Treatment Of Myofascial Trigger Points Research Articles

Effects of Treatment of Myofascial Trigger Points on the Pain of Fibromyalgia

Myofascial pain syndromes (MPSs) from trigger points (TrPs) and fibromyalgia syndrome (FMS) are common musculoskeletal pain conditions that frequently coexist in the same patients. In recent decades, it has become evident that these entities greatly influence each other's clinical expression. FMS is mainly rooted in the central nervous system, while TrPs have a peripheral origin. However, the nociceptive impulses from TrPs may have significant impact on symptoms of FMS, probably by enhancing the level of central sensitization typical of this condition. Several attempts have been made to assess the effects of treatment of co-occurring TrPs in FMS. We report the outcomes of these studies showing that local extinction of TrPs in patients with fibromyalgia produces significant relief of FMS pain. Though further studies are needed, these findings suggest that assessment and treatment of concurrent TrPs in FMS should be systematically performed before any specific fibromyalgia therapy is undertaken.

Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial

BackgroundShoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain.MethodsA single-assessor, blinded, randomized, controlled trial was conducted. The intervention group received comprehensive treatment once weekly consisting of manual compression of the MTrPs, manual stretching of the muscles and intermittent cold application with stretching. Patients were instructed to perform muscle-stretching and relaxation exercises at home and received ergonomic recommendations and advice to assume and maintain good posture. The control group remained on the waiting list for 3 months. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score (primary outcome), Visual Analogue Scale for Pain (VAS-P), Global Perceived Effect (GPE) scale and the number of muscles with MTrPs were assessed at 6 and 12 weeks in the intervention group and compared with those of a control group.ResultsCompared with the control group, the intervention group showed significant improvement (P < 0.05) on the DASH after 12 weeks (mean difference, 7.7; 95% confidence interval (95% CI), 1.2 to 14.2), on the VAS-P1 for current pain (mean difference, 13.8; 95% CI, 2.6 to 25.0), on the VAS-P2 for pain in the past 7 days (mean difference, 10.2; 95% CI, 0.7 to 19.7) and VAS-P3 most severe pain in the past 7 days (mean difference, 13.8; 95% CI, 0.8 to 28.4). After 12 weeks, 55% of the patients in the intervention group reported improvement (from slightly improved to completely recovered) versus 14% in the control group. The mean number of muscles with active MTrPs decreased in the intervention group compared with the control group (mean difference, 2.7; 95% CI, 1.2 to 4.2).ConclusionsThe results of this study show that 12-week comprehensive treatment of MTrPs in shoulder muscles reduces the number of muscles with active MTrPs and is effective in reducing symptoms and improving shoulder function in patients with chronic shoulder pain.Trial registration numberISRCTN: ISRCTN75722066

Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy

To describe the immediate effects of ischemic compression (IC) as a trigger point therapy in a case of a patient with neck pain. The application of IC is a safe and effective method to successfully treat elicited myofascial trigger points. The purpose of this method is to deliberate the blockage of blood in a trigger point area in order to increase local blood flow. This washes away waste products, supplies necessary oxygen and helps the affected tissue to heal. In this case study, we treated a 27-year-old female patient with a medical report of neck pain for at least four months. The physical examination revealed a neck pain and stiffness at the left side and pain increases when moving the neck. An active myofascial trigger point was found in the left trapezius muscle. The following data were recorded: active range of motion of cervical rachis measured with a cervical range of motion instrument, basal electrical activity of the left trapezius measured with electromyography, and pressure tolerance of the myofascial trigger point measured with visual analogue scale, assessing local pain evoked by the application of 2.5 kg/cm2 pressure with an analogue algometer. Immediately after application of the IC, all measured parameters improved compared to base line. The application of IC has been shown effective in the treatment of myofascial trigger points in a patient with neck pain. The results show a relation between active range of motion of cervical rachis, basal electrical activity of the trapezius muscle and myofascial trigger point sensitivity. In this case of a patient with neck pain, active range of motion of cervical rachis, basal electrical activity of the trapezius muscle and myofascial trigger point sensitivity gaining short-term positive effects with the application of one single ischemic compression session. Nevertheless, randomized controlled double-blinded studies should be conducted in future to examine the effectiveness of this ischemic compression technique in case of the presence of myofascial trigger points in the neck.

Workshop 2B.5: An introduction to dry-needling technique in the treatment of myo-fascial trigger points

Workshop 2B.5: An introduction to dry-needling technique in the treatment of myo-fascial trigger points

Myofascial Pain Trigger Points

Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Trigger points may be relieved through noninvasive measures, such as spray and stretch, transcutaneous electrical stimulation, physical therapy, and massage. Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.

Immediate Effect of Ultrasound and Ischemic Compression Techniques for the Treatment of Trapezius Latent Myofascial Trigger Points in Healthy Subjects: A Randomized Controlled Study

Objective The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle. Methods Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm 2 of pressure using a pressure analog algometer. Results The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained. Conclusion In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.

A Case Series of Pulsed Radiofrequency Treatment of Myofascial Trigger Points and Scar Neuromas: Table 1

Pulsed radiofrequency (PRF) current applied to nerve tissue to treat intractable pain has recently been proposed as a less neurodestructive alternative to continuous radiofrequency lesioning. Clinical reports using PRF have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within our practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. Nine patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of nine patients experienced 75-100% reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of nine (67%) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. Our review suggests that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted.

The use of low intensity laser therapy in the treatment of myofascial trigger points: an updated critical review

Objectives: This review describes the possible factors that may have contributed to the variability of the results between studies that have assessed the efficacy of low intensity laser therapy (LILT) in treating myofascial trigger points (MTrPs). Furthermore, it aims to make recommendations to overcome the methodological shortcomings identified.Methods: A search of the literature was conducted by a single reviewer. Only randomised controlled and clinical trials were included.Results: Sixteen studies were critically reviewed and showed considerable variability in treatment parameters, techniques, symptoms duration and diagnoses.Discussion: Studies that have investigated the use of LILT in treating MTrPs produce conflicting results regarding the efficacy of this treatment modality. However, these are probably due to varying symptoms duration, treatment parameters and techniques, non-homogenous populations, and inaccessible and/or poor laser machine specifications.

Treatment of myofascial trigger points in common shoulder disorders by physical therapy: A randomized controlled trial [ISRCTN75722066

BackgroundShoulder disorders are a common health problem in western societies. Several treatment protocols have been developed for the clinical management of persons with shoulder pain. However available evidence does not support any protocol as being superior over others. Systematic reviews provide some evidence that certain physical therapy interventions (i.e. supervised exercises and mobilisation) are effective in particular shoulder disorders (i.e. rotator cuff disorders, mixed shoulder disorders and adhesive capsulitis), but there is an ongoing need for high quality trials of physical therapy interventions. Usually, physical therapy consists of active exercises intended to strengthen the shoulder muscles as stabilizers of the glenohumeral joint or perform mobilisations to improve restricted mobility of the glenohumeral or adjacent joints (shoulder girdle). It is generally accepted that a-traumatic shoulder problems are the result of impingement of the subacromial structures, such as the bursa or rotator cuff tendons. Myofascial trigger points (MTrPs) in shoulder muscles may also lead to a complex of symptoms that are often seen in patients diagnosed with subacromial impingement or rotator cuff tendinopathy. Little is known about the treatment of MTrPs in patients with shoulder disorders.The primary aim of this study is to investigate whether physical therapy modalities to inactivate MTrPs can reduce symptoms and improve shoulder function in daily activities in a population of chronic a-traumatic shoulder patients when compared to a wait-and-see strategy. In addition we investigate the recurrence rate during a one-year-follow-up period.Methods/DesignThis paper presents the design for a randomized controlled trial to be conducted between September 2007 – September 2008, evaluating the effectiveness of a physical therapy treatment for non-traumatic shoulder complaints. One hundred subjects are included in this study. All subjects have unilateral shoulder pain for at least six months and are referred to a physical therapy practice specialized in musculoskeletal disorders of the neck-, shoulder-, and arm.After the initial assessment patients are randomly assigned to either an intervention group or a control-group (wait and see). The primary outcome measure is the overall score of the Dutch language version of the DASH (Disabilities of Arm, Shoulder and Hand) questionnaire.DiscussionSince there is only little evidence for the efficacy of physical therapy interventions in certain shoulder disorders, there is a need for further research. We found only a few studies examining the efficacy of MTrP therapy for shoulder disorders. Therefore we will perform a randomised clinical trial of the effect of physical therapy interventions aimed to inactivate MTrPs, on pain and impairment in shoulder function in a population of chronic a-traumatic shoulder patients. We opted for an intervention strategy that best reflects daily practice. Manual high velocity thrust techniques and dry-needling are excluded. Because in most physical therapy interventions, blinding of the patient and the therapist is not possible, we will perform a randomised, controlled and observer-blinded study.Trial RegistrationThis randomized clinical trial is registered at current controlled trials ISRCTN75722066.

Myofascial Trigger Points: Translating Molecular Theory into Manual Therapy

Theories regarding the molecular pathophysiology of myofascial trigger points (MFTrPs) have undergone fundamental revisions in recent years. New research suggests that MFTrPs are evoked by the abnormal depolarization of motor end plates. The motor endplate transduces electrical potential into muscle contraction. This review article expands the proposed etiology to include presynaptic, synaptic, and postsynaptic mechanisms, such as excessive release of acetycholine (ACh), defects of acetylcholinesterase, and upregulation of nicotinic ACh receptors, respectively. Dysfunctional motor endplates and sustained muscular contraction give rise to a localized "ATP energy crisis" associated with sensory and autonomic reflex arcs that is sustained by central sensitization. This working hypothesis has given rise to several new approaches in the treatment of MFTrPs.

The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle

Introduction Sustained manual pressure has been advocated as an effective treatment for myofascial trigger points (MTrPs). 1 Hou C.R. Tsai L.C. Cheng K.F. Chung K.C. Hong C.Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical and Medical Rehabilitation. 2002; 82: 1406-1414 Abstract Full Text Full Text PDF Scopus (221) Google Scholar , 2 Simons D.G. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies. 2002; 6: 81-88 Abstract Full Text PDF Scopus (131) Google Scholar , 3 Simons D.G. Travell J.G. Simons L.S. 2nd ed. Myofascial pain and dysfunction, the trigger point manual, the upper extremities. vol. 1. Williams and Wilkins, Baltimore, USA1999 Google Scholar This study aimed to investigate the effect of manual pressure release (MPR) on the pressure sensitivity of latent MTrPs in the upper trapezius muscle, using a novel pressure algometer. Design Randomised blinded clinical trial. Methods Participants: Thirty-seven subjects (mean age 23.1 years±3.2; M=12, F=23) were screened for the presence of latent MTrPs in the upper trapezius muscle (tender band that produced referred pain to the neck and/or head on manual pressure). Intervention: Subjects were randomly allocated into either treatment (MPR pressure sustained for 60 s) or control (sham myofascial release) group. Outcome Measures: The pressure pain threshold (PPT) was recorded pre- and post-intervention using a digital algometer, consisting of a capacitance sensor attached to the tip of the palpating thumb. Changes in pressure sensitivity were also measured during the application of MPR via a verbal analogue pain scale (0–10, 0=no pain, 10=severe pain). Results There was a significant increase in mean PPT following MPR (P<0.001), but not following the sham treatment. Pressure was monitored and maintained during the application of MPR, and a reduction in perceived pain and significant increase in tolerance to treatment pressure (P<0.001) appeared to be caused by a change in tissue sensitivity, rather than an unintentional reduction of pressure by the examiner. Conclusions The results suggest that MPR may be an effective therapy for MTrPs in the upper trapezius muscle. Sustained manual pressure has been advocated as an effective treatment for myofascial trigger points (MTrPs). 1 Hou C.R. Tsai L.C. Cheng K.F. Chung K.C. Hong C.Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical and Medical Rehabilitation. 2002; 82: 1406-1414 Abstract Full Text Full Text PDF Scopus (221) Google Scholar , 2 Simons D.G. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies. 2002; 6: 81-88 Abstract Full Text PDF Scopus (131) Google Scholar , 3 Simons D.G. Travell J.G. Simons L.S. 2nd ed. Myofascial pain and dysfunction, the trigger point manual, the upper extremities. vol. 1. Williams and Wilkins, Baltimore, USA1999 Google Scholar This study aimed to investigate the effect of manual pressure release (MPR) on the pressure sensitivity of latent MTrPs in the upper trapezius muscle, using a novel pressure algometer. Randomised blinded clinical trial. Participants: Thirty-seven subjects (mean age 23.1 years±3.2; M=12, F=23) were screened for the presence of latent MTrPs in the upper trapezius muscle (tender band that produced referred pain to the neck and/or head on manual pressure). Intervention: Subjects were randomly allocated into either treatment (MPR pressure sustained for 60 s) or control (sham myofascial release) group. Outcome Measures: The pressure pain threshold (PPT) was recorded pre- and post-intervention using a digital algometer, consisting of a capacitance sensor attached to the tip of the palpating thumb. Changes in pressure sensitivity were also measured during the application of MPR via a verbal analogue pain scale (0–10, 0=no pain, 10=severe pain). There was a significant increase in mean PPT following MPR (P<0.001), but not following the sham treatment. Pressure was monitored and maintained during the application of MPR, and a reduction in perceived pain and significant increase in tolerance to treatment pressure (P<0.001) appeared to be caused by a change in tissue sensitivity, rather than an unintentional reduction of pressure by the examiner. The results suggest that MPR may be an effective therapy for MTrPs in the upper trapezius muscle.

Myofascial Trigger Points: Pathophysiology and Treatment with Dry Needling

IntroductionThe aim of this article is to review the possible mechanisms relating to the pathophysiology and treatment of myofascial trigger points with the technique of dry needling.Muscles and myofascial trigger points (MTrP’s) are a major source of persistent pain (Travell 1983). Myofascial pain is often associated with MTrP’s in muscles, tendons and fascia (Sola 1990, Simons 1999). It is characterized by regional muscle pain and described as dull or achy.

Proximal hamstring rupture, restoration of function without surgical intervention: A case study on myofascial trigger point pressure release

Summary Proximal hamstring rupture is a rare occurrence, although documented in the literature during water skiing. This case study highlights the treatment of a proximal hamstring rupture whilst water skiing. In this case, physiotherapy was the main therapeutic intervention with no subsequent surgical referral. An initial first course of extensive physiotherapy rehabilitation had increased hamstring strength and everyday function. However, the patient a 26-year-old tennis player and runner, had been unable to return to running or tennis. A second (substantially shorter) course of physiotherapy was initiated, the therapist utilizing myofascial trigger points (MTrPs) in the treatment and diagnosis. This case study highlights how the identification and treatment of MTrPs using trigger point pressure release within a physiotherapy and home self management programme, was effective in restoring her sporting function. It also highlights the need for medical and healthcare professionals to include MTrPs as an assessment and therapeutic tool in musculoskeletal dysfunction. Further research is needed to fully ascertain the clinical efficacy of this intervention.

The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle

Summary Sustained manual pressure has been advocated as effective treatment for myofascial trigger points (MTrPs). This study aimed to investigate the effect of manual pressure release (MPR) on the pressure sensitivity of latent MTrPs in the upper trapezius muscle using a novel pressure algometer. Subjects ( N = 37 , mean age 23.1±3.2, M = 12 , F = 23 ) were screened for the presence of latent MTrPs in the upper trapezius muscle (tender band that produced referred pain to the neck and/or head on manual pressure). Subjects were randomly allocated into either treatment (MPR) or control (sham myofascial release) groups. The pressure pain threshold (PPT) was recorded pre- and post-intervention using a digital algometer, consisting of a capacitance sensor attached to the tip of the palpating thumb. There was a significant increase in the mean PPT of MTrPs in the upper trapezius following MPR ( P 0.001 ), but not following the sham treatment. Pressure was monitored and maintained during the application of MPR, and a reduction in perceived pain and significant increase in tolerance to treatment pressure ( P 0.001 ) appeared to be caused by a change in tissue sensitivity, rather than an unintentional reduction of pressure by the examiner. The results suggest that MPR may be an effective therapy for MTrPs in the upper trapezius.

Masaje de fricción transversal. Una alternativa terapéutica para el tratamiento del síndrome de dolor miofascial

Myofascial pain syndrome (MPS) is thought by some authors to be the main cause of headache and neck pain. Presence of Myofascial Trigger Point (MTrP) in many pathologies provoke the necessity of many researches about physical therapy treatment in this entity. Nowadays, there are a lot of therapeutically techniques about the MTrP's treatment: manual therapy (ischemic compression, strain/counterstrain, massage, muscle energy techniques, etc.), TENS, láser, ultrasound, superficial heat therapy, etc. However, we can see that the transverse friction massage, many times using in tendinopathies treatment, has not been applied in MTrP's treatment. ObjectiveThe aim of this series cases is to evaluate the immediate effectiveness of one session of the transverse friction massage technique in the management of MPS. Material and Methods10 volunteer patients diagnose of MTrP in the trapezius muscle's upper fibres according to Travell and Simons criteria. Patients received one session of transverse friction massage technique. Sessions had a duration of 3 minutes. There were analyzed the Pressure Pain Threshold (PPT), the visual analogue scale (VAS)and the evocation of referred pain during the application of the technique. Pre treatment and post–treatment data were collected. ResultsThe results show immediate statistically significant improvement (p = 0,001) on PPT. Analysing VAS we found that the application of the transverse friction massage is painful to the patients (VAS = 6,3). ConclusionsThe results show that this technique is effective; however is so painful for the patient. The few existence of randomized controlled trials that analyze the physical therapy effects in the treatment of MTrP, and the difference in the methodology application of the techniques, it make so difficult to draw a comparison between the results obtained. Nowadays there are different techniques that have being used in the MPS's treatment that have not been scientifically studied.

Poster 81: A novel injection technique for the treatment of myofascial trigger points at the subscapularis muscle and serratus anterior insertion

Setting: Outpatient musculoskeletal pain and sports clinic. Patients: Persons with shoulder pain and dysfunction related to subscapularis muscle trigger points and serratus anterior weakness. Case Description: Patients are instructed to lie on the involved side, with the elbow directly underneath the ribs and in 90° of flexion. This position moves the medial scapula superficial and outward, opening access to the subscapularis muscle and serratus anterior insertion at the medial border of the scapula. Needling and infiltration of 1% lidocaine is performed from underneath the medial scapula, directing the needle away from the ribs to the entire taut band, introducing 0.2mL at each stop either where there is a twitch response, an increase in muscle tone, or a pain complaint on needle penetration. A total of 3 to 5mL can be introduced at the attachment of the muscles. Aspiration is done prior to each injection. On days 1, 2, and 3 postinjection, patients should receive sessions of physical therapy with superficial heat and electric stimulation, sinusoid surging, at the injection sites. Relaxation exercises are performed at hourly intervals by contraction of external rotator muscles. Main perpetuating factors such as biomechanical imbalances should also be addressed. Assessment/Results: This procedure has been performed routinely at our clinic without complications. Usually 1 or 2 sessions are necessary for complete relief of symptoms. Discussion: This is the first report of this novel injection technique, to our knowledge, of the treatment of myofascial trigger points in the subscapularis muscle and serratus anterior insertion in this fashion. Conclusion: Injections for treatment of myofascial pain at the subscapularis muscle and serratus anterior insertion can be performed in an easier and safer manner by the novel injection technique described here. No complications were reported.

Myofascial Trigger Points

To the Editor: I am a practicing physical therapist in a private orthopedic and sports medicine practice in downtown Manhattan. In my practice, a vast majority of my patients have cervical, scapular, and thoracic pain as well as headaches with related trigger points throughout the scapular musculature. In reviewing the literature and attempting to expand my expertise in this area, I have found a disappointingly sparse amount of research focusing on the treatment of myofascial trigger points. Because of this, I was excited to find “Effectiveness of a Home Program of Ischemic Pressure Followed by Sustained Stretch for Treatment of Myofascial Trigger Points” by Hanten et al in the October 2000 issue of Physical Therapy . As a physical therapist, I am fully aware of the pressure that third-party payers place on our practice patterns and patient care, many times forcing us to treat patients for a shorter period of time than our better judgment would otherwise dictate. In keeping with Hanten and colleagues' statements, I am also in favor of involving my patients in their treatment as much as possible through home exercise programs and patient education. I feel that doing so is as important as any other element of the care we provide for all diagnoses, especially in orthopedics. I believe that Dr Hanten and his colleagues used sound research and data analysis. Their results are important to our profession and should lead to further study in this area. I find a problem, however, with the statements in the conclusion of the article. The authors stated, “Our results indicate that clinicians can manage neck and upper …

Effectiveness of a Home Program of Ischemic Pressure Followed by Sustained Stretch for Treatment of Myofascial Trigger Points

Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Treatment of myofascial trigger-points with ultrasound combined wiht massage and exercise — a randomized controlled trial: Gam AN, Warming S, Larsen LH, Jensen B, Hoydalsmo O, Allon I. Anderson B, Gotzsche NE, Petersen M, Mathiesen B. Pain 1998; 77: 73–79

Treatment of myofascial trigger-points with ultrasound combined wiht massage and exercise — a randomized controlled trial: Gam AN, Warming S, Larsen LH, Jensen B, Hoydalsmo O, Allon I. Anderson B, Gotzsche NE, Petersen M, Mathiesen B. Pain 1998; 77: 73–79

Treatment of myofascial trigger-points with ultrasound combined with massage and exercise – a randomised controlled trial

The effect of treatment with ultrasound, massage and exercises on myofascial trigger-points (MTrP) in the neck and shoulder was assessed in a randomised controlled trial. The outcome measures were pain at rest and on daily function (Visual Analogue Scale, VAS), analgesic usage, global preference and index of MTrP. Long-term effect for treatment and control groups was assessed after 6 months using a questionnaire. The patients were randomised to three groups. The first group was treated with ultrasound, massage and exercise (A), the second group with sham-ultrasound, massage and exercise (B), while the third group was a control group (C). The duration of the study was 6 weeks. Treatment was given twice a week from the second to the fifth week. The number and index of MTrPs were recorded at each treatment session in groups A and B but only at entry as well as end of study in group C. VAS and analgesic usage was recorded in all three groups throughout the study period. Six months after the last treatment session a questionnaire was send to the patients. A total of 67 patients were included. Nine patients dropped-out during the study, which left 58 patients that could be included in the final analysis. Twenty patients were randomised to group A, 18 to group B and 18 to group C. A significant reduction in index were found between treatment groups (A and B) and control group (C), but no difference between group A and B. VAS scores, analgesic usage or global preference showed no difference between group A, B or C. The patients in the group C were offered treatment (ultrasound, massage, exercise) after the 6 weeks treatment period. At the questionnaire after 6 month 44 (87%) of the 52 patients from all three groups who had treatment responded. Sixty-four percent answered that they had had good or some effects, 68 percent were still doing the exercise programme and 17 percent had received other forms of therapy after they had completed the study. No difference between groups given ultrasound or sham ultrasound were found. It is concluded that US give no pain reduction, but apparently massage and exercise reduces the number and intensity of MTrP. The impact of this reduction on neck and shoulder pain is weak.