Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points

doi:10.1016/j.jbmt.2010.06.007

Journal of Bodywork and Movement Therapies

Volume 15, Issue 3, July 2011, Pages 319-325

https://doi.org/10.1016/j.jbmt.2010.06.007 Get rights and content

Summary

Objective

The purpose of this study was to assess the effectiveness of ischemic pressure on myofascial trigger point (MTrP) sensitivity.

Design

Randomized, controlled study with the researcher assessing MTrP sensitivity blinded to the intervention.

Participants

Twenty-eight people with two MTrPs in the upper back musculature.

Intervention

The sensitivity of two MTrPs in the upper back was assessed with a JTECH algometer. One of the two MTrPs was randomly selected for treatment with a Backnobber II, while the other served as a control.

Outcome measures

Pre- and post-test pressure–pain thresholds of the MTrPs

Results

There was a significant difference between the pre- and post-test sensitivities of the treated and non-treated MTrPs (p = 0.04).

Conclusions

The results of this study confirm that the protocol of six repetitions of 30-s ischemic compression with the Backnobber II rendered every other day for a week was effective in reducing MTrP irritability.

Introduction

Travell and Simons (1989, p. 5) clinically define a myofascial trigger point (MTrP) as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.” MTrPs can develop from a number of conditions including: genetics, aging, and performing a strenuous activity (Cheng, 1987). MTrPs can be brought on by macrotrauma or by cumulative microtrauma. Abnormal posture, repetitive motion, or psychological stresses are examples of cumulative microtrauma (Fishbain et al., 1986; Horowitz and Sarkin, 1992; Travell and Simons, 1989). Formation and presence of a MTrP is correlated with muscle pain, weakness, and movement dysfunction (Graven-Nielsen et al., 1991, Hong and Simons, 1998, Liley, 1956, Mense, 1991, Mense, 1993, Mense, 1994, Mense, 1996, Simons et al., 1995a, Simons et al., 1995b; Simons, 1996, Travell and Simons, 1989).

There are a variety of modalities purported to relieve or diminish the symptoms associated with MTrPs, including ischemic compression (Kostopoulos et al., 2008, Travell and Simons, 1989), massage (Cantu and Grodin, 1992, Ebel and Wisham, 1952, Fernandez-de-las-Penas et al., 2006, Pemberton, 1939, Prentice, 1982, Sjolund and Eriksson, 1976, Tappon, 1988, Travell and Simons, 1989), needling (Hammeroff et al., 1981, Hong and Simons, 1998, Jaeger and Skootsky, 1987, Lewit, 1979, Melzack and Wall, 1965, Melzack et al., 1977, Rantanen et al., 1999, Sjolund and Eriksson, 1976, Tappon, 1988, Travell and Simons, 1989), vapocoolant spray and stretch (Kostopoulos and Rizopoulos, 2008, Melzack, 1981, Simons, 1996, Travell and Simons, 1989), electrical stimulation (Castel, 1982, Clement-Jones, 1980, Hooker, 1998, Hsueh et al., 1997, Malizia, 1979), laser therapy (Castel, 1982, Cheng, 1987, Laakso et al., 1967, Saliba and Foreman, 1998, Snyder-Mackler and Bork, 1988), ultrasound (Aguilera et al., 2009, Draper and Prentice, 1998, Draper, 1996, Gam et al., 1998, Gulick et al., 2001, Mardimen et al., 1995, McDarmid and Burns, 1987, Srbely et al., 2008, Williams et al., 1987), and diathermy (McCray and Patton, 1984).

Anecdotal reports have supported the efficiency of the use of ischemic compression tools in the treatment of MTrPs. However, randomized controlled studies are lacking. In addition, there are no standardization protocols regarding the appropriate amount of pressure, the duration of the compression, or the frequency of treatments. This study was intended to be the first in a series to develop a clinical protocol for use of an ischemic compression tool in the treatment of MTrPs. The purpose of this study was to determine the effectiveness of a home program of ischemic compression using the Backnobber II device.

Section snippets

Instrumentation

An algometer (JTECH Medical, Salt Lake City, UT) with a 1-cm diameter tip was used to measure pressure sensitivity (in Newtons) of the participants’ myofascial trigger points (Figure 1). Steinbroker was the first to adapt a push–pull gauge called the “palpometer” to quantify articular tenderness. McCarty et al. (1965) developed a similar instrument, the “dolorimeter,” which was used in the evaluation of anti-inflammatory therapy. Test–retest correlations of various forms of this instrument have

Results

The demographic data were as follows: age 24.5 ± 4.1 yrs; height 170 ± 8 cm; weight 71.4 ± 15.3 kg. The means and standard deviation pressure–pain thresholds for the MTrPs are displayed in Table 1. The one-tailed t-test results were p = 0.00998 (critical t = 1.7056). The MTrPs treated with ischemic compression using the Backnobber II yielded an increase in pressure–pain threshold as compared to the non-treated MTrPs.

Discussion

The implementation of an efficacious treatment for MTrPs is a challenge when the pathophysiology remains in question. Observation of the electrical activity of a MTrP has suggested that the taut band formation is the result of an end plate dysfunction with excessive acetylcholine release (Simons, 1996, Simons et al., 1995a, Simons et al., 1995b). Hence the hypothesis that MTrPs are an “energy crisis” that perpetuate until the vicious cycle is interrupted (Simons, 1996, Simons et al., 1995a,

Conclusion

Although there are numerous anecdotal reports of successful pain relief using ischemic compression with the Backnobber II (http://www.pressurepositive.com/index.aspx), there are currently no other research studies assessing this product. The current study is the first step towards establishing a protocol for the use of the Backnobber II in the management of MTrPs. Release of a MTrP can be instrumental in the reduction of pain and the increase in muscle flexibility. The systematic manipulation

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While managing chronic musculoskeletal pain with self-care approaches has been identified as important [14] and aspects of therapeutic massage lends itself well to self-care, no self-massage studies were identified by the systematic search in 2014 [41,42]. Although several studies examining massage self-care as a stand-alone treatment for musculoskeletal pain had been published prior to [36,43] and since [37,44,45] the 2014 Pain Medicine supplement, more feasibility and pilot work for massage self-care approaches to address musculoskeletal pain are needed to inform efficacy trial designs particularly in specific populations such as those with CNP. The current study sought to develop and pilot a trigger point self-care (TrP-SC) group training program for CNP and examine four feasibility related research questions and two exploratory clinical outcomes related research questions to inform future clinical trials.
Trigger points are thought to be associated with chronic neck pain and can be treated with massage self-care techniques such as trigger point self-care. We sought to examine the feasibility of a developed group training approach for trigger point self-care to inform future efficacy focused clinical trials for chronic neck pain.
Self-identified adults with chronic neck pain were recruited to participate in one of two scheduled group training sessions. Data was collected pre- and post-training with follow-up at 1-, 4-, and 8-weeks. Measures included a trigger point self-care training objectives survey, daily self-report logs, and neck disability and pain via the Neck Disability Index. Training included interactive lecture, demonstration, supervised practice, and assessment for an individualized trigger point self-care plan. Handouts and tools were provided for training and home use.
Five participants (women = 3; ages 22–58; White = 4) enrolled and completed the study. All participants completed each data collection point, attended a post-intervention focus group or interview, submitted their completed daily self-care log, and reported achieving all intended training objectives. All participants felt the downtown university location was convenient and non-clinical environment simulated a real-world educational/training experience. Two participants reported having some discomfort the day after training, most expected the training would help them, and several expressed excitement about learned content and empowerment to manage their own pain. Neck Disability Index scores at week-1 did not change for 1 participant, worsened for 1 participant, and improved for 3 participants. All participants’ Neck Disability Index scores were better than baseline at week-4 and week-8.
Our trigger point self-care group training approach was acceptable to study participants and is feasible to implement in future clinical trials. Larger studies including participants with more severe neck pain and disability are needed to test the trigger point self-care approach.
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For the practice of self-massage, therapeutic tools have provided firm or gentle pressure to the muscles12,15,25 but the effect of the mechanical properties of the therapeutic tools has not been considered. Since the transmission of compression force to the deep muscle layer with low muscle tension is emphasized in MTrP pressure release2,17,23,24,26 we believe that self-massage tools that provide gentle pressure are favourable to the practice of self-massage. This study has several limitations.
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In reviewing the methodology of both phases, it appeared the frequent use of the dolorimeter to assess pain threshold may have actually been providing repeated compression to both the treatment and control groups. Ischemic compression has been shown to be an effective treatment technique (Fryer and Hodgson, 2005; Gulick et al., 2011). Thus, phase III resulted in yet another change.
A myofascial trigger point (MTrP) has been defined as a hyperirritable, palpable nodule in a skeletal muscle. The signs and symptoms of a MTrP include muscle pain, weakness, and dysfunction. MTrPs are common problems associated with soft tissue pathology. Having an intervention to decrease MTrP pain can be clinically valuable.
To determine if a series of six instrument-assisted soft tissue mobilization (IASTM) treatments rendered over three weeks would influence the pressure pain threshold (PPT) of a myofascial trigger point (MTrP).
Randomized, control trial of healthy individuals (n = 29) with MTrPs in the upper trapezius muscle. The intervention was six IASTM treatments rendered over three weeks. Each treatment included 1 min of sweeping with the GT-1/HG-2 (handle bar), 1 min of swivel with the knob of the GT-1/HG-2 directly over the MTrP, 2 min of fanning with the GT-4/HG-8 (convex single bevel), and concluded with 1 min of sweeping with GT-1/HG-2.
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^☆: Financial disclosure: we certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (e.g., NIH or NHS grants) and work are clearly identified in the title page of the manuscript.

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Myofascial painEffect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points☆

Summary

Objective

Design

Participants

Intervention

Outcome measures

Results

Conclusions

Introduction

Section snippets

Instrumentation

Results

Discussion

Conclusion

Journal of Manipulative and Physiological Therapeutics

Journal of Bodywork and Movement Therapies

Pain

Pain

Journal of Bodywork and Movement Therapies

Pain

Pain

Archives of Physical Medicine and Rehabilitation

Journal of Bodywork and Movement Therapies

Pain

Lancet

Pain

Pain

American Pain Society Journal

Clinical Biomechanics

Pain

Lancet

Pain

Ultrasound in Medicine and Biology

Pressure algometry in healthy subjects: inter-examiner variability

Scandinavian Journal of Rehabilitation Medicine

The effects of time on static stretch on the flexibility of the hamstring muscles

Physical Therapy

The effects of time and frequency of static stretching on flexibility of the hamstring muscles

Physical Therapy

Myofascial Manipulation: Theory and Clinical Applications

Pain management with acupuncture and transcutaneous electrical nerve stimulation technique and photo simulation (laser)

Increased B-endorphin but not metenkephalin levels in human cerebral spinal fluid after acupuncture for recurrent pain

Lancet

Therapeutic ultrasound

Ten mistakes commonly made with ultrasound use: current research sheds light on myths

Athletic Training

Effect of massage on muscle temperature and radiosodium clearance

Archives of Physical Medicine and Rehabilitation

The diagnostic value of pressure algometry in myofascial pain of the jaw muscles

Journal of Oral Rehabilitation

Effects of experimental muscle pain on muscle activity and co-ordination during static and dynamic motor function

American Journal of Physiological Pharmacology

Effect of ultrasound on pain associated with myofascial trigger points

Journal of Orthopedic and Sports Physical Therapy

Myofascial pain
Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points☆