Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity

doi:10.1053/apmr.2002.34834

Archives of Physical Medicine and Rehabilitation

Volume 83, Issue 10, October 2002, Pages 1406-1414

https://doi.org/10.1053/apmr.2002.34834 Get rights and content

Abstract

Hou C-R, Tsai L-C, Cheng K-F, Chung K-C, Hong C-Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002;83:1406-14. Objective: To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle. Design: Randomized controlled trial. Setting: Institutional practice. Patients: One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs). Intervention: Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release). Main Outcome Measures: The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect. Results: In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05). Conclusions: Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Participants and experimental design

Patients with cervical myofascial pain were recruited from our university's department of rehabilitation medicine. A total of 119 subjects (107 women, 12 men; age range, 30–60y) with clinically active, palpable MTrPs in a single side or both sides of the upper trapezius muscle were recruited between March and October 2000 for this study. The criteria for subject selection included (1) no neck or shoulder surgery within the past year; (2) no clinical evidence of radiculopathy or myelopathy; (3)

Stage 1: Immediate effect of ischemic compression with various pressures and durations

The data for subjects in the 6 ischemic compression groups (stage 1) are listed in table 1.

. Subjects' data in stages 1 and 2

Group	n	Sample Sizes of MTrPs	Women	Men	Mean Age ± SD (y)
Stage 1
P1T1	8	14	8	0	49.50±11.14
P1T2	8	14	8	0	45.50±14.59
P1T3	8	14	8	0	38.11±8.24
P2T1	8	14	8	0	41.00±14.63
P2T2	8	14	8	0	46.25±14.54
P2T3	8	14	8	0	45.50±13.20
Stage 2
B1	21	35	17	4	47.86±13.68
B2	13	22	12	1	50.62±15.32
B3	9	17	8	1	46.89±14.91
B4	10	17	7	3	53.20±16.77
B5	9	16	6	3	51.00±16.19
B6	9	16	9	0	39.67±7.55

Abbreviations: P1, pain threshold; P2, average of pain threshold and pain

Discussion

Copper et al³⁷ and Fricton et al³⁸ have proposed that the incidence of MTrPs appears to be higher in women than in men, and that, among all age groups, patients 30 to 40 years old appear to have the highest prevalence of trigger points. Of our 119 subjects (age range, 30–60y), 107 were women, which indicates that the incidence of MTrPs is higher in women than in men. Patients with MTrPs in the upper trapezius muscle usually complain of neck pain, headache, muscle stiffness, restricted ROM of

Conclusions

Ischemic compression therapy with quantified pressure and duration provides alterative treatments by using either the pressure of pain threshold with a long duration of 90 seconds or the pressure of the average of pain threshold and pain tolerance with a duration of 30 seconds. It provides immediate pain relief and reduces the MTrP sensitivity of the cervical myofascial pain.

Immediate relief from cervical myofascial pain can be obtained in 6 therapeutic modalities. Hot pack plus active ROM,

References (49)

DA Fishbain et al.
Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria
Pain
(1986)
CZ Hong et al.
Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points
Arch Phys Med Rehabil
(1998)
JR. Fricton
Myofascial pain syndrome
Neurol Clin North Am
(1989)
P Hansson et al.
Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain
Pain
(1983)
R. Melzack
Prolonged relief of pain by brief, intense transcutaneous somatic stimulation
Pain
(1975)
BH Pomeranz et al.
Naloxone blockade of acupuncture analgesia: endorphin implicated
Life Sci
(1976)
B Kaada et al.
In search of mediators of skin vasodilatation induced by TENS: serotonin implicated
Gen Pharmacol
(1983)
L Bendtsen et al.
Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues
Pain
(1994)
AA. Fischer
Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold
Pain
(1987)
JL Reeves et al.
Reliability of pressure algometer as a measure of myofascial trigger points sensitivity
Pain
(1986)

B Jaeger et al.

Quantification of changes in myofascial trigger point sensitivity with pressure algometer following passive stretch

Pain

(1986)

SB Graff-Radford et al.

Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity

Pain

(1989)

JR Fricton et al.

Myofascial pain syndrome of the head and neck: a review of the clinical characteristics of 164 patients

Oral Surg Oral Med Oral Pathol

(1985)

L Bendtsen et al.

Qualitative altered nociception in chronic myofascial pain

Pain

(1996)

CZ. Hong

Persistence of local twitch response with loss of conduction to and from the spinal cord

Arch Phys Med Rehabil

(1994)

U Hoheisel et al.

Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain?

Neurosci Lett

(1993)

CZ Hong et al.

Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points

Arch Phys Med Rehabil

(1998)

SC Han et al.

Myofascial pain syndrome and trigger-point management

Reg Anesth

(1997)

JR. Fricton

Myofascial pain syndrome: characteristics and epidemiology

SA Skootsky et al.

Prevalence of myofascial pain in general internal medicine practice

West J Med

(1989)

DG Simons et al.

Travell & Simons' myofascial pain and dysfunction: the trigger point manual, volume 1. Upper half of body

(1983)

DG. Simons

Myofascial pain syndrome due to trigger points

DG. Simons

Referred phenomena of myofascial trigger points

RD. Gerwin

The management of myofascial pain syndrome

J Musculoskel Pain

(1993)

Cited by (248)

Unknotting tech neck by breaking the cycle of pain and disability: Comparing the impact of instrument assisted soft tissue mobilization on specific muscles and superficial back arm line
2024, Journal of Bodywork and Movement Therapies
Computer professionals often develop a forward head posture due to prolonged hours of computer use, leading to neck pain. Instrument-assisted soft tissue mobilization (IASTM), an advanced technique for treating myofascial trigger points, has become increasingly popular for addressing these musculoskeletal issues.
The study aimed to compare the effectiveness of IASTM mobilization on SBAL (superficial back arm line) and SM(specific muscles-upper trapezius, levator scapulae, and sternocleidomastoid) in managing chronic neck pain among computer professionals.
The study involved 62 computer professionals, randomly divided into two groups. Group A received IASTM on SBAL and group B received IASTM on SM for neck pain each receiving three sessions weekly for four weeks. Outcome variables like Neck Disability Index (NDI), NPRS(Neck Pain Rating Scale), Craniovertebral angle (CVA), and range of motion (ROM) for flexion, and side flexion (right & left side) were evaluated at baseline, 2 weeks and 4 weeks.
Significant improvement in NPRS were observed in both the SBAL and SM groups after 2 weeks of IASTM, wth the SBAL group demonstrating greater improvement. At 4 weeks, IASTM on SBAL showed significantly higher improvements in NPRS, CVA, NDI, and flexion compared to the SM group. The repeated measures ANOVA indicated a significant main effect of both time and group, along with a significant interaction between time and group for all outcome variables, except for CVA.
The study indicates that IASTM on SBAL may offer a more effective treatment for chronic neck pain in computer professionals compared to targeting specific muscles.
The effects of dry needling and face yoga on pain, depression, function, and sleep quality in patients with temporomandibular dysfunction
2024, Explore
Temporomandibular joint dysfunction (TMD) poses significant challenges due to its diverse symptoms and impact on patients' daily lives.
This study aimed to explore the effectiveness of two innovative interventions, dry needling and face yoga, in managing TMD-related issues such as pain, depression, and sleep quality.
Ninety patients with TMD symptoms were enrolled in a prospective randomized controlled trial. The patients were divided into three groups: dry needling, face yoga, and a control group. Various assessments, including Visual Analog Scale for pain, Beck Depression Inventory for depression, and Pittsburgh Sleep Quality Index for sleep quality, were conducted before and 6 weeks after the interventions.
A decrease in pain levels and a statistically significant increase in jaw joint movements (mouth opening, protrusive movement, lateral movements) were observed in the dry needling and face yoga groups after treatment (p <0.05). Additionally, improvements in sleep quality were observed (p <0.05).
Dry needling and face yoga interventions demonstrated efficacy in managing TMD symptoms, including pain relief and improved jaw movement. The findings suggest that these interventions can be valuable additions to the treatment regimen for patients suffering from TMD-related issues. However, further research is warranted to explore the long-term effects and mechanisms underlying these interventions in TMD management.
Instrument Assisted Soft Tissue Mobilization versus Integrated Neuromuscular Inhibition Technique in Nonspecific Chronic Neck Pain: Single-blinding Randomized Trial
2023, Journal of Chiropractic Medicine
This study aimed to compare the effects of instrument-assisted soft tissue mobilization (IASTM) vs integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, neck disability, and electrophysiological properties in nonspecific chronic neck pain.
We performed a pre-post prospective randomized controlled trial on 90 participants with nonspecific chronic neck pain. The participants were chosen randomly from physical therapy out-patient clinics in the Giza governorate and allocated randomly by permuted block to the following 3 groups: Group A received INIT on the upper trapezius in addition to supervised traditional therapy (STT) as hot pack, stretching and strengthening exercises, Group B received IASTM on the upper trapezius in addition to STT, and Group C received STT only. Treatment was 3 times per week for 4 weeks. Pain intensity by visual analog scale (VAS), pressure pain threshold (PPT) by commander algometer, neck disability by Arabic Neck Disability Index (ANDI), and electrophysiological properties in the form of muscle amplitude by root mean square (RMS), and fatigue by median frequency (MDF) were measured at baseline and after 4 weeks.
In the within-group analysis, there was a statistically significant decrease in VAS, ANDI, and RMS% values within each group with favor to INIT. In PPT and MDF, there was a significant increase within each group with regard to INIT as P value <.05. In the between-group analysis at posttreatment, the results reported a statistically significant difference between INIT and STT, and also between IASTM and STT in all variables. Between INIT and IASTM, there was no statistically significant difference in VAS and NDI, but there was a statistically significant difference in PPT, RMS%, and MDF. The post hoc test reported improvement in all variables in all groups, with more favor to the INIT group in PPT and electrophysiological properties only.
In this study, we found no statistically significant differences between INIT and IASTM in VAS and ANDI posttreatment, but there were differences between INIT and STT group and IASTM and STT group.
Myofascial Release Effects in Teachers’ Posture, Muscle Tension and Voice Quality: A Randomized Controlled Trial
2023, Journal of Voice
Citation Excerpt :
Since fascia is a continuous tissue in our body, a restriction of it in one area can cause stress and dysfunction in other regions. The MFR can then decrease or eliminate the restrictions being reported as effective in relieving pain and relaxing tissues.24,25 However, specific evidence concerning the MFR effects on body posture, muscle tension and voice has been lacking.
Myofascial release (MFR) comprises a set of manual therapeutic techniques applied to many conditions, but specific evidence concerning its effects on body posture, muscle tension and voice has been lacking. Thus, the aim of this study was to verify the effects of MFR in teachers’ posture, muscular tension and voice quality.
Randomized controlled trial – crossover.
Twenty-four teachers, after completing a Sociodemographic and Clinical Questionnaire and providing written informed consent, were randomly distributed into two groups designated Group 1 (G1; n = 12; received MFR first) and Group 2 (G2; n = 12; belong to control group first). All participants received treatment and were into control group, since, after a 14 day period, procedures were switched between groups. Photogrammetry, muscle tension assessed through palpation, algometry, aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were performed before and after interventions.
Regarding voice, statistically significant differences were found when intervention was applied to both groups for maximum phonation time (MPT) (G1 P = 0.019; G2 P = 0.004). The acoustic variables did not differ. Concerning the auditory-perceptual analysis of voice statistically significant differences were found when intervention was applied in both groups for Grade in G2 (P = 0.046) and for Roughness in G1 (P = 0.025). Regarding the photogrammetry assessment statistically significant differences were found when intervention was applied to both groups in many parameters while as control group they did not. Concerning the algometry and muscle tension assessed through palpation statistically significant differences were found when intervention was applied in all muscles.
Findings indicated that MFR seems to be an effective therapy in improving MPT, two subscales (Grade and Roughness) of the GRABASH scale, muscle tension assessed through palpation and algometry. Regarding photogrammetry, MFR had an immediately effect in improvement of the posture, especially related with head.
Autonomic nerve regulation in joint hypermobility patients with myofascial trigger points by Musculoskeletal Interfiber Counterirritant Stimulation (MICS)
2022, Medical Engineering and Physics
Joint hypermobility (JH) conditions suggest dysfunction in the autonomic nervous system (ANS) (dysautonomia), associated with multifactor non-articular local musculoskeletal pain, and remains a complex treatment. This study aims to determine the effects of musculoskeletal interfiber counterirritant stimulation (MICS) as an innovative treatment of myofascial trigger points (MTrPs) on the upper trapezius muscle in JH patients. We evaluate the ANS activity by wavelet transform spectral analysis of heart rate variability (HRV) in sixty women, equally divided: MTrP, MTrP + general joint hypermobility (GJH), and MTrP + joint hypermobility syndrome (JHS). The protocol phases were rest, stimulation, and recovery, with clinical and home treatment for three-days. All groups show a significantly decreased in pain perception during and post-treatment, and an increased parasympathetic ANS activity under MICS in the GJH and JHS groups. The variables low-frequency (LF) vs. high-frequency (HF) showed significant differences during the protocol phases, and the LF/HF ratio maintained a predominance of sympathetic activity (SA) throughout the protocol. The new MICS technique reduces the pain perception and modulates the ANS activity by an increase in vagal tone, and a decrease in sympathetic tone. This modulation was followed by an increase in the HRV in JH patients after treatment with MICS. Clinical Trials: RBR-88z25c5.
Within-Subject Changes in Shoulder Girdle Muscle Activation After Soft Tissue Mobilization of the Upper Trapezius
2022, Journal of Chiropractic Medicine
The purpose of this study was to investigate the effect of the integrated neuromuscular inhibition technique (INIT) of the upper trapezius (UT) on shoulder muscle activity in chronic shoulder pain.
Twenty-two patients (mean age 42.5 ± 16.07) with chronic unilateral shoulder pain with UT myofascial trigger points (MTrPs) (n = 27) and scapular dyskinesis received a single session of INIT (∼15 minutes for each MTrP). The pain on the visual analog scale, along with surface electromyographic activity, maximum voluntary contraction in % (in arm raising and lowering in scapular plane), and pressure pain threshold (PPT) of 5 girdle muscles UT, lower trapezius, serratus anterior, middle deltoid, and infraspinatus were measured before and immediately after treatment. Wilcoxon signed-rank test was used for analysis (at α ≤ 0.05).
Muscle activity of all the muscles, especially the lower trapezius, was reduced during arm raising in the scapular plane (76.69%-71.14% [p = 0.003]). UT activity decreased during arm lowering also (56.70%-45.99% [p ˂ 0.001]). The intensity of shoulder pain reduced (50.50 mm to 22 mm, [p ˂ 0.001]), and PPT values of all 5 muscles improved post-treatment.
The findings of this study provide preliminary evidence for the application of a single session of INIT on UT MTrPs in reducing activity in the scapular muscles, improving shoulder pain, and PPT in chronic unilateral shoulder pain.

View all citing articles on Scopus

^☆: Reprint requests to Chuen-Ru Hou, PhD, Institute of Biomedical Engineering, National Cheng Kung University, No. 1, Ta-Hsueh Rd, Tainan 701, Taiwan, e-mail: [email protected].

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

^★: Supplier

^★★: a. Pain Diagnostics & Treatment Inc, 233 E Shore Rd, Ste 108, Great Neck, NY 11023.

^♢: b. Staodynamics Inc, 1225 Flordia Ave, Box 1379, Longmont, CO 80502.

^♢♢: c. Celcom Inc, 2213, Tokoji-Mochi, Hakata-Ku, Fukuoka 816, Japan.

^♦: d. Gebauer Co, 9410 Saint Catherine Ave, Cleveland, OH 44104-5526.

View full text

Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity☆,☆☆,★,★★,♢,♢♢,♦

Abstract

Section snippets

Participants and experimental design

Stage 1: Immediate effect of ischemic compression with various pressures and durations

Discussion

Conclusions

Pain

Arch Phys Med Rehabil

Neurol Clin North Am

Pain

Pain

Life Sci

Gen Pharmacol

Pain

Pain

Pain

Pain

Pain

Oral Surg Oral Med Oral Pathol

Pain

Arch Phys Med Rehabil

Neurosci Lett

Arch Phys Med Rehabil

Reg Anesth

Myofascial pain syndrome: characteristics and epidemiology

Prevalence of myofascial pain in general internal medicine practice

West J Med

Travell & Simons' myofascial pain and dysfunction: the trigger point manual, volume 1. Upper half of body

Myofascial pain syndrome due to trigger points

Referred phenomena of myofascial trigger points

The management of myofascial pain syndrome

J Musculoskel Pain