncture group showed a transient increase in the HF component, but no significant changes in heart rate (HR) or LF/HF. In the control group, no significant changes were observed in HR, HF component, or LF/HF. Conclusions: These data suggest that acupuncture stimulation of TPs of the right extensor digitorum muscle, tibialis anterior muscle, gluteus medius muscle, and masseter muscle increases parasympathetic nerve activity transiently.

Plasma rich in growth factors injection effectiveness for myofascial pain treatment in masticatory muscles. Randomised controlled trial.

Myofascial pain in masticatory muscles is one of the most common temporomandibular disorder. Nowadays, the most usable treatment methods are based on the muscle taut band cell membrane disruption, which releases the taut band. Platelet-rich plasma, made with PRGF Endoret® method, gives an opportunity to use platelet-derived growth factors in treatment processes. It has been proven that platelet-derived growth factors can relief pain and activate muscle regeneration. To test a hypothesis that PRGF injections can be effective for treating myofascial pain in masticatory muscles. Fifty adult patients participated in the study. Participants were randomly divided into two groups. The first group received 1-mL lidocaine injections to trigger point in their masseter muscle. The second group of patients received 1-mL PRGF injections. The patients' pain was measured by using visual analogue scale (VAS). Statistically significant difference in pain levels before the procedure and 4weeks after it was found in both groups. There was no statistically significant difference between groups in pain levels before the procedure (P=.063) and 2weeks after it (P=.123); however, statistically significant difference was noticed 4weeks after the procedure (P<.001). Four weeks after the procedure, patients' average pain in lidocaine group was 3.4 on VAS, and it was 0.9 in PRGF group. PRGF injections in masseter muscle affected by myofascial pain syndrome are an effective treatment method. PRGF injections more effectively relief myofascial pain in masseter muscle than lidocaine injections.

Foci of Segmentally Contracted Sarcomeres in Trapezius Muscle Biopsy Specimens in Myalgic and Nonmyalgic Human Subjects: Preliminary Results.

The myofascial trigger point hypothesis postulates that there are small foci of contracted sarcomeres in resting skeletal muscle. Only one example, in canine muscle, has been published previously. This study evaluated human muscle biopsies for foci of contracted sarcomeres. The Departments of Rehabilitation Sciences and Physiotherapy at Ghent University, Ghent, Belgium. Biopsies from 28 women with or without trapezius myalgia were evaluated, 14 in each group. Muscle biopsies were obtained from regions of taut bands in the trapezius muscle and processed for light and electron microscopy and for histochemical analysis. Examination of the biopsies was blinded as to group. A small number of foci of segmentally contracted sarcomeres were identified. One fusiform segmental locus involved the entire muscle fiber in tissue from a myalgic subject. Several transition zones from normal to contracted sarcomeres were found in both myalgic and nonmyalgic subjects. The distance between Z-lines in contracted sarcomeres was about 25-45% of the same distance in normal sarcomeres. Z-lines were disrupted and smeared in the contracted sarcomeres. A small number of foci of segmentally contracted sarcomeres were found in relaxed trapezius muscle in human subjects, a confirmation of the only other example of spontaneous segmental contraction of sarcomeres (in a canine muscle specimen), consistent with the hypothesis of trigger point formation and with the presence of trigger point end plate noise.

Anatomical basis of the temporal muscle trigger points

BackgroundMyofascial syndrome is a common cause of chronic musculoskeletal pain associated with activity restrictions and is characterized by myofascial trigger points (MTP). MTP are clinically identified by palpation of a muscle or fascial taut band. Pathophysiology of MTP is unclear, coincidence between them and muscle motor plate has been suggested. The temporal muscle is related to headache and temporomandibular disorders. Pain radiates from hyperalgesic points to distant areas just as it is reported in patients with neck pain and symptoms in the orofacial region. Temporal muscle locates trigger areas and trigger points in various parts of the muscle. Four trigger points are selected, but an anatomical correlation is missingMethodsTemporal muscles from six cadavers were carefully dissected from their origins in order to observe the exact point where nerve fibers penetrated the muscle belly. As muscle size varies among individuals, we calculated the relative entry point of the nerve into the muscle by defining six different areas in the muscle belly: three superior (I, II and III) and three inferior (IV, V and VI), beginning at the posterior margin of the muscle. Statistical analyzis OF anatomical data was obtainded by Poisson distribution and logarithm link function followed by Bonferroni multiple comparisons. (p &lt;0.05)ResultsAreas II and III had the largest number of temporal nerve entry sites, with a mean of 3 sites (25%), followed by quadrant V and VI with a mean of 2 sites (16%) and quadrant I and IV with a mean of 1 site (9%).ConclusionIn accordance with the clinical literature, the branches of the temporal nerve in the temporal muscle corresponded to the described areas of the myofascial trigger points (MTPs). Anatomical correlations between MTPs may be a useful tool for a better understanding of the physiopathology of these disorders and may provide a rational basis for their treatment.

Effect of dry needling on submaximal strength and pain in patients with active myofascial trigger points in the rectus femoris: A case series

AbstractA myofascial trigger point (MTrP) is a hyperirritable area of a skeletal muscle, of nodular appearance on palpation and located in a taut band. One of the techniques for the treatment of MTrP is dry needling (DN). The aim of the present work was to determine whether treatment with DN is effective in terms of pain relief and improvement of muscle weakness. For this purpose, differences in the Visual Analog Scale (VAS) and the Brzycki Test were observed before and after treatment of an active MTrP of the rectus femoris. In total, 5 patients received the treatment, of which 80% showed an improvement in pain and an increase in submaximal strength. Although it is not possible to establish a causal relationship, the results appear consistent with our hypothesis that DN is able to generally improve the symptoms of pain and weakness that appeared in patients.

The Effectiveness of the Polarized Low-Level Laser in the Treatment of Patients With Myofascial Trigger Points in the Trapezius Muscles.

Introduction: This study assessed the effect of polarized low-level laser therapy (PLLLT) on the treatment of myofascial trigger points (MTrPs) in the trapezius muscles. Its effectiveness in pain reduction was compared to low-level laser therapy (LLLT). Methods: Sixty-four patients with MTrPs were randomly divided into 2 groups, namely PLLLT and LLLT. Each patient received treatment for a period of 2 weeks, 5 sessions a week. The intensity of laser irradiation to the skin surface was 6 J/cm2 . The system exit power was 160 mw at a 755 nm wavelength. The visual analog scale (VAS) for the 1st, 5th and 10th sessions was analyzed through two-way repeated measures ANOVA. Results: Increasing the number of treatment sessions was effective in reducing pain intensity (P>0.05). The effect of LLLT on pain reduction was significantly greater than that of PLLLT (P>0.05). Referred pain (RP), the limitation of neck movement (LNM), the presence of muscular taut band (PMTB) and the sensitivity of muscular taut band (SMTB) were reduced significantly by the end of the 10th session, compared with participants' condition at the beginning of the 1st session in both groups. Conclusion: PLLLT and LLLT can effectively treat MTrPs in the trapezius muscles and they reduce RP, LNM, PMTB, and SMTB in particular. However, the effect of the LLLT was significantly greater than that of PLLLT. In accordance with the observed results, LLLT is recommended as an effective method for treating MTrPs.

Relative Effectiveness of Electroacupuncture and Biofeedback in the Treatment of Neck and Upper Back Myofascial Pain: A Randomized Clinical Trial

ObjectiveTo determine the differences between clinical effects of electroacupuncture and biofeedback therapy in addition to conventional treatment in patients with cervical myofascial pain syndrome (MPS). DesignRandomized clinical trial. SettingPhysical medicine and rehabilitation clinic of a university hospital. ParticipantsFifty patients (N=50) aged 25-55 years of both sexes with chronic neck pain diagnosed with MPS (characterized by trigger points within taut bands) were randomly assigned to 2 equal groups of 25 individuals. InterventionsThe patients in electroacupuncture group were treated with standard acupuncture and concomitant electrical stimulation; those in biofeedback group received visual electromyography biofeedback therapy for muscle activity and relaxation. Both groups received the intervention 2 times a week for a total of 6 sessions. Basic exercise training and medicines were administered for all the patients. Main Outcome MeasuresPain severity based on the visual analog scale (VAS), functional status using Neck Disability Index (NDI), cervical range of motion (ROM) using and inclinometer, and pressure pain threshold (PPT) using an algometer were evaluated before and at 3 and 12 weeks after the treatment. Primary outcome was defined as 20% reduction in the 3-month neck pain and dysfunction compared to baseline, assessed through the NDI. ResultsFifty patients (39 women, 11 men) with a mean age (years) ± SD of 39.0±5.5 and neck pain duration (weeks) of 6.0±2.2 were analyzed. All parameters, except for PPT of the lower trapezius and paravertebral muscles were improved significantly in both groups, while baseline values were controlled. The primary outcome was achieved more significantly in the acupuncture group than in the biofeedback group: 20 (80.0%) vs 10 (40.0%); rate ratio=2 with 95% confidence interval (CI), 1.19-3.36; number needed to treat (NNT)=2.5 with 95% CI, 1.54-6.58. Advantages of acupuncture over biofeedback were observed according to values obtained from the NDI, VAS, extension and left lateral-bending ROM, and PPT on the left upper trapezius after the last session of intervention until 3 months (P<.05). ConclusionsBoth electroacupuncture and biofeedback therapies were found to be effective in management of MPS when integrated with conventional treatment. However, intergroup differences showed priority of acupuncture in some parameters vs biofeedback. Thus, electroacupuncture seems to be a better complementary modality for treatment of MPS in the neck and upper back area.

Relationship between muscle spindles and myofascial trigger spots according to Hoffmann reflex pathway and tissue morphology characteristics in a rat model.

To determine how muscle spindles are involved in the pathophysiology of chronic myofascial trigger spots (MTrSs, similar to myofascial trigger points) in a rat injury model according to the characteristics of the Hoffmann reflex (H-reflex) and the anatomical relationship between muscle spindles and MTrSs. 16 male Sprague-Dawley rats (7 weeks old) were randomly divided into experimental and control groups. A blunt strike injury and eccentric exercise were applied to the gastrocnemius muscle of rats in the experimental group once a week for 8 weeks as a MTrS modelling intervention. Subsequently, the rats were reared normally and rested for 4 weeks. At the end of the 12th week, the rats were examined for the presence of MTrSs defined by the detection of a palpable taut band exhibiting both a local twitch response and spontaneous electrical activity. After modelling, evocation of the H-reflex and morphological examination of muscle spindles and MTrSs were conducted. The threshold (0.35±0.04 mA) of the H-reflex and latency (1.24±0.18 ms) of the M wave recorded at MTrSs were not significantly different to those at non-MTrSs (P>0.05). Compared with non-MTrSs, a lower Mmax (4.28±1.27 mV), higher Hmax (median (IQR) 0.95 (0.80-1.08) mV) and Hmax/Mmax (median (IQR) 0.21 (0.16-0.40)), and shorter H wave latency (4.60±0.89 ms) were recorded at MTrSs (P<0.05). Morphologically, there was a close anatomical relationship between the MTrS cells and the muscle spindles. Compared with normal muscles, the H-reflex myoelectrical activity was enhanced and some muscle spindles might have been influenced by active MTrSs. Thus, muscle spindles may play an important role in the pathological mechanism underlying myofascial trigger points.

Peripheral EphrinB1/EphB1 signalling attenuates muscle hyperalgesia in MPS patients and a rat model of taut band-associated persistent muscle pain.

BackgroundMyofascial pain syndrome (MPS) is an important clinical condition that is characterized by chronic muscle pain and a myofascial trigger point (MTrP) located in a taut band (TB). Previous studies showed that EphrinB1 was involved in the regulation of pathological pain via EphB1 signalling, but whether EphrinB1-EphB1 plays a role in MTrP is not clear.MethodsThe present study analysed the levels of p-EphB1/p-EphB2/p-EphB3 in biopsies of MTrPs in the trapezius muscle of 11 MPS patients and seven healthy controls using a protein microarray kit. EphrinB1-Fc was injected intramuscularly to detect EphrinB1s/EphB1s signalling in peripheral sensitization. We applied a blunt strike to the left gastrocnemius muscles (GM) and eccentric exercise for 8 weeks with 4 weeks of recovery to analyse the function of EphrinB1/EphB1 in the muscle pain model.ResultsP-EphB1, p-EphB2, and p-EphB3 expression was highly increased in human muscles with MTrPs compared to healthy muscle. EphB1 (r = 0.723, n = 11, P < 0.05), EphB2 (r = 0.610, n = 11, P < 0.05), and EphB3 levels (r = 0.670, n = 11, P < 0.05) in the MPS group were significantly correlated with the numerical rating scale (NRS) in the MTrPs. Intramuscular injection of EphrinB1-Fc produces hyperalgesia, which can be partially prevented by pre-treatment with EphB1-Fc. The p-EphB1 contents in MTrPs of MPS animals were significantly higher than that among control animals (P < 0.01). Intramuscular administration of the EphB1 inhibitor EphB1-Fr significantly suppressed mechanical hyperalgesia.ConclusionsThe present study showed that the increased expression of p-EphB1/p-EphB2/p-EphB3 was related to MTrPs in patients with MPS. This report is the first study to examine the function of EphrinB1-EphB1 signalling in primary muscle afferent neurons in MPS patients and a rat animal model. This pathway may be one of the most important and promising targets for MPS.

Myofascial Pain Syndrome and Its Relation to Trigger Points, Facial Form, Muscular Hypertrophy, Deflection, Joint Loading, Body Mass Index, Age and Educational Status.

ABSTRACTIntroduction:Myofascial pain (MFP) is a type of pain characterized by the presence of a trigger point (TrPs) in taut band of skeletal muscles or its fascia. Based on the current literature, the prevalence of head and neck myofascial pain (HNMFP) varies among different communities. To better understand this condition and its relation to facial form, muscular hypertrophy, deflection, and joint loading, the study aimed at evaluating the prevalence of HNMFP among the population of Jeddah, Saudi Arabia.Materials and Methods:This was a cross-sectional study to survey a sample of Jeddah residents, Saudi Arabi between the ages of 18–65 for HNMFP who were attending a public event in December 2019. Participants were asked to complete a questionnaire for demographics and history of HMFP signs and symptoms followed by a comprehensive clinical examination including facial form, muscular hypertrophy, maximum vertical opening, and joint loading. In addition, examination of upper quarter muscles was completed using flat or pincer palpation as needed. Data were collected and summarized as frequencies and percentages and group differences were tested using the chi-square statistical method.Results:A total of 197 participants were examined in this study, in which 136 (69.0%) had signs and symptoms consistent with HNMFP. Study subjects’ educational status was significantly associated with HNMFP (P = 0.008). Older subjects were more likely to report spontaneous pain whereas younger subjects were more likely to report pain following trauma (P = 0.049). Older subjects were more likely to have muscular hypertrophy (P = 0.011), while Younger subjects were more likely to have symmetrical facial form (P = 0.004). In terms of gender, males were more likely to experience pain aggravation with pressure and cold application whereas females were more sensitive to jaw function (P = 0.015). Distribution of joint loading showed a statistically significant difference between males and females (P = 0.008) with females having deflection on opening more frequently compared to males (P = 0.001). Furthermore, female subjects showed a significantly higher frequency of positive TrPs compared to males.Conclusion:Based on the current data, HNMFP is a common condition among the population of Jeddah. Factors such as body mass index and educational level were found to be linked to HNMFP. Younger subjects were more likely to have symmetrical facial form while older subjects were more likely to have muscular hypertrophy. The distribution of joint loading showed a statistically significant difference between males and females with females having deflection on opening more frequently compared to males. Further studies with a larger group of patients are needed to confirm these findings.

Dry Cupping, Ischemic Compression, or Their Combination for the Treatment of Trigger Points: A Pilot Randomized Trial.

Background: Chronic neck pain (NP) attributed to myofascial pain syndrome is one of the particularly common skeletal muscle disorder associated with the hyperirritable zone in the taut band of muscle. Trigger points (TPs) are the physical interpretation of the myofascial pain syndrome. In the United States, 30%–85% of pain patients have been affected by myofascial TPs.Objectives: To reveal preliminary evidence on the clinical efficacy of ischemic compression therapy, dry cupping, and their combination on improving the TPs' pressure pain threshold (PPT), neck range of motion (NROM), and neck disability index (NDI) in patients with TPs and nonspecific NP. Besides, assess the feasibility of conducting a randomized clinical trial (RCT).Design: A randomized pilot study was conducted on 24 patients with TPs and nonspecific NP. Patients were randomly assigned to three groups: the cupping group, the ischemic compression group, and the combination therapy group. PPT, NROM, and NDI were assessed before and after 4 weeks of treatment.Results: The results showed a statistically significant improvement in NDI, PPT, and NROM compared with values before the treatment (p < 0.05) in all groups. Although no significant difference was detected between ischemic compression (IC) and dry cupping, the combination approach showed significantly higher and faster improvement (p < 0.05).Conclusions: It is feasible to conduct a main RCT. Both IC and dry cupping may hold promise in treating TPs; a combination of the two therapies may provide superior improving rate.