Trigger Points Research Articles

Effects of Myofascial Release Techniques on Joint Range of Motion of Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Although myofascial release techniques (MRTs) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRTs may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on the ROM performance of athletes. (2) Methods: The electronic databases of Cochrane Library, PubMed, Scopus, and Web of Science were searched to identify relevant articles published up to June 2023. This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using the robust variance estimator, and subgroup analyses were conducted using the Hotelling Zhang test. (3) Ten studies met the inclusion criteria. The overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the active or passive control groups. (4) Conclusions: Alternative MRTs, such as myofascial trigger point therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRTs.

Efficacy of ganglion impar block combined with pudendal nerve pulsed radiofrequency for pudendal neuralgia management—a randomized clinical trial

BackgroundPudendal neuralgia is a chronic and debilitating condition. Its prevalence ranges from 5 to 26%. Currently, therapeutic approaches to treat pudendal neuralgia include patient education, medication management, psychological and physical therapy, and procedural interventions, such as nerve block, trigger point injections, and surgery. Drug therapy has a limited effect on pain relief. A pudendal nerve block may cause a significant decrease in pain scores for a short time; however, its efficacy significantly decreases over time. In contrast, pudendal nerve pulsed radiofrequency can provide pain relief for 3 months, and ganglion impar block has been widely used for treating chronic perineal pain and chronic coccygodynia. This study aimed to determine the efficacy and safety of monotherapy (pudendal nerve pulsed radiofrequency) and combination therapy (pudendal nerve pulsed radiofrequency plus ganglion impar block) in patients with pudendal neuralgia.MethodsThis randomized, controlled clinical trial will include 84 patients with pudendal neuralgia who failed to respond to drug or physical therapy. Patients will be randomly assigned into one of the two groups: mono or combined treatment groups. The primary outcome will be a change in pain intensity measured using the visual analog scale. The secondary outcomes will include a Self-Rating Anxiety Scale score, Self-Rating Depression Scale score, the use of oral analgesics, the Medical Outcomes Study Health Survey Short Form-36 Item score, and the occurrence of adverse effects. The study results will be analyzed using intention-to-treat and per-protocol analyses. Primary and secondary outcomes will be evaluated between the mono and combined treatment groups. Subgroup analyses will be conducted based on the initial ailment, age, and baseline pain intensity. The safety of the treatment will be assessed by monitoring adverse events, which will be compared between the two groups.DiscussionThis study protocol describes a randomized, controlled clinical trial to determine the efficacy and safety of mono and combination therapies in patients with pudendal neuralgia. The study results will provide valuable information on the potential benefits of this combination therapy and contribute to the development of more effective and safer treatments for patients with pudendal neuralgia.Trial registrationChinese Clinical Trial Registry (ChiCTR2200061800).

Evaluating the Effectiveness of Radiofrequency Therapy and Manual Pelvic Fascial Release in Treating Myofascial Pelvic Pain.

Myofascial pelvic pain (MFPP), characterized by sensitive trigger points in the pelvic floor muscles, leads to chronic pain and affects various aspects of life. Despite the availability of different treatment modalities, there is limited comparative research on their effectiveness. This study compares radiofrequency (RF) therapy and myofascial manual therapy (MMT) in treating MFPP. We aimed to evaluate pelvic floor muscle strength changes, clinical symptoms, and patient comfort during treatment. The study involved 176 participants, divided equally into RF and MMT groups. We assessed pelvic floor pain using the Visual Analogue Scale (VAS), muscle strength using the Modified Oxford Scale (MOS) and surface electromyography (sEMG), clinical symptom improvement through questionnaires, and patient discomfort during treatment. Both RF and MMT groups significantly reduced pelvic floor and paraurethral muscle pain (VAS scores, p < 0.001). RF treatment significantly decreased vaginal laxity in its group (p < 0.001), with no notable change in the MMT group (p = 0.818). RF therapy also resulted in greater patient comfort than MMT (p < 0.001). Although both treatments improved clinical symptoms, there was no significant difference between the two (p = 0.692). MOS scores and pelvic floor sEMG values showed no significant differences between the groups before and after treatment (p > 0.05). Both RF and MMT effectively alleviate pelvic floor pain and improve clinical symptoms in MFPP patients. RF therapy, however, offers additional benefits in reducing vaginal laxity and enhancing treatment comfort.

Pseudo-NRBC in the Mindray BC-6800Plus analyzer: A clue for diagnostic anticipation of fungemia. Experimental and preliminary clinical reports.

Candidemia can be a significant cause of death in immunosuppressed or debilitated patients particularly. Abnormalities of the instrumental cytograms of some hematological analyzers, such as Mindray BC-6800Plus, can be related to circulating Candida. We studied the possible diagnostic usefulness of this information. A fungal bloodstream infection has been simulated by adding aliquots of Candida albicans, Candida parapsilosis, and Candida glabrata to 75 leftovers and anonymized peripheral blood samples. Cytographic abnormalities like those of experimental samples were used to select patients with possible fungemia. The microscopic review of peripheral blood smears constituted the confirmatory method. In all experimental samples, the various Candida types caused pseudo-NRBC and morphological abnormalities of WNB and DIFF cytograms. Circulating blastospores, free or engulfed by neutrophils, were the microscopic findings in the peripheral blood smears. In the clinical verification, 72 patients were recruited based on the presence of an evocative cluster in the WNB and DIFF cytograms. The microscopic review of 39 out of 72 samples was positive for NRBC. According to blood cultures, light microscopy revealed fungal forms of several Candida or non-Candida types in the remaining 33 samples. Nine of these cases were not yet known to suffer from bloodstream infection. Although further confirmatory clinical studies are required for these diagnostic abilities, the BC 6800Plus cytographic abnormalities related to fungemia have proven helpful in rapidly monitoring persistent fungemia in already diagnosed patients. In unknown or undiagnosed cases, they could be the trigger point for the subsequent diagnostic-therapeutic pathway.

Современные алгоритмы терапии диабетического макулярного отека (Обзор литературы. Часть II)

This review presents up-to-date information on officially approved intravitreal angiogenesis inhibitors, provides the comparative analysis of the data obtained during large-scale randomized trials on their efficacy and safety as well as possible schemes of their administration. Special attention is paid to the problem of refractory diabetic macular edema and alternative therapies, including the use of glucocorticoids, inhibition of Rho/ROCK signaling pathway. The dynamics of the central foveal thickness according to optical coherence tomography and best-corrected visual acuity are the main criteria for evaluating the diabetic macular edema therapy effectiveness. According to current data, intravitreal injection of angiogenesis inhibitors is a first-line treatment. In diabetic macular edema, the following drugs have been registered in Russia: ranibizumab, aflibercept, brolucizumab, faricimab. Laser retinal photocoagulation is used mainly for the non-central edema treatment. Intravitreal glucocorticoids are considered as an alternative therapy, but their use is limited by the presence of side effects in the form of secondary drug-induced ophthalmic hypertension and/or glaucoma and the development of cataracts. However, the suboptimal response to standard treatment and the development of refractory forms stimulate the development of novel drugs and delivery systems, as well as the use of several types of therapy that affect different points of the pathogenesis. The review emphasizes the need to further study the trigger points of the diabetic retinopathy pathogenesis and the development of diabetic macular edema in order to find novel drugs and individualize the treatment of each patient. Key words:diabetic retinopathy, diabetic macular edema, vascular endothelial growth factor, VEGF-therapy

Active Occipital Motion with Digipressure as Preoperative Screening in Migraine Surgery

Background: Modern surgical therapy of chronic headaches/migraines is essentially based on the release/neurolysis of extracranial nerves, which, when compressed or inflamed, act as trigger points and, as such, trigger headache attacks. The aim of this article was to describe a novel maneuver we use as an aid in the preoperative planning of occipital trigger sites. Methods: In the period of January 2021–September 2023, we operated on 32 patients (11 men, 21 women, age range: 26–68 years), who underwent migraine surgery for occipital trigger point release. All patients were evaluated using the described preoperative maneuver. In a dedicated card, the levels of tenderness at each point were marked accordingly, differentiating them by intensity as nothing (−), mild (+), medium (++), or high (+++). Patients were then operated on at the points corresponding only to the ++ and +++ signs. Results: At 6-month follow-up, we observed significant improvement (&gt;50%) in 29 patients (91%), with complete recovery in 25 patients (78%). Conclusions: In our experience, the maneuver described, in addition to being very simple, has been shown to have good sensitivity and reproducibility. We therefore recommend its use, especially for those surgeons beginning their practice in this particular area of plastic surgery.

An evaluation of wet and dry needling techniques for treating myofascial pain in trapezius muscle – A meta-analysis

Abstract Introduction: Myofascial pain is a common sign of temporomandibular joint disorders and a significant cause of dysfunction in the general population. Although there are many ways to treat it, because of their ease of use and effectiveness in reducing pain, needling therapies, particularly those inside the masticatory muscles, have seen a recent surge in attention. Aim: The aim of the study was to evaluate the comparison between wet and dry needling therapies in myofascial pain management. Materials and Methods: The following study was built using the PICOS and Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols. A comprehensive search of the literature utilizing the PubMed search engines with the keywords acupuncture, dry needling, wet needling, botulinum toxin, local anesthesia, and masticatory muscle problems was done. A total of 412 items were found after searching the databases. Finally, the analysis contained 21 publications that met the parameters. Results: A statistically significant (P &lt; 0.001) impact on pain reduction was seen by this meta-analysis when comparing wet versus dry needling (mean difference = 0.80, 95% confidence interval = −0.52–2.12, n¼ 7 trials). Discussion: The effectiveness of wet and dry needling in treating symptoms of neck discomfort with musculoskeletal origins related to TrPs was compared in this meta-analysis. We found strong evidence that lidocaine, a local anesthetic, used in wet needling reduced pain more effectively than dry needling. Conclusion: Evidence from this meta-analysis suggests that in individuals with trigger points (TrPs) associated with symptoms of neck discomfort, lidocaine TrP injection works better than dry needling to reduce pain.

Mono-methylated histones control PARP-1 in chromatin and transcription.

PARP-1 is central to transcriptional regulation under both normal and stress conditions, with the governing mechanisms yet to be fully understood. Our biochemical and ChIP-seq-based analyses showed that PARP-1 binds specifically to active histone marks, particularly H4K20me1. We found that H4K20me1 plays a critical role in facilitating PARP-1 binding and the regulation of PARP-1-dependent loci during both development and heat shock stress. Here, we report that the sole H4K20 mono-methylase, pr-set7, and parp-1 Drosophila mutants undergo developmental arrest. RNA-seq analysis showed an absolute correlation between PR-SET7- and PARP-1-dependent loci expression, confirming co-regulation during developmental phases. PARP-1 and PR-SET7 are both essential for activating hsp70 and other heat shock genes during heat stress, with a notable increase of H4K20me1 at their gene body. Mutating pr-set7 disrupts monomethylation of H4K20 along heat shock loci and abolish PARP-1 binding there. These data strongly suggest that H4 monomethylation is a key triggering point in PARP-1 dependent processes in chromatin.

Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series.

Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. Three patients were referred for dry needling once a week for 6weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6weeks. This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.

Neural Interconnections of Extracranial Nerves in Headache Surgery: Anatomical Landmarks and Clinical Implications - A Review of Literature.

Headache disorders (HD) remain a nationwide challenge for the US healthcare system affecting nearly 60% of the US population. Surgical deactivation of the peripheral trigger site, also referred to as headache surgery, represents an effective treatment for patients with refractory HD pain or non-response to pharmacological regimes. Research stemming from other surgical specialties has underlined the clinical relevance of neural interconnections in refining diagnostic algorithms, adapting surgical techniques, and improving overall patient outcomes. While different HD trigger points have been identified, there is a paucity of studies discussing these mostly sensory neural interconnections between these trigger points in a comprehensive fashion. Herein, we aim to provide an overview of the specific nerves involved in HD and synthesize the current literature on HD nerve interconnections to, ultimately, deduce clinical implications. Overall, this line of research may help refine the perioperative workflow and enhance HD patient care.

Dental patients' tinnitus profile: prevalence, types, and associated factors with oral and maxillofacial diseases.

Maxillofacial diseases may pose a risk factor for the onset of tinnitus, and may influence the severity of its symptoms. The objective of this study was to investigate the prevalence of tinnitus among patients routinely visiting the Faculty of Dentistry and to assess the relationship between tinnitus and maxillofacial diseases. This was a prospective cross-sectional study conducted on 3,626 patients. Demographic data, information on tinnitus symptoms, temporomandibular disorder (TMD) presence, the existence of trigger points in masticatory muscles, toothache, and bruxism were evaluated. Tinnitus was detected in 385 patients, resulting in a prevalence rate of 10.61%. Of the patients, 38.4% were male and 61.6% were female, and the mean age was 42.66 ± 16.34 years. Tinnitus was categorised as normal in 47.8% of the patients and pathological in 52.2% of the patients. Bruxism was identified in 65.5% of the patients, toothache in 42.9%, TMD in 33.8%, and masticatory trigger points in 27.0% of the patients. A tendency towards tinnitus provoked by toothache was observed in 5.9% of the patients. The presence of pathological tinnitus was found to increase the risk by 1.839 times for toothache and 1.456 times for bruxism. There may be an association between oral and maxillofacial diseases and tinnitus, especially bruxism and toothache. Therefore, the evaluation of these conditions may be a routine part of tinnitus management.

Musculoskeletal evaluation of the lower pelvic complex in women with endometriosis: A case-control study

ObjectiveUse clinical pain measurement tools to investigate and compare the prevalence of pelvic loin disoders in women with and without endometriosis. Study DesignChronic pelvic pain (CPP) associated with endometriosis has diverse origins, including musculoskeletal factors. Musculoskeletal dysfunction in the pelvic region is theorized to result from sustained muscular contraction, triggered by altered visceral stimuli and adoption of antalgic postures, causing secondary damage to muscles, ligaments, and joints. CPP significantly impacts quality of life, relationships, sexuality, and mental health. However, limited data exists on musculoskeletal impacts of endometriosis and CPP. It was made a case-control study at Maternidade Escola Assis Chateaubriand from August 2017 to January 2021. Evaluated 71 women: 41 in endometriosis group (EG) and 30 in control group (CG). Data collection included sociodemographic questionnaires, musculoskeletal physiotherapeutic evaluations, pain mapping, pressure pain thresholds, kinesiophobia, and disability measurements. Statistical analysis was performed using Spearman's Rho test to determine correlations. ResultsMean age of participants was 31 years. EG exhibited lower pain threshold variations in lumbopelvic trigger points than CG (P < .05). Significant muscle flexibility differences between groups were observed; EG had reduced flexibility (P < .05). Most common pain areas were hypogastrium in EG (48.78 %) and left lumbar in CG (30 %). EG had higher kinesiophobia values (P = .009). There was a weak association between kinesiophobia-pressure threshold association observed in CG's lumbar pelvic region. ConclusionWomen with Endometriosis and CPP exhibit higher prevalence of musculoskeletal disorder, lower pain thresholds, decreased lumbopelvic muscle range of motion, higher kinesiophobia scores, and increased disability indices with low back pain compared to healthy women.

Analysis of the Propagation of Temperature and Thermal Conductivity of Sawdust Pyrolysis Process with Modeling Fea and Experiment

The study uses densified sawdust with heat propagation and thermal conductivity to achieve better pyrolysis and gasification processes. Analysis of sawdust's heat propagation and thermal conductivity during pyrolysis was developed with Finite Element Analysis (FEA). The thermal conductivity values of sawdust (k) obtained from FEA are 1.49, 1.3, 1.1, and 0.7 W/m C considering the sawdust heated with a triggering temperature (T0) 535 ºC and reaches a constant temperature of T1 = 265 ºC, T2 = 165 ºC, T3 = 115, and T4 = 95 ºC respectively after 20 minutes. The temperature distribution of sawdust heated shows between the experimental and FEA results is quite the same; however, differences on graph T1 show the experimental thermal conductivity (k) value is distinct from the simulated thermal conductivity (k) value due to a significant change that occurred as sawdust transformed into charcoal at minute 70, where the distance between point T1 and the trigger point (T0) is 40mm and after 180 minutes the sawdust had turned into charcoal completely. Furthermore, 31 grams (6.46%) of sawdust underwent pyrolysis in this experiment. The findings can aid future research and development in this field and provide valuable insight into the duration of time a bio stove utilizing compacted sawdust can produce a sustainable flame and be used as a reference for future experiments.

Effects of myofascial trigger point injection on the disease activity in patients with comorbidity of fibromyalgia and cervical myofascial pain syndrome

Aims: To investigate the effect of myofascial trigger point injection on the disease activity of FS in patients with myofascial trigger points in the coexistence of fibromyalgia syndrome (FS) and chronic cervical myofascial pain syndrome (MAS). Methods: 30 consenting patients between the ages of 18-60 who has had FS for at least for 3 months and also MPS in trapezius, levator skapula, splenius capitis, and multifidus muscles in cervical region and 15 patients with FS but without MPS were included in the present study. Patients newly diagnosed with FS, were evaluted for the presence of MPS and FS, disease activity was evaluated before administering treatment and after administration of trigger point injection tretament for cervical MPS. In the group with only FS, cervical region tender point injection was carried out. Patients were evaluated before injection and one month after injection. Severity of pain was evaluated with VAS (visual analog scale), pressure pain threshold was measured with algometer, total myalgic score (TMS) , fibromiyalgia impact questionnaire (FIQ), Pittsburgh sleep quality index (PSQI) , Beck depression inventory (BDI), Beck anxiety inventory (BAI), fatique severity scale (FSS) results were evaluated prior to and after treatment. Results: When patients were evaluted at 1st month after myofacial trigger point and cervical tender point injections statistically significant decrease was found in VAS, TMS, PSQI, FIQ, FSS, BAI and BAI scores and the number of trigger points in both FS and FS+MAS groups. (for all parameters p&lt;;0,005). However, this decrease was more evident in FS+MPS group. Conclusion: In conclusion, in the concomitance of MPS and FS, which is one of the most common causes of widespread musculoskletal pain, the treatment of MPS with trigger point injection has been shown to exert positive effects on the severity of FS, affective disorders, sleep and fatique. In the treatment of FS, thetreatment of MPS, which is one of the periheral pain generators, should be given priority.

Effectiveness of dry needling on pain & disability in athletes with iliotibial band tightness- a clinical trial

IntroductionDry needling (DN) for Myofascial trigger points (MTrP's) can be done on superficial or deep tissue levels for the management of a range of neuromusculoskeletal pain disorders. There is still much to learn about dry needling, despite the fact that it has been demonstrated to be useful for a variety of illnesses. The aim of the current study was to determine the effectiveness of DN with stretching on pain and disability in the treatment of athletes with iliotibial band (ITB) tightness. DesignA Clinical Trial. MethodsFor this study, 38 athletes both male and female, aged between 18 to 28 years, with tight iliotibial bands were divided into two groups: DN (n = 19) [Mean age (Years) 21.11 ± 2.96, Height (Cm) 171.16 ± 8.97, Weight (Kg) 63.73 ± 14.12, BMI (Kg/m2) 21.68 ± 3.53] and control group (n = 19) [Mean age 20.26 ± 2.37 (Years), Height (Cm) 166.31 ± 7.97, Weight (Kg) 56.02 ± 9.49, BMI (Kg/m2) 20.17 ± 2.39] who received ITB stretching. As outcome measures both before and after the treatment, the Visual Analogue Scale (VAS) and the Lower Extremity Functional Scale (LEFS) were used. ResultsThe difference in pain and functional scale was assessed using paired and unpaired t-tests. Post-treatment, individuals who received DN showed statistically greater improvements in pain (p = 0.000) and disability (p = 0.001) than those who received stretching. ConclusionAccording to this trial's findings, three sessions of DN with stretching are more effective at reducing pain and enhancing iliotibial band functionality.

The effect of physical therapy rehabilitation on fatigue and pain in female patients with fibromyalgia

This study aimed to examine the impact of physical therapy rehabilitation program on fatigue, pain and quality of life in female patients with fibromyalgia. It was designed as a single-blinded, randomized, pre and post-test controlled trial. Eighty female patients, aged 25 to 45, diagnosed with fibromyalgia were selected from the Kasr Al Ainy rheumatology outpatient clinic. The participants were allocated into two equal groups using a randomization procedure. Group (A) (control group, n=40) received transcutaneous electric nerve stimulation (TENS), moist heat, core muscle retraining, and manual therapy for trigger points, 3 times/week, for 4 weeks. Group (B) (study group, n=40) received the same treatments as Group A, plus aerobic exercises, flexibility exercises, and cognitive behavioural therapy (CBT), 3 times/week, for 4 weeks. Both groups were assessed before and after treatment using the Fatigue Severity Scale (FSS) and the Fibromyalgia Impact Questionnaire (FIQ). Statistically significant improvements were observed in FSS and FIQ scores for both groups post-treatment (p&lt;0.05). When the two groups were compared after therapy, the study group (B) showed significantly greater improvement in FSS and FIQ (p&lt;0.05). These findings suggest that physical therapy rehabilitation can effectively reduce fatigue, pain, and improve the quality of life for women with fibromyalgia.

Approach for contact medical device development via integrated testing, skeletal muscle modeling, and finite element analysis

Development of novel medical devices for the treatment of musculoskeletal pain associated with neuro-muscular trigger points requires a model for relating the mechanical responses of in vivo biological tissues to applied palliative physical pressures and a method to design treatments for optimal effects. It is reasonable to hypothesize that the efficacy of therapeutic treatment is proportional to the maximum tensile strain at trigger point locations. This work presents modeling of the mechanical behavior of biological tissue structures and treatment simulations, supported by indentation experiments and finite element (FE) modeling. The steady-state indentation responses of the tissue structure of the posterior neck were measured with a testing device, and an FE model was constructed using a first-order Ogden hyperelastic material model and calibrated with the experimental data. The error between experimental and FE-generated displacement-load curves was minimized via a two-stage optimization process comprised of an Optimal Latin Hypercube design-of-experiments analysis and a Bayesian optimization loop. The optimized Ogden model had an initial shear modulus (μ) of 5.16 kPa and a deviatoric exponent (α) of 11.90. Another FE model was developed to simulate the deformation of the tissue structures in the posterior neck adjacent to the C3 vertebrae in response to indentation loading, in order to determine the optimal location and angle to apply an indentation force for maximum therapeutic benefit. The optimal location of indentation was determined to be 28° lateral from the sagittal plane along the surface of the skin, measured from the centerline of the spine, at an angle of 8° counterclockwise from the surface normal vector. The optimized spatial orientation of the indentation corresponded to the average of the maximum principal strain across the deep muscle region of the model.

Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome.

The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.

New insight of two kinds of M components in a multi-branch rocket triggered lightning flash

After the first and second return strokes (RSs) of a multi-branch triggered lightning flash, the M component of two different initiation mechanisms burned: (1) Upward leader (UL)-M component, (2) Downward leader (DL)-M component. The UL-M component burned immediately after the RS (about 0.5 ms after the RS). At this time, an UL developing to the cloud generated outside the main channel of the continuous current (CC). With the development of the UL, the M component is formed in the CC channel. The obvious DL process can be observed during DL-M component. The speed of DL is about 2 × 107 m/s, when DL was intercepted by CC channel, M component will generate. The current peak and electric field peak of the UL-M component were larger than those of the DL-M component. It was worth noting that the M component formed by the UL slightly developing to the ground at the head of it did not produce an electric field change at the observation point 2 (1550 m horizontally from the rocket triggered lightning point), which was a result of the combined effect of the positive charge in the branch head and the negative charge in the main channel at the same height. The reflection phenomenon of the M component was also observed in a DL-M component process. The CC in the channel after the RS plays a key role in the formation of the M component. It forms the M component by intercepting the current wave transmitted to the ground from the cloud or the lightning branch.

Immediate Effects of Instrument-Assisted Soft-Tissue Mobilization Versus Dry Needling on Trigger Point Pain and Tightness of Calf Muscles in Long-Distance Runners.

Introduction Muscle tightness is frequently identified as a potential precursor to muscle injuries. Reclaiming flexibility and enhancing range of motion (ROM) is crucial for preventing injuries and achieving improvements in performance.The present study examines the immediate effects of instrument-assisted soft-tissue mobilization (IASTM) and dry needling (DN) in reducing trigger point pain and calf tightness in long-distance runners. Methodology A total of 40 long-distance runners were recruited in the study (30 males and 10 females). The procedure was performed under the author's surveillance at the sports complex. These recruited players were placed into two groups: the IASTM (n=20) and the DN (n=20) group.The outcome measures used were the pressure algometer for assessing pain pressure threshold and the lunge test. An iPhone Measure app (Measure app, Apple App Store 2023) is used to assess ankle dorsiflexion ROM. The evaluation took place both prior to and immediately following the interventionand 48 hours after the intervention. Result The analysis within each group revealed a significant alteration in pain pressure threshold for both the IASTM and DN groups (p≤0.05), along with a relative enhancement in ankle dorsiflexion ROMobserved in the IASTM group (p≤0.05). Between-group analysis revealed a notable difference with an effect size difference of Cohen's d=1.06 (large difference) in pain pressure threshold, d=0.21 (small difference) in lunge test, and d=0.57 (medium difference) in ankle dorsiflexion ROM. Conclusion The present study concludes that both groups, IASTM and DN, showed significant effects in improving pain pressure threshold in long-distance runners. However, DN showed better results. IASTM showed significant results in enhancing the ankle dorsiflexion ROM immediately. This implies thatit can be used in conjunction with stretching to decrease pain and enhance flexibility, hence improving performance and preventing injuries.