Trigger Points In Patients Research Articles

Comparative Effectiveness of Radial Extracorporeal Shock Wave Therapy on Single and Multipul Trigger Points in Patients with Biceps Tendinopathy

Comparative Effectiveness of Radial Extracorporeal Shock Wave Therapy on Single and Multipul Trigger Points in Patients with Biceps Tendinopathy

Effect of Extracorporeal Shock Wave on Upper Trapezius Trigger Points in Patients With Cervicogenic Headache: A Randomized Clinical Trial.

A recent study was designed to ascertain the impact of extracorporeal shock wave therapy on upper trapezius trigger points in cervicogenic headaches patients. A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20-40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (4 wks). There was a significant difference of headache disability index, visual analog scale scores, and upper trapezius electromyographic characteristics with P value <0.05 in both groups, in favor of the shock wave group. Extracorporeal shock wave therapy could be used for clinical and research concerns because its positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients.

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

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

Immediate Effect of Ischemic Compression Therapy to Release Suboccipital Trigger Points in Tension-Type Headache among Adult Population of GCUF

Tension-type headache is a nervous illness and characterized by pain, causes stretch on both sides and stiffness which feels like a band or pressure leads to disruption in daily activities. Objective: To see the immediate effects of ischemic compression therapy to release sub-occipital trigger points in tension type headache. Methods: It was a quasi-experimental study. Study population was students and faculty members of GC University, Faisalabad from age between 25 to 35 years. Sample size of the study was 35. A convenient sampling technique was used to select individuals according to the defined inclusion criteria. Trigger points were evaluated by palpating the occipital region. Data collection tools including visual analogue scale (VAS) and HIT-6 was used to measure intensity of pain and tension-type headache. SPSS version 25.0 was used to analyze the data. Results: Post-treatment values of VAS showed the reduction in pain intensity (mean=0.57) as compared to the pre-intervention values (mean = 5.03). A notable reduction in HIT-6 impact from (mean = 65.13) to (mean = 40.40) was observed. Paired sample t-test showed a p-value below 0.05 for both VAS and HIT-6, highlighting the positive effects of ischemic compression therapy to release sub-occipital trigger points in tension type headache. Conclusions: There was a notable reduction of pain intensity immediately after the treatment session. Ischemic compression therapy was significantly effective to release sub-occipital trigger points in patients with tension type headache.

Electrical dry needling versus a non-invasive multicomponent intervention in the treatment of myofascial trigger points in patients with chronic low back pain: A randomised clinical trial

Objective To compare the effects of electrical dry needling with a non-invasive multi-component intervention in patients with chronic low back pain. Design A randomised single-blind clinical trial. Setting Outpatient Physiotherapy Clinic; home. Participants Sixty-four patients with chronic low back pain aged 30–65 years. Interventions Six-week electrical dry needling on myofascial trigger points, and a non-invasive multicomponent intervention (home exercise programme, stretching and ischemic compression). Main measures Pain (Visual Analogue Scale), disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), kinesiophobia (Tampa Scale of Kinesiophobia), quality of life and sleep (Short Form 36-item Health Survey and Pittsburgh Sleep Quality Index), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion (finger-to-floor distance), and pressure pain threshold (algometer) were assessed at baseline, after 6 weeks, and after 2 months. Results ANOVA showed statistically significant differences in group-by-time interaction for most pain pressure thresholds of myofascial trigger points (P < 0.05), for disability (Roland-Morris Disability Questionnaire: F = 6.14, P = 0.016; and Oswestry Disability Index: F = 7.36, P = 0.009), for trunk anteflexion (F = 10.03, P = 0.002) and for habitual sleep efficacy (F = 6.65, P = 0.012), use of hypnotics (F = 4.77, P = 0.033) and total score of quality of sleep (F = 8.23, P = 0.006). Conclusions In comparison to a non-invasive multicomponent intervention, electrical dry needling has more positive effects on disability, pain intensity, kinesiophobia, and reducing patients’ sensitivity to myofascial trigger points pressure, at post-treatment and at 2 months. Clinical Trial Registration number NCT04804228. Registered on May 28th, 2021. Available at https://clinicaltrials.gov/ct2/show/NCT04804228

Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design.

Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine.

Association Between Subscapularis Trigger Point and Frozen Shoulder: A Cross Sectional Study

Background: Uncertainty surrounds the relationship between subscapularis trigger sites and the development of frozen shoulder syndrome. Objectives: The purpose of this study was to investigate the relationship between subscapularis trigger points and immobilized shoulder in patients from the Outpatient Physical Therapy Department at NMC Hyderabad. Methods: This cross-sectional study was conducted from September 2022 to February 2023 and included 71 patients diagnosed with grade 1 or 2 frozen shoulder based on Codman's criteria and aged 35 or older. Using an axillary approach, subscapularis trigger points were identified manually, and their presence was evaluated on both the affected and unaffected sides. Using the Chi-square test in SPSS version 22, the relationship between subscapularis trigger points and immobilized shoulder was analyzed. Results: 33 (46.5%) of the 71 participants were male, while 38 (53.5%) were female, with a mean age of 53.32 years. On the affected side, there was a significant association between frozen shoulder and subscapularis trigger points (p =.001). Intriguingly, a statistically significant difference was also observed in the unaffected shoulder joint (p =.001). Practical Implications: It highlighted the importance of diagnosing and treating subscapularis trigger points in patients with frozen shoulder, potentially guiding new therapeutic strategies to improve shoulder mobility and reduce pain in these individuals. Conclusion: Our findings indicate a considerable association between subscapularis triggers points and frozen shoulder, making these trigger points possible therapeutic targets. To investigate the underlying mechanisms and validate these results in larger populationss, additional research is required. Keywords: Frozen shoulder syndrome; Orthopedics; Subscapularis trigger points; Surgery

Comparison Between the Effectiveness of Muscle Energy Technique and Ischemic Compression On Myofascial Trigger Points in Patients with Chronic Shoulder Pain

Patients with chronic shoulder pain often experience myofascial trigger points. An ischemic compression (IC) slows blood flow and relieves tension by applying sustained digital pressure for a specific period of time. MET, which stands for Muscle Energy Technique, is another manual method for releasing muscle tension (inhibition). Objective: To compare the effectiveness of muscle energy technique and ischemic compression on myofascial trigger points in patients with chronic shoulder pain. Methods: In this quasi-experimental study, 40 patients were enrolled from Physical Therapy Department, DHQ hospital Faisalabad, during September 2018 to March 2019. Patients were allocated into two groups. Muscle energy technique was applied on group A (n=20) and ischemic compression was applied on group B (n=20). Both groups received treatment three days a week for four weeks. Disabilities of Arm, Shoulder and Hand questionnaire, Neck Disability Index, Visual Analogue Scale and Goniometer were used to take measurements at baseline and after four weeks of treatment. SPSS 20.0 was used for data entry and analysis. Difference between two treatments was determined by using independent t-test. Results: A statistically significant difference was found between the two groups for all outcome measures (p &lt; 0.05) at four weeks follow-up. Conclusions: Results suggest that muscle energy technique seems more effective compared to ischemic compression in terms of decreasing pain, upper limb and neck disability and improving shoulder mobility in patients with chronic shoulder pain having myofascial trigger points.

Effectiveness of polarized polychromatic light therapy on myofascial trigger points in chronic non-specific low back pain: a single blinded randomized controlled trial

BackgroundPhototherapy has been used for the treatment of chronic low back pain. However, the effect of linear polarized polychromatic light (PL) has not been examined on myofascial trigger points in patients with chronic non-specific low back pain (NSLBP).ObjectivesTo investigate the effectiveness of PL on pain intensity, pain sensitivity of active myofascial trigger points (MTrPs) in gluteus medius (GM) and quadratus lamborum (QL) muscles, back disability, and lumbar range of motion in chronic NSLBP.MethodsForty-two participants of both genders with chronic NSLBP were randomly allocated into two equal groups: group A (Linear polarized polychromatic light (PL): 21 participants received polarized light therapy in the range of red and near-infrared rays on myofascial trigger points of bilateral GM and QL muscles for 5 min/point followed by stretching and strengthening exercises for 4 weeks. Group B (Sham PL): 21 participants received the same program but with sham linear polarized polychromatic light therapy. Numeric pain rating scale, pressure algometer, and Roland-Morris Disability Questionnaire were used to measure pain intensity, pain sensitivity (as represented by pain pressure threshold (PPT) of MTrPs of the target muscles and back disability respectively. Further, lumbar flexion, extension, and bilateral rotation were examined with a tape measure, while bilateral side bending were examined with a universal goniometer.ResultsAfter the intervention program, significant improvements (p < 0.05) in pain intensity, PPT of MTrPs of left GM (Effect Size (ES): 1.23) and bilateral QL muscles (ES Rt QL: 0.9; Lt QL: 1.56) were found in group A in comparison with group B. Nevertheless, the two groups displayed similar improvements (p > 0.05) in lumbar range of motion and back disability.ConclusionLinear polarized polychromatic light therapy in the range of red and near-infrared rays improves pain intensity and pain sensitivity of myofascial trigger points in chronic NSLBP.Trial registrationPACTR, PACTR202111577053926. Registered 22 June 2019-Prospectively registered.

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

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

Effects of Neuromuscular Reeducation with Ischemic Compression on Myofascial Trigger Points in Patients with Neck Pain- a Randomized Controlled Trial

Aim: To determine the effects of neuromuscular Reeducation technique along with ischemic compression on upper trapezius myofascial trigger points regarding pain and lateral cervical ROM. Methodology: A randomized controlled trial was conducted.50 patients (25 in each group; aged 32.00 ±7.12 years), diagnosed with neck pain having upper trapezius myofascial trigger points and reduced lateral cervical range of motion were included. Patients were randomized into ischemic compression group (A) and Neuromuscular Reeducation group (B). Both groups were associated with conventional physiotherapy, which continued for two weeks. Outcomes were measured by using a Goniometer for lateral cervical ROM and pain intensity by using NPRS, assessed at baseline and on 8th post-intervention. Results: 49 participants were analyzed due to a lost in follow-up of one subject from Control Group-A. Intragroup comparison of pre to post value for cervical ROM and NPRS showed a significant (p value=.000) for both groups. Intergroup comparison of baseline to end value for cervical ROM was significantly improved on post-intervention along with significantly improved NPRS Conclusion: This study concluded that Neuromuscular Reeducation along ischemic compression approach for MTRPs has proven to be more effective to improve cervical range of motion and reducing pain. Keywords: Myofascial trigger points, Ischemic Compression, Neuromuscular reeducation, Upper Trapezius, Neck pain.

Effectiveness of pregabalin treatment for trigger points in patients with comorbid myofascial pain syndrome and fibromyalgia syndrome: a randomized controlled trialIntroduction

Aim of the study Myofascial pain syndrome (MPS) is a common problem in the general population. MPS should not be a local/peripheral painful syndrome and considered to be a syndrome of central sensitivity. We aimed to investigate the effect of pregabalin in patients with MPS in this study. Materials and methods We randomized 40 patients into two groups, and 17 patients per group completed the study. Female patients in group I received pregabalin and exercise therapy, whereas those in group II received exercise therapy alone. All patients were evaluated as follows: for pain by visual analog scale (VAS); trigger-point pressure pain threshold-(PPT) by algometry; neuropathic pain using the Douleur Neuropathique en 4 Questions (DN4) and quality of life with the Short Form-36 (SF36). Evaluations were performed pre-treatment and at the end of the first and third months of treatment. Clinical trial ID: NCT04600037, retrospectively registered 20/10/2020. Results In group I, significant improvements were observed in VAS, trigger-point-PPT, physical component summary-SF-36, at the first and third months. In group II, statistically significant improvements were observed in VAS, trigger-point-PPT after the first and third months. Group I showed statistically better improvements in VAS, trigger points-PPT, physical component summary-SF36 compared with group II by the third month. Conclusion Pregabalin treatment is effective for controlling trigger points. Pregabalin treatment is also more effective than exercise treatment at improving quality of life in patients with MPS.

Dry Needling and Management of Trigger Points with Low Back Pain: An Evidence to Practice Review

Low back pain is a common health concern. The development of myofascial trigger points due to low back pain can cause debilitating pain and loss of functional movement in patients. Dry needling is a minimally invasive procedure that has shown to be useful in the treatment of myofascial trigger points when used with other forms of treatment. However, the literature surrounding dry needling and myofascial trigger points in patients with low back pain is lacking. The guiding systematic review and meta-analysis sought to analyze the effectiveness of dry needling for patients with low back pain. The review utilized eight databases for randomized controlled trials and selected 11 of 784 articles for analysis based on inclusion and exclusion criteria. A 6-subgroup meta-analysis was conducted on these studies, and 6 of the 11 studies were found to have high risk of bias. The included studies used both pain measurements and functional measurements including the visual analogue scale (VAS), Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ). The studies did not include objective functional measurements. Overall researchers found a clinically meaningful decrease in outcome scores in the short-term, but there were no significant differences in pain or functional outcomes through long-term follow-up. This seems to correlate with the current literature on dry needling and its inflammatory effects on the body, suggesting that dry needling alone does not provide any long-term effect on myofascial trigger points in patients with low back pain. Dry needling should be combined with other treatments and high-quality rehabilitation to provide longer-lasting results and better treatment outcomes for patients with low back pain.

Mouth opening, jaw disability, neck disability, pressure pain thresholds, and myofascial trigger points in patients with disc displacement with reduction: A descriptive and comparative study

ABSTRACT Objective To assess jaw and neck function, pressure pain threshold (PPT), and the presence of trigger points (TrPs) in disc displacement with reduction (DDWR) subjects compared to healthy subjects. Methods One hundred DDWR subjects and 100 matched controls were studied. Clinical evaluations included demographic data, range of motion, jaw and neck disability, PPT, and muscle TrPs. Results DDWR subjects have limited pain-free opening limitation (p < 0.001), jaw and neck disability limitation (p < 0.001), and higher presence of active and latent TrPs limitation (p < 0.001) compared to healthy subjects. Conclusion DDWR subjects present a limited pain-free mouth opening, higher jaw and neck disability, lower PPT, and major presence of active and latent TrPs compared to healthy subjects. Cervical spine and TMJ evaluation and treatment should be considered in DDWR patients.

Effectiveness of Met and Strain-Counterstrain in Treating Acute Myofascial Upper Trapezius Trigger Points in Patients with Mechanical Neck Pain - A Comparative Study

Effectiveness of Met and Strain-Counterstrain in Treating Acute Myofascial Upper Trapezius Trigger Points in Patients with Mechanical Neck Pain - A Comparative Study

Effectiveness of Injection of Trigger Points with Platelet Rich Plasma as A Pain Management Method in Rotator Cuff Syndrome

هدفت الدراسة إلى تقييم فعالية حقن نقاط التوتر بالبلازما الغنية بالصفائح الدموية كطريقة لمعالجة الآلام المزمنة في مرضى متلازمة الكفة المدورة، طريقة البحث صممت الدراسة بأثر رجعي للفترة من 1 آب 2016 لغاية 31 تموز 2019, 36 مريض (21 أناث و15 ذكور) راجعوا العيادة الخاصة للباحث في محافظة كركوك، العراق بسبب شكواهم من الام مزمنة في الكتف، تم حقن نقاط التوتر العضلي عند المرضى بالبلازما الغنية بالصفائح الدموية التي تم تحضيرها بواسطة الطرد المركزي للدم المسحوب من المرضى. وصنفت الاستجابة للعلاج الى: ممتاز وجيد ومقبول وضعيف النتائج معدل العمر للمرضى هو 52,3±1,9 سنة. معظم المرضى (عدد 33, 92%) لديهم زيادة في الوزن أو سمنة و (عدد 16, 44,6%) مصابون بارتفاع ضغط الدم لوحده أو مع داء السكري. معظم المرضى (عدد 30, 83,3%) تلقوا ثلاث جرعات بينما (عدد 6, 16,7%) تلقوا جرعة واحدة من البلازما الغنية بالصفائح الدموية. معظم المرضى (عدد 28, 77,8%) أظهروا أما استجابة جيدة أو ممتازة للعلاج، بينما (عدد 8, 22,2%) من المرضى أظهروا أما استجابة مقبولة أو ضعيفة وبينت النتائج وجود فروق معنوية بين المجموعتين بدلالة p˂0.01. الاستنتاج ان حقن نقاط التوتر العضلي بالبلازما الغنية بالصفائح الدموية هي طريقة فعالة وأمينة ورخيصة لمعالجة الآلام المزمنة الناتجة من متلازمة الكفة المدورة

Subscapularis Trigger Points as a Predictor for Frozen Shoulder Syndrome: Correlation Study

Trigger points in the shoulder region muscles restrict movement of shoulder and create pain on movement and at rest. The key muscle that must be examined is the subscapularis muscle. The aim of this study is to investigate the relationship between subscapularis trigger with shoulder pain, shoulder abduction and shoulder external rotation. 50 patients diagnosed with frozen shoulder. Data obtained regarding pressure pain threshold (PPT) using pressure algometry, shoulder pain and disability index (SPADI)using questionnaire, shoulder abduction and external rotation ROM using digital inclinometer were statistically analysed and compared. Strong negative significant correlation between PPT with SPADI, strong positive significant correlation between PPT with shoulder abduction and external rotation. Subscapularis trigger points in patients with frozen shoulder affect shoulder pain, shoulder abduction, and external rotation.

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.

Effect of integrated neuromuscular inhibition technique on trigger points in patients with nonspecific low back pain: Randomized controlled trial

Background and Objective: Trigger points in the myofascial system form the major reason for pain and tenderness in nonspecific low back pain (NSLBP). These points can be treated using manual therapy techniques such as integrated neuromuscular inhibition technique (INIT). Due to lack in the literature about its effect in NSLBP condition, the present study was undertaken to evaluate the effects of INIT on trigger points in patients with NSLBP. Materials and Methods: Forty-four patients with NSLBP were randomly assigned to either of the two study groups using envelope method. Group A (n = 22) was treated with stretching and strengthening exercises, whereas Group B (n = 22) was treated with INIT. Both the groups received hot moist pack and therapeutic ultrasound as common treatment. Five consecutive sessions of intervention were given over 5 days. Outcome measures in terms of pain pressure threshold (quadratus lumborum [QL] and erector spinae [ES]), lumbar range of motion (ROM), and disability were measured at baseline and end of the fifth session of treatment. Results: The within-group analysis showed a reduction in pain, improved ROM, and disability in both the study groups (P 0.05). Conclusion: The present study concluded that INIT is superior to stretching and strengthening exercises in reducing trigger point tenderness and better functionality in patients with nonspecific low back pain.

Widespread Pressure Pain Hypersensitivity, Health History, and Trigger Points in Patients with Chronic Neck Pain: A Preliminary Study.

Pain sensitivity in chronic neck pain patients may be influenced by health conditions related to higher levels of widespread pressure pain hypersensitivity (sensitization). Trigger points have also been reported to play a role in the sensitization process. To investigate the association between pressure pain thresholds, trigger points, and health conditions in patients with chronic neck pain. Original research, preliminary study. A private clinic. Thirty-four chronic mechanical neck pain patients and 34 chronic whiplash-associated neck pain patients, giving a final sample of 68 chronic neck pain patients. Patients underwent an assessment of pressure pain thresholds over the upper trapezius, extensor carpi radialis longus, and tibialis anterior muscles and were screened for the presence of trigger points in the upper trapezius muscle. Further, information about health history conditions was obtained and collected in a form. Significantly negative correlations between all pressure pain thresholds and duration of health history conditions were found (all P < 0.02). Significantly lower pressure pain thresholds (all P < 0.01) were found in patients with active trigger points as compared with those with latent trigger points. Widespread pressure pain hypersensitivity was associated with duration of health history conditions, suggesting that long-lasting health complaints may act as a triggering/perpetuating factor, driving sensitization in individuals with chronic neck pain. Active trigger points may be associated with higher widespread pressure hypersensitivity.