Trigger Points Research Articles

Effectiveness of intra-oral botulinum toxin injection in comparison to the extra-oral approach on pain and quality of life in patients with myofascial pain: a randomized clinical trial

Objective To evaluate and compare the effectiveness of the ultrasound-guided intra-oral and extra-oral transcutaneous injection techniques on the clinical outcome variables in patients with myofascial trigger points within the masseter muscle.Materials and methodsThis prospective randomized trial included 42 patients diagnosed with myofascial pain. Patients were randomly allocated into one of two groups based on the technique of trigger point injection: intraoral and extraoral injection technique groups. Each trigger point was injected with 0.1 ml of botulinum-A toxin guided by ultrasound. Pain intensity, mouth opening, and patient quality of life were monitored six months post-injection.ResultsThe pain scores were significantly higher in the extraoral group during all follow-up assessments, whereas the MMO was considerably greater in the intraoral group up to three months of follow-up (p < 0.008). However, the difference in MMO ceased to be statistically non-significant after six months of follow-up (p = 0.927). Additionally, the patient’s quality of life score was significantly higher in the intraoral group compared to the extraoral group (p < 0.001) at both the three- and six-month follow-ups.ConclusionThe intraoral injection technique might be an effective treatment modality for myofascial trigger points in the masseter muscle. It produces pain relief, increases mouth opening, and enhances the overall quality of life compared to the extraoral injection technique.Clinical significanceThe intraoral injection technique for myofascial trigger points is more effective than the extraoral technique; it reduces the need for additional injections, saves money, and enhances patients’ quality of life.Trial registrationClinicaltrials.gov (NCT05673655).

The influence of osteopathic correction on the functional state of volleyball athletes

Introduction. One of the main indicators refl ecting the functional state of the athlete′s organism and limiting his professional achievements in such sports as volleyball, basketball, handball, etc., is jumping ability. Sharp accelerations and jolts of the lower limbs during jumping and landing can contribute to the formation of reversible structural and functional changes in volleyball athletes, both in the region of the lower limbs and in the overlying regions, including the pelvis. Somatic dysfunctions (SD) of the pelvic region can contribute to the formation of lower limb length disparity (LLLD) and activation of myofascial trigger points with the appearance of myofascial pain syndrome, decreased strength of the corresponding muscles, limiting the functional state of the athlete. In the conditions of toughening of anti-doping legislation, the requirements to injury prevention and improvement of functional capabilities of volleyball athletes using non-medicamentous methods of infl uence are increasing.The aim of the study: to substantiate the inclusion of osteopathic correction in the support of training and playing processes of volleyball athletes.Materials and methods. A randomised controlled prospective study involved 45 female volleyball athletes of a professional volleyball team. Inclusion criteria: age 16–25 years; high level of sportsmanship; satisfactory general health at the time of the fi rst examination and throughout the study programme. Inclusion criteria: conditions and diseases that are absolute contraindications to osteopathic correction; contraindications to functional tests; presence of anatomical LLLD. According to the inclusion and non-inclusion criteria, 32 subjects were selected and divided using the randomisation envelope method into main and control groups of 16 subjects each. At the beginning of the study, the osteopathic status, clinical parameters (severity of LLLD, pain according to verbal rating scale) and jump height were assessed. Osteopathic correction was performed only in the main group and only 1 time at the beginning of the study. In both groups, standard treatment was applied as indicated. After that, dynamic studies in both groups (1 week, 2 weeks, 2 weeks, 3 weeks, 1 month, 2 months, 3 months) with evaluation of osteopathic status, clinical parameters and jump height were performed.Results. No global level SD was found in the study group. Various regional level SDs were identifi ed in volleyball athletes, the most frequently identifi ed for this group were SDs of the regions pelvic somatic component (100 per 100 subjects), lumbar somatic component (94 per 100 subjects), thoracic somatic component (87 per 100), lumbar visceral component (65 per 100) and pelvic visceral component (59 per 100). Also characteristic for this group were SDs of the local level, which were chronic in nature (muscular-fascial formations and joints of the upper and lower extremities). Inclusion of osteopathic correction in athletes of the main group led to a decrease in the frequency of detection of regional and local level SD (p&lt;0,05) compared to athletes of the control group. All clinical parameters and jump height in the main group improved signifi cantly (p&lt;0,05) and remained at the achieved level for about 2 months.Conclusion. The obtained data demonstrate the positive infl uence of osteopathic correction on the functional state of volleyball athletes, and the most important indicator for them — jumping ability. We can recommend the use of osteopathic correction every 2 months in the accompaniment of professional athletes-volleyball players.

Modelling resilience dynamics for smart manufacturing systems: quantification and empirical analysis

ABSTRACT Smart manufacturing contributes to a better management of uncertainties and risks in today’s business environment, leading to a more resilient system. Despite its significance, the quantification of resilience in manufacturing environments is not well developed and is considered a pressing research gap. This study introduces a novel approach for assessing resilience through the development of a mathematical model for smart manufacturing systems. The sensitivity and applicability of the proposed model are investigated through simulation-based experimentation. The results demonstrate the level of resilience with the adaptability of smart manufacturing technologies. Interestingly, the trigger point derived from the simulation results is an indicator of the threshold limit for effective implementation of smart manufacturing technologies for the desired system resilience. The research provides a tool for decision-makers in industry that are considering investing in smart manufacturing solutions to increase their operational resilience. Decision-makers can design the deployment of smart manufacturing systems based on an informative trade-off to maintain the required resilience capabilities and achieve a competitive edge in the market.

Effectiveness of dry needling combined with eccentric strength training in lateral epicondylalgia with trigger points

IntroductionLateral epicondylalgia (LE) is commonly presented with myofascial trigger points (MTrPs) among adults. Dry needling (DN) is used less frequently as a first-line treatment in LE with trigger points, and the short and long-term effectiveness of DN in these populations were not studied. Hence, this study compared the effectiveness of DN with conventional physiotherapy in the population of LE with myofascial trigger points.MethodsFor four weeks, the experimental group (&lt;i&gt;n&lt;/i&gt; = 19) received DN with weekly one session, and the control group (&lt;i&gt;n&lt;/i&gt; = 19) received therapeutic ultrasound combined with deep friction massage for 2 sessions per week at the active sites of active MTrPs. Both groups performed two eccentric exercises sessions from the 5th to the 6th week. Handgrip, pain and disability scores of patient rated tennis elbow evaluation (PRTEE) at baseline, 4th week, 6th week, and follow-up of 12th week were analysed.ResultsHandgrip strength, pain, and disability scores were significantly improved for the experimental group at 4th week (SMD of 1.21 kg in handgrip, 12.26 in PRTEE scores) and 6th week (SMD of 1.58 kg in handgrip, 10.15 in PRTEE scores) compared to the control group. However, no significant group differences (p &gt; 0.05) after 12th week either grip strength (SMD = 0.84) or PRTEE scores (SMD = 3.74) were obtained.ConclusionsDry needling with exercise produced greater short-term improvements in grip strength and disability compared to the control group. However, no significant difference in outcomes was found between groups over a 12-week follow-up period.

Dry needling as an adjunct treatment to multimodal rehabilitation protocol following rotator cuff repair surgery: a preliminary, randomized sham-controlled trial

BackgroundRotator cuff repair (RCR) is one of the most prevalent procedures to manage rotator cuff tears (RCT). Postoperative shoulder pain is a common complication following RCR and may be aggravated by activation of myofascial trigger points (MTrP) associated with the injury to the soft tissues surrounding the surgical incision. This study aimed to describe a preliminary, randomized, sham-controlled trial to evaluate the effectiveness of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) as a muscle treatment approach along with 10 sessions of multimodal rehabilitation protocol (MRh) consisting of therapeutic exercise, manual therapy, and electrotherapy on postoperative shoulder pain, range of motion (ROM), strength, and functional outcome scores for patients following RCR surgery.MethodsForty-six patients aged 40–75 following RCR surgery were recruited and randomly allocated into 2 groups: (1) MTrP-DN plus MRh (experimental group), and (2) sham dry needling (S-DN) plus MRh (control group). This trial had a 4-week intervention period. The primary outcome was the Numeric Pain Rating Scale (NPRS) for postoperative shoulder pain. Secondary outcomes were the Shoulder Pain and Disability Index (SPADI), ROM, and strength. The mentioned outcomes were measured at baseline and week 4. In the current study, adverse events were recorded as well.ResultsNo statistically significant differences were observed between groups when adding MTrP-DN to MRh for postoperative shoulder pain after 4 weeks of intervention (mean difference 0.32, [95% CI -0.41,1.05], p = 0.37). However, this trial found a small effect size for postoperative shoulder pain. No significant between-group differences were detected in any of the secondary outcomes (p > 0.05) either. We found significant within-group changes in all studied outcome measures. (p < 0.001). This study also reported minor adverse events. following the needling approach.ConclusionThe lack of statistically significant differences in the outcomes and small clinical significance in shoulder pain highlights the complexity of pain management, suggesting that alternative methodologies may be needed for meaningful clinical benefits. Future studies should consider different control groups, long-term follow ups, larger sample sizes, and more MTrP-DN sessions to better understand their potential impact.Trial registrationThis trial was registered at (https://www.irct.ir), (IRCT20211005052677N1) on 19/02/2022.

Effects of Manual Therapy and Home Exercise Treatment on Pain, Stress, Sleep, and Life Quality in Patients with Bruxism: A Randomized Clinical Trial

Background and Objectives: This study aimed to examine the effects of manual therapy (MT) and home exercise (HE) treatments on pain, sleep quality, stress level, and quality of life in patients with bruxism. Materials and Methods: The study included 30 bruxism patients ages 18–25 years who were randomly divided into the manual therapy group (MTG) and home exercise group (HEG). Before treatment (T1), all patients were asked to fill out the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Fonseca Anamnestic Index (FAI), and Quality of Life Scale/Short Form-36 (SF-36), and additionally, the number of trigger points (NTP) and pain levels were determined. MT and HE were applied for 8 weeks, and all tests were repeated at the end of treatment (T2). A paired-samples t test was used for intra-group comparisons at T1 and T2, and an independent t test was used for inter-group comparisons. The statistical significance level was accepted as p &lt; 0.05. Results: When the results obtained with MT and HE were examined after 8 weeks of treatment, a significant difference was found for all parameters (FAI, PSQI, PSS, SF-36, NTP, activity pain, and night pain levels, p &lt; 0.05) except rest pain in HEG. According to the inter-group comparison, a significant difference was found in PSQI, FAI, and NTP (p &lt; 0.05). However, it was determined that both groups showed statistically similar effects in terms of pain, perceived stress, and quality of life (p &gt; 0.05). Conclusions: MT and HE reduce perceived stress and pain intensity and also improve quality of life and sleep in patients with bruxism. HE is as effective as MT in terms of pain, stress quality of life. MT is more effective than HE in improving sleep quality and TMD symptoms. Both manual therapy and home exercise applications can be applied as alternative treatment methods in the treatment of bruxism.

Resistant and refractory migraine – two different entities with different comorbidities? Results from the REFINE study

BackgroundResistant and refractory migraine are commonly encountered in specialized headache centers. Several comorbidities, mostly psychiatric conditions, have been linked to migraine worsening; however, there is little knowledge of the comorbidity profile of individuals with resistant and refractory migraine.MethodsREFINE is a prospective observational multicenter international study involving individuals with migraine from 15 headache centers. Participants were categorized into three groups based on the European Headache Federation criteria: non-resistant and non-refractory (NRNRM), resistant (ResM), and refractory (RefM). We explored the prevalence of 20 comorbidities at baseline in the three groups.ResultsOf the 689 included patients (82.8% women), 262 (38.0%) had ResM, 73 (10.4%) had RefM and 354 (51.4%) NRNRM. A higher prevalence of psychiatric comorbidities, trigger points, temporomandibular joint disorders, thyroiditis, and cerebrovascular diseases was observed in the RefM group, followed by ResM and NRNRM. Multiple comorbidities were more common in the RefM group, followed by the ResM group and by the NRNRM group (41.6% vs. 24.5% vs. 14.1% respectively; p < 0.001). At the sensitivity analysis, exploring participants with chronic migraine, significant differences among the NRNRM, ResM, and RefM groups were found in the prevalence of anxiety (p < 0.001), asthma and rhinitis (p = 0.013), bipolar and other psychiatric disorders (p = 0.049), cerebrovascular diseases (p < 0.001), depression (p < 0.001), obesity (p = 0.002), thyroiditis (p < 0.001), and trigger points (p = 0.008).ConclusionREFINE data indicate that individuals with ResM and RefM have a higher burden of comorbidities than those with NRNRM. It can be postulated that those comorbidities may have an impact on the progression of migraine from a form that is easy to treat to a form that is resistant or refractory to treatments. Longitudinal studies are needed to understand the direction of the association between ResM or RefM and those comorbidities and if proper treatment of comorbidities might help overcome treatment resistance or refractoriness.

Efficacy of Myofascial Release Therapy and Positional Release Therapy in Patients with Upper Trapezius Trigger Points: Study Protocol of a Double-blinded Randomized Clinical Trial.

Myofascial trigger points are incredibly prevalent and are a painful aspect of almost everyone's life at some point. Myofascial trigger point pain can be excruciating and severely impair the quality of life. Therefore, in patients with neck pain caused by upper trapezius trigger, this current clinical trial will demonstrate the effectiveness of myofascial release therapy and positional release therapy in improving the level of pain, neck impairment, pain threshold, and standard of life. A double-blinded randomized clinical trial will be conducted. Fifty-two participants with active myofascial trigger points in the upper trapezius muscle will be recruited based on selection criteria. They will be randomly allocated into group A (conservative treatment + myofascial release technique) or group B (conservative treatment + positional release technique). Both groups will receive the intervention three times a week for 2 weeks. The study will use the Numeric Pain Rating Scale, pressure algometer, Neck Disability Index, and a 36-Item Short-form Questionnaire as outcome measures. This trial will help identify the effectiveness of the positional and myofascial release techniques in active upper trapezius muscle trigger points and their effect on physical parameters. This trial has been prospectively registered at the Clinical Trials Registry-India (CTRI/2023/07/055126) on 12 July 2023.

Dry needling for orofacial pain: a systematic review and meta-analysis of randomized clinical trials.

Orofacial pain (OFP) is an ache in the front part of the head and typically has musculoskeletal, dental, neural, or sinogenic origin. Dry needling (DN) is the insertion of a solid sterile fine needle through the skin aimed at deactivating the myofascial trigger points has extensively been studied in randomized clinical trials (RCTs). This systematic review was aimed at evaluating the evidence base for the effectiveness of DN for OFP. We searched Medline, Cochrane Central, and Web of Science (from their respective inceptions to February 2024) for RCTs evaluating the effectiveness of DN in patients with OFP. Studies with individuals suffering from cervicogenic or tension type headaches as well as observational studies were excluded. Primary outcomes were pain intensity and severity; secondary outcomes were disability, quality of life, and adverse effects. The review adhered to the methods described by in the Cochrane Handbook. Twenty-four RCTs with a total of 1,318 patients suffering from OFP were included. Most had an unclear or high risk of bias, and the quality of the evidence ranged from very low to low for all comparisons and outcomes. A meta-analysis suggested that, compared with usual care alone, DN + usual care had no effect on pain intensity (visual analogue scale) (standardized mean difference = -1.89, 95% confidence intervals -5.81 to 2.02, very low certainty evidence) at follow-ups of up to 6 weeks. There is little reliable evidence for the effectiveness of DN in reducing OFP. Future, larger, more rigorous studies might reduce the existing uncertainties.

Electromyographic Activity of Cervical Muscles in Patients with Neck Pain and Changes After Dry Needling: A Narrative Review.

Neck pain can be associated with specific conditions, such as neurological disorders, vascular or inflammatory diseases, fractures, herniated discs, etc. However, the majority of neck pain cases cannot be attributed to a specific cause. The objective of this review is to describe the muscle dysfunctions associated with neck pain, as measured by electromyography, and to determine the effectiveness of dry needling in improving these muscular dysfunctions. The research was conducted using the following databases: PubMed, Alcorze, and Google Scholar. The next conclusions have been extracted after the revision of the 65 selected manuscripts. The current scientific evidence supports electromyographic pathological findings in individuals with chronic neck pain, especially during general upper limb movement, repetitive work, violin playing, cervical force, and cervical movement tasks. Dry needling applied to an active myofascial trigger point in the upper trapezius can be suggested as an intervention to enhance the performance in the cranio-cervical flexion. Dry needling applied to latent myofascial trigger points in the upper trapezius after typing tasks in healthy subjects resulted in decreased upper trapezius activity and fatigue in the short term. In women with trapezius myalgia, dry needling applied to the upper trapezius led to a lower increase in electromyography activity compared to no intervention.

Physiotherapy techniques used in injury treatment: A systematic review of tennis elbow

Background and Study Aim. This review provides a comprehensive analysis of the physiotherapy methods used to treat tennis elbow, emphasizing the importance of understanding its pathophysiology and etiology to inform effective treatment strategies. Material and Methods. This review explores a range of physiotherapy interventions, including manual therapies that alleviate pain and improve joint function. Techniques such as joint mobilization, soft tissue massage, and myofascial release are highlighted. Additionally, exercise rehabilitation plays a key role, with individualized exercise programs designed to strengthen weakened muscles and improve elbow biomechanics. The study utilized the Harzing Publish or Perish application for its literature search, sourcing relevant studies from Google Scholar and PubMed using keywords like "Cyriax," "myofascial release," "tendinitis," "trigger points," "tennis elbow," and "degeneration." Boolean operators "WITH," "AND," and "OR" were employed to refine the search results.. Results. Various physiotherapy approaches, including manual therapy, the Cyriax method, deep friction massage, Mill manipulation, myofascial release techniques, laser therapy, pulse shortwave diathermy, and ultrasound, have demonstrated positive outcomes in reducing pain, enhancing function, and promoting tissue repair. Conclusion. In conclusion, this review emphasizes the critical role physiotherapy plays in the effective management of tennis elbow. By compiling the latest research and best practices, it offers valuable insights for practitioners seeking to improve patient outcomes for this prevalent and disabling condition.

Comment to the article: Efficacy of trigger point injection therapy in noncardiac chest pain

Comment to the article: Efficacy of trigger point injection therapy in noncardiac chest pain

The efficacy of thread embedding acupuncture on pain score, neck disability index, and pressure pain threshold for myofascial pain therapy in the upper trapezius muscle.

Myofascial pain characterized by myofascial trigger point (MTrP) is a common cause of musculoskeletal pain and the main cause of neck and shoulder pain in the working population. Thread embedding acupuncture (TEA) is a new modality that can provide long-term stimulation toprolong the same therapeutic effect as conventional acupuncture. This study aimed to determine the effect of TEAtherapy on pain score, neck disability index (NDI), and pressure pain threshold (PPT) for myofascial pain in the upper trapezius muscle. The research design in this study was a double-blind, randomized clinical trial. This study with 44 research subjects was divided into TEA group (n=22) and sham TEA group (n=22). Both groups will receive TEA therapy once using CARA brand monofilament polydioxanone thread 29Gx50mm or sham TEA (thread removed) at one trigger point in the upper trapezius muscle which will be followed-up on 3days, 1week, 4weeks, and 8weeks post-therapy. Both groups experienced significantly reduced pain intensity and disability, also increased PPT at 3days, 1week, 4weeks, and 8weeks post-therapy (p<0.001). TEA therapy had better effectiveness in improving pain intensity at 4weeks (p=0.007) and 8weeks post-therapy (p=0.004), NDI scores at 8weeks post-therapy (p=0.004), and PPT at 4weeks (p=0.04) and 8weeks post-therapy (p=0.002) compared to sham TEA. TEA reduced pain intensity and disability, and increased PPT for patients with myofascial pain in the upper trapezius muscle.

Frontal Migraine Surgery: Indications and Results

Recent studies have identified that certain types of migraines, including frontal migraines, may be attributed to the irritation of specific extracranial nerves. This systematic review addresses the following questions: Which surgical techniques are most effective for chronic frontal migraines? How do combined surgical approaches compare to isolated procedures regarding efficacy and complication rates? Our objective is to comprehensively analyze surgical options for frontal migraines, including their success rates and safety profiles. A literature search was performed using the PubMed database, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, to provide a systematic review of the literature on the surgical treatment of chronic frontal site migraine. A total of 756 citations from PubMed were initially identified. After a title and abstract review, records were considered relevant. Following a full-text examination, only 16 articles from the initial research, published between 2000 and 2024, met the inclusion criteria and were included in the systematic review. In total, 1004 patients suffering from Frontal Migraine Headaches (FMH) underwent surgical treatment, encompassing all the established procedures. Surgical interventions for migraine demonstrated significant symptom reduction, with response rates ranging from 57% to 94% across techniques. Various surgical interventions for frontal trigger site migraines demonstrate significant effectiveness, with endoscopic approaches showing higher success rates. Techniques like foraminotomy and the integration of botulinum toxin A may further enhance outcomes. However, multi-center, high-quality studies are needed to standardize techniques, evaluate long-term consequences, and assess patient quality of life post-surgery.

Occipital neuralgia as an initial manifestation of atypical Lemierre syndrome: A case report.

Lemierre syndrome is a life-threatening but treatable septic thrombosis of the internal jugular vein (IJV) derived from a craniocervical bacterial infection. Metastatic septic embolization is common. However, diagnostic delay and poor prognosis remain a problem, largely due to the diverse clinical presentations and unclear symptomatology of Lemierre syndrome. In contrast, occipital neuralgia is a common disease typically treated with symptomatic therapy in emergency settings, as most cases are not life-threatening. The present case involved a 70-year-old female with Lemierre syndrome stemming from Streptococcus anginosus infection originating in sinusitis or periodontitis. The onset was characterized by headache with typical occipital neuralgia, a severe trigger point in the posterior neck ipsilateral to the infected IJV, and reduced sensation of the C2 nerve root area. Given the anatomical relationship of the cranial venous emissary system into the posterior cervical venous plexus, the case highlights the potential for the neighboring occipital nerve to be directly involved in Lemierre syndrome. Interestingly, despite Lemierre syndrome typically arising from pharyngeal bacterial infections and infected IJV located in the "anterior" neck, many prior case reports have described "occipital" or "posterior" pain at the head or neck. History taking and physical examination remain essential to identify the causes of these posterior/occipital symptoms, since imaging investigations, as in this case, often fail to identify them. Early recognition of occipital neuralgia as a potential initial symptom of Lemierre syndrome could lead to earlier diagnosis and treatment, potentially improving patient outcomes.

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

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

Current State of Dry Needling Practices: A Comprehensive Analysis on Use, Training, and Safety.

Background and Objectives: Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction. Despite its efficacy in a broad plethora of musculoskeletal pain conditions, its safety remains a topic of debate among clinicians and researchers. The aim of this study was to provide an overview of the current practice of DN through a national survey, focusing on the frequency of its use and the incidence of adverse events (AEs), considering factors including physiotherapist experience, clinical workload, the extent of training received by practitioners, and the use of ultrasound guidance. Materials and Methods: An online cross-sectional survey was conducted. Respondents were licensed physical therapists (PTs) working in Spain. The survey covered demographics, professional data, frequency of adverse effects, and if they use ultrasound routinary for guiding interventions. Results: A total of 422 PTs participated in the study, mostly having 21-60 h of DN training (38.6%), less than 2 years of experience (36%), and not using ultrasound during the interventions (85.5%). Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported. Adverse event frequencies varied significantly based on training hours, experience, patient percentage treated with DN, and weekly clinical dedication. Clinicians with more hours of DN training or fewer years of experience reported higher incidences of certain complications. Conclusions: DN is a common intervention among PTs, with minor AEs frequently occurring and major AEs being less common but still significant. The accidental puncture of non-desired structures highlights the necessity for improve training on anatomical landmarks, needle insertion depth, cross-sectional anatomy education, and patient monitoring. To ensure safe practice, emphasize comprehensive training, adhere to safety protocols, exercise caution, and prioritize the use of ultrasound-guide is encouraged.

Investigating the Effect of Dry Needling on Myofascial Trigger Point in Soleus Muscle of Soccer Players with Medial Tibial Stress Syndrome

Introduction: This study investigates the impact of dry needling on myofascial trigger points in the soleus muscles among soccer players with medial tibial stress syndrome (MTSS). Materials and Methods: Soccer players diagnosed with MTSS were enlisted and randomly divided into two groups (11 participants in the experimental group [Group 1] and 11 participants in the control group [Group 2]). Pre-intervention measurements included repeated shuttle sprint ability, MTSS score, and pain pressure threshold (PPT) for both groups. In the experimental group, dry needling was performed on the soleus muscle, followed by active stretching and cryotherapy. The control group underwent active stretching of the soleus muscle and cryotherapy exclusively. Post-intervention measurements of repeated shuttle sprint ability, MTSS score, and PPT were taken for both groups after 2 days. Results: The experimental group exhibited a statistically significant improvement in PPT, MTSS score, and repeated shuttle sprint ability. Conversely, within the control group, statistically significant changes were observed only in PPT values through paired t-test assessment. Between-group analysis using an independent t-test revealed significant enhancement in PPT (P=0.000) and MTSS score (P=0.01) within the experimental group compared to the control group. Conclusion: Addressing myofascial trigger points in the soleus muscle through dry needling offers a more effective approach to treating MTSS than relying solely on muscle stretching.

Bumpless transfer control of switched systems: A dynamic event-triggering switching control approach

This paper studies the bumpless transfer (BT) control issue for switched systems with event-triggered (ET) control input. The aim is to reduce the jumps in control input at both switching and triggering points, while capturing the stability of the switched systems. First, a dynamic ET program is constructed with the triggering condition based on the level of suppression of input signal jumps. This not only reduces input jumps at triggering points, but also prevents Zeno behavior caused by triggering within the operation time interval of subsystems. Second, a sampled state-dependent switching signal is designed to ensure a dwell time for subsystems to prevent Zeno phenomenon induced by switching. Further, a switched ET controller with alleviated jumps is designed. Third, conditions are obtained to simultaneously reach both stabilization and BT of switched systems. Finally, the effectiveness of the theoretical results is demonstrated through a simulation of an engine model.

A utilização da ozonioterapia no tratamento de hérnia de disco em cão

Herniated disc is an affection of the intervertebral disc that often affects dogs of all breeds, ages and sex, and may have higher incidence in the breeds Dachshund, Pug, Cocker Spaniel and Pekinese. There are predisposing causes for the development of these discopathies, such as obesity, anatomical peculiarities of the spine of some breeds, falls, or trauma. The affected patients usually present pain, resistance to locomotion, proprioceptive ataxia, urinary and fecal incontinence or urinary retention, loss of sensation in the extremities, and may evolve to paresis or paralysis. The diagnosis is made by imaging exams, most commonly magnetic resonance and/or tomography, which indicate disc protrusions and extrusions causing spinal cord compression and dehydration/degeneration of the intervertebral disc. The treatment acquired depends on the clinical condition that the animal is in, and may be drug treatment, integrative medicine such as ozone therapy, physiotherapy, acupuncture, or in more severe cases such as disc extrusion, the treatment may be surgical. In this report the case of a 07-year-old pug dog that underwent ozone therapy sessions as a treatment for disc herniation will be discussed. The animal presented a great recovery after 10 sessions of ozone therapy through paravertebral, trigger point and rectal insufflation techniques. Because it is a very common diagnosis in the clinical routine, it is of utmost importance the investigation of the clinical signs and complementary exams to reach the correct diagnosis, and to have anatomical knowledge and the ozone therapy techniques to obtain success in the integrative treatment.