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

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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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