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Objective: To evaluate the efficacy and safety of ultrasound-guided acupotomy (UgA) for the treatment of thoracodorsal myofascial pain syndrome (TDMPS) and monitor its mid-term efficacy at 3 months after treatment. Methods: A 3-week, evaluator-blinded randomized clinical trial was conducted among 100 patients with TDMPS (visual analogue scale [VAS] score > 3) in the outpatient clinic of the Department of Orthopaedics of the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, with a 3-month follow-up starting after completion of treatment. These patients were randomly assigned to receive UgA (n = 50) or oral celecoxib (n = 50). Recruitment was conducted between January 2021 and July 2022. The primary outcome was the VAS score, and the secondary outcomes included the Oswestry Disability Index (ODI), Pain Anxiety Symptoms Scale (PASS), and TNF-α and IL-1β levels. Outcome data were collected at baseline, week 3 (post-treatment) and week 15 (follow-up). Results: Compared with that in the celecoxib group, the pain in the UgA group was alleviated more strongly, with an adjusted mean group difference of -0.69 (95% CI,-1.07 to -0.31 after multiple imputation) at week 3 and -1.96 (95% CI,-2.33 to -1.59 after multiple imputation) at week 15 (p < 0.001 for overall group x time interaction). Both groups exhibited improvements in the ODI and PASS scores at weeks 3 and 15, but these improvements were significantly greater in the UgA group (p < 0.05). At week 3, the TNF-α and IL-1 levels were significantly lower in both groups, but celecoxib was more effective (p < 0.05). Results from analyses with multilevel multiple imputation for missingness were similar. Conclusion: UgA led to greater and safer alleviation of pain, dysfunction, and pain anxiety in patients treated with TDMPS than did celecoxib and had a durable 3-month efficacy but was inferior to celecoxib in reducing the level of inflammatory factors. These findings may prompt clinicians to recommend UgA as an alternative and supplementary therapy for pain management in patients with TDMPS. [ABSTRACT FROM AUTHOR]

Background: Myofascial trigger points found along taut bands of muscle fibers are a common cause of pain among nursing professionals. Instrument-assisted soft-tissue mobilization (IASTM) and myofascial release (MFR) are two techniques to relieve pain and disability. This study aimed to compare the effects of IASTM and MFR on pain, range of motion, and functional disability on upper trapezius trigger points (UTTPs) in nursing professionals. Materials and Methods: Thirty nursing professionals with UTTPs were allotted to two groups (n = 15 each). The IASTM group received IASTM plus a home exercise program, whereas the MFR group received myofascial release plus a home exercise program. Both groups received two sessions per week for three weeks. Patients were assessed for pain, range of motion, and functional disability at baseline and after 3 weeks. Results: The results indicated statistically significant differences between the IASTM group and the MFR group for pain, disability, and range of motion, except for active cervical rotation on the left side. Within each group, all the variables showed significant improvement. Conclusion: Although both groups had significant improvements in all variables, participants treated with IASTM had better results in reducing pain, improving range of motion, and improving functional status. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated. Objective: To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain. Methods: Thirty‐one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Results: The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale. Conclusion: Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia. [ABSTRACT FROM AUTHOR]

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background The investigation aimed to assess the impacts of magnesium sulphate (MgSO4) iontophoresis and high-power pain-threshold ultrasound (HPPT-US) on pain, range of motion (ROM), and functional activity in physical therapy students suffering from mechanical cervical pain. Methods Typically, 75 males aged 19 to 30 years suffering from mechanical neck pain were enrolled in this investigation. Participants were divided at random into three groups. Group A received iontophoresis plus conventional physical therapy program, Group B received HPPTUS along with conventional therapy, and Group C received conventional therapy only. The outcomes were pain evaluated by visual analog scale (VAS) and Digital Electronic Pressure Algometer, cervical range of motion measured by Myrin gravity reference goniometer, and Arabic Neck disability index (ANDI) evaluate neck function. Results The differences within and between groups were detected utilizing a mixed-design multivariate analysis of variance (MANOVA). The within- and between-group analysis of all outcome measures revealed that there were statistically significant differences at post-intervention between high-power ultrasound and conventional group at all variables and also between iontophoresis and conventional group, but there was no statistically significant variation between high-power ultrasound and iontophoresis. Conclusion MgSO4 iontophoresis and HPPT-US are effective in decreasing pain, improving neck function, and improving neck ROM in subjects with mechanical neck pain who have active myofascial trigger points (MTrPs) on the upper fibers of the trapezius with no superiority of one over the other. Trail registration The study was registered in the Clinical Trials Registry (registration no: NCT05474898) 26/7/2022.

Trigeminal neuralgia (TN) is a debilitating neuropathic condition characterized by excruciating, lancinating pain attacks. The standard first-line treatment of TN is carbamazepine medication, but some patients do not experience relief from this drug. For cases that do not respond to medication, surgical procedures that cut or remove portions of the peripheral nerves, such as the inferior alveolar and mental nerves, can be attempted. However, these neurectomy surgeries often have high rates of severe facial pain recurring over time. A 40-year-old man suffered from chronic, debilitating trigeminal neuralgia. He underwent multiple tooth extractions and took carbamazepine, but neither provided improvement in his agonizing facial pain. He then had surgical neurectomies of the mental and inferior alveolar nerves, which provided only partial pain relief. The patient was not relieved, so he underwent a surgical neurectomy of the lingual nerve. This third procedure successfully provided a significant reduction in his trigeminal neuralgia pain. Lingual neurectomy emerges as a potentially definitive treatment modality for trigeminal neuralgia refractory to medication or alternative neurectomy procedures. This minimally invasive surgical approach offers a valuable option for patients seeking sustained pain relief, particularly those who are not suitable candidates for or desire to avoid, more extensive or resource-intensive interventions.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

AbstractPurposeMethodsResultsConclusionRegistration number\nIMPLICATIONS FOR REHABILITATIONTo evaluate the effectiveness of trigger point manual therapy (TPMT) in treating rotator cuff related shoulder pain (RCRSP).Randomized controlled trials that compared the effects of TPMT with no or other conservative treatments in patients with RCRSP were included. Primary outcomes were shoulder pain intensity and function. Secondary outcomes were pressure pain threshold (PPT) and number of myofascial trigger points (MTrPs). The Cochrane Risk of Bias 2.0 tool, PEDro scale and GRADE approach were employed.Ten studies were included in this systematic review and seven in the meta-analysis. Very low to low quality of evidence showed no statistically significant difference between TPMT and other conservative treatments in rest and activity pain reduction in the short term (3 days to 12 weeks), and the difference in shoulder function was statistically significant in favor of TPMT. Furthermore, TPMT was found to be effective in the improvement of PPT and the inactivation of active MTrPs in the short term.TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term, and slightly more effective for functional improvement. TPMT seems to be effective to treat the active MTrPs in RCRSP.CRD42023409101Trigger point manual therapy (TPMT) seems to be effective to treat the active trigger points of rotator cuff related shoulder pain (RCRSP) in the short term (3 days to 12 weeks).TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term (3 days to 12 weeks), and slightly more effective for functional improvement.TPMT may be recommended for use in comprehensive treatment programs which may include active components such as exercise therapy and education for the rehabilitation of RCRSP.Trigger point manual therapy (TPMT) seems to be effective to treat the active trigger points of rotator cuff related shoulder pain (RCRSP) in the short term (3 days to 12 weeks).TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term (3 days to 12 weeks), and slightly more effective for functional improvement.TPMT may be recommended for use in comprehensive treatment programs which may include active components such as exercise therapy and education for the rehabilitation of RCRSP. [ABSTRACT FROM AUTHOR]

Introduction: Myofascial pelvic pain (MFPP) is a prevalent yet frequently overlooked condition characterized by myofascial trigger points located within the pelvic floor muscles. Women with MFPP often experience severely reduced quality of life due to impaired sexual health. Here, we examined the relationship between MFPP and sexual function. Materials and Methods: Eighty-three women with a benign gynecological condition were included in this pilot study. For each patient, we obtained a complete medical history, measured different types of subjective pain intensity using a visual analog scale, performed a validated standardized examination of the pelvic floor muscles for measuring MFPP, and used the German Female Sexual Function Index (FSFI-d) questionnaire. Results: Compared to women without MFPP (46 out of 83; 55.4%), the women with MFPP (37 out of 83; 44.6%) reported experiencing pain on more days per month (8 vs. 3 days/month; p = 0.002) and higher median VAS scores for dyspareunia (4 vs. 0; p < 0.001). We also found a significant inverse correlation between the severity of MFPP and overall FSFI-d scores (r = −0.35; p < 0.001), particularly in the FSFI-d subdomains of pain (r = −0.364; p < 0.001), lubrication (r = −0.230; p = 0.005), and arousal (r = −0.360; p < 0.001). Conclusions: Due to the higher prevalence of dyspareunia and pelvic pain, MFPP significantly impacts several aspects of female sexual health and function. This information, combined with increased awareness regarding MFPP, may provide a foundation for designing individualized therapies, thereby improving the quality of life of women affected by MFPP. [ABSTRACT FROM AUTHOR]

IntroductionAimStudy DesignMethodResultConclusionMedial tibial stress syndrome (MTSS) is also called soleus syndrome because the resultant periostitis is localized to the medial insertion of the soleus muscle. This study explores the effectiveness of dry needling (DN) targeting soleus myofascial trigger points (MTrPs) in managing MTSS.To assess the impact of DN on pain reduction and ankle range of motion (ROM) improvement in athletes with MTSS.This randomized controlled trial (RCT) included 50 university-level athletes. (DN group = 25; control group = 25)Outcome variables, pain, and ankle dorsiflexion ROM were measured using the Numeric Pain Rating Scale (NPRS) and universal goniometer, respectively. The trial used statistical analyses like Wilcoxon rank test for within-group comparisons and Mann-Whitney U test for between-group comparisons. The trial was registered with the Clinical Trials Registry of India; CTRI/2023/10/058837.There were 24 Females (Age = 21.4 ± 2.06) & 26 Males (Age = 20.5 ± 2.35). DN significantly reduced pain in the intervention group from NPRS 7 ± 1.30 to 2 ± 0.87 (p < 0.001), but in the control group, the pain increased from NPRS 7 ± 0.99 to 7 ± 1.05 (p = 0.009). There was no improvement in ankle ROM.DN effectively alleviated MTSS-associated pain in the short-term but was not effective in improving ankle ROM. [ABSTRACT FROM AUTHOR]

Myofascial pain syndrome, which has trigger points, is one of the most common causes of acute and chronic musculoskeletal pain. The trigger points formed by damage to the muscle fibers are focal areas of taut bands in the skeletal muscle that are hypersensitive to palpation. When manual pressure is applied over a trigger point, it produces distinct local and referred pain. Although various modalities have been used to treat trigger points, trigger point injection is the most effective treatment modality to inactivate trigger points. This article reviews the diagnosis and treatment of myofascial pain syndrome and the technique of trigger point injection. [ABSTRACT FROM AUTHOR]

Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the subjects was used to determine the Frankfort plane and to study its degree of inclination. Myofascial pain syndrome is one of the most common causes of musculoskeletal pain. Trigger points are hyperirritable spots located in a palpable taut band of skeletal muscle that is painful on compression or stretch and causes a local twitch in response to snapping or palpation of the band. Objectives: The aim of this study was to analyze the relationship between the Frankfort plane and the presence of myofascial trigger points causing cervical myofascial pain. Methods: This is a cross-sectional descriptive observational study. All subjects underwent a photographic study to determine the degree of Frankfort plane inclination, and the posterior cervical musculature was palpated to find myofascial trigger points that were measured with a pressure algometer in three cervical locations on the right and left sides. Results: Our study included 47 subjects who had suffered at least one episode of cervical pain in their lifetimes. The mean age was 22.3 ± 2.9 years. Statistically significant results were found in the first right location and sports practice (p = 0.007), in the second right location and gender (p = 0.0097), in the second right location and sports practice (p = 0.0486), in the third right location and gender (p = 0.0098), and in the first, second, and third left locations and gender (p = 0.0083; p = 0.024; p = 0.0016, respectively). In the correlation between the Frankfort plane and the presence of myofascial trigger points, all locations were positive, with the first right location being statistically significant (p = 0.048). Conclusions: A positive relationship was found between the Frankfort plane and the presence of myofascial trigger points. The greater the angle of the Frankfort plane, the less the myofascial pain. [ABSTRACT FROM AUTHOR]

As a distinctive feature of Motion Acupuncture therapy, the treatment target of needling is the "Motion Acupuncture Point", which is dynamic and highly precise. This article provides a detailed introduction to the theoretical origins of motion acupuncture points, including traditional concepts such as "treating based on pain", Ashi points, and meridian points, as well as modern concepts like tendon-related points, tender points, and trigger points. The article proposes a selection method based on the "three steps and one process" approach to accurately locate motion acupuncture points. The application of motion acupuncture treatment using motion acupuncture needles following this method can achieve significant clinical therapeutic effects. This represents an innovation in the selection of acupuncture points in the field of acupuncture. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome (CPPS). A total of 79 female patients diagnosed with CPPS from January 2021 to December 2022 were prospectively analyzed. Every patient received 3 weeks of treatment which included myofascial release therapy combined with electrical and magnetic stimulation. The visual analog score (VAS) of pelvic floor muscle (PFM) trigger points (TrPs) and the changes in pelvic floor surface electromyography before and after treatment were compared. Multiple linear regression was used to analyze the influencing factors of each outcome index. There were significant differences in VASs of muscle TrPs before and after treatment (P < 0.05). For the surface electromyography of PFMs, the differences in pre-baseline rest, post-baseline rest, isometric contractions for muscle endurance evaluation, and coefficient of variation were statistically significant (P < 0.05). Linear regression analysis showed that disease course (X 1), dyspareunia (X 5), and urinary incontinence (X 6) were influencing factors for the decline of pre-baseline rest (r5 = 1.067, R 2 = 0.089), post-baseline rest (r1 = 0.055, r5 = 0.99, R 2 = 0.119), VASs of ischial spine (r5 = 0.916, R 2 = 0.102), obturator internus (r5 = 0.796, r6 = −0.703, R 2 = 0.245), and pubococcygeus (r5 = 0.885, R 2 = 0.149) after treatment in the CPPS group. This study confirmed that individualized myofascial release therapy combined with electrical and magnetic stimulation has significant efficacy for patients with CPPS. At the same time, it is more effective for CPPS patients with longer course of disease, dyspareunia, and without urinary incontinence.

This study investigated whether abnormal peak inversion spontaneous potentials (PISPs) recorded at resting myofascial trigger points (MTrPs) stem from the discharge of muscle spindles. Forty-eight male Sprague-Dawley rats were randomly divided into six groups. Five groups underwent MTrP modeling intervention, whereas one group did not receive intervention and was duly designated as the blank control. After model construction, five rat models were randomly subjected to ramp-and-hold stretch tests, succinylcholine injection, eperisone hydrochloride injection, saline injection, and blank drug intervention. By contrast, the rats in the blank control group were subjected to ramp-and-hold stretch tests as a control. Frequencies and amplitudes of PISPs were recorded pre- and post-interventions and compared with those of the blank group. Stretch tests showed that the depolarization time and amplitude of PISPs ranged from 0.4 ms to 0.9 ms and from 80 uV to 140 μV, respectively. However, no PISPs were observed in the control rats. The frequency of PISPs in the ramp and hold phases and the first second after the hold phase was higher than that before stretching (p < 0.01). Succinylcholine and eperisone exerted excitatory and inhibitory effects on PISPs, respectively. In the group injected with 0.9% saline, no considerable differences of the PISPs were observed during the entire observation period. In conclusion, PISPs recorded at resting MTrPs are closely related to muscle spindles. The formation of MTrPs may be an important factor that regulate dysfunctional muscle spindles. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the difference between the integrated neuromuscular inhibition technique (INIT) and spray and stretch technique in patients with neck pain and upper trapezius active trigger points. Methods: A convenience sample of 60 patients with neck pain and active trigger points were recruited from physiotherapy students and allocated randomly to three groups INIT plus stretching exercise spray and stretch technique plus stretching exercise, and stretching exercise only. Treatment was three times per week for four weeks. Pain intensity by visual analogue scale (VAS), pain pressure threshold (PPT), neck disability by Arabic neck disability index (ANDI), and muscle amplitude in the form of root mean square (RMS) by electromyography (EMG) were measured at baseline and after four weeks. Results: Between groups analysis; the results revealed statistical significant difference between three groups after four weeks of intervention as p =0.0001. Within the group analysis, post hoc tests reported improvement at all variables in both INIT and spray and stretch technique groups with mean differences 64.5 and 65.1 in VAS, 20 and 18.15 in ANDI, −1.45 and −0.81 in PPT, and 2.47 and 1.88 in muscle amplitude, respectively. But there was no statistically significant difference in stretching only group in all variables except VAS. Both INIT and spray and stretch techniques had a clinical and statistical effects on pain, function, PPT, and RMS. According to results, there were statistical significant differences between INIT and spray and stretch groups at post-treatment in all variables except VAS with more favor to INIT group, but there were no clinical differences between INIT and spray and stretch groups. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the evidence for the impact of dry needling (DN) on hip pain and function. Methods: Medline/PubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL databases were searched systematically through June 2022 for randomized clinical trials (RCTs) investigating the impact of DN on hip pain and function. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias. Descriptive analysis was conducted to explain the outcomes and adverse events of DN in hip joint diseases. Meta-analysis was not feasible due to significant heterogeneity. Results: A total of seven eligible studies (including 273 patients) were included out of 2152 screened records. Five studies were in participants with hip osteoarthritis (OA; n = 3), greater trochanteric pain syndrome (GTPS; n = 1) or piriformis syndrome (n = 1); the other two studies were conducted in healthy athletes (n = 2). Two articles assessed changes in participants' short-term visual analog scale (VAS) scores (<1 week), one of which showed that DN significantly reduced pain (P < 0.05). One-week VAS scores were analyzed in three studies, all of which demonstrated reduced scores following DN (P < 0.05). Hip range of motion (ROM) and muscle force were also improved following DN. No serious side effects were reported. Conclusion: DN may be safe and effective at relieving hip pain and improving hip function. DN performs significantly better than several different types of control intervention (including sham DN, no treatment, corticosteroid injections and laser). Strong evidence (high degree of certainty around the results) is lacking, and future studies should ideally use longer follow-up periods and larger sample sizes. Review registration number: CRD42022297845 (PROSPERO). [ABSTRACT FROM AUTHOR]

Abstract Objective: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Methods: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. Results: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P

Objective: Nocturnal calf cramps (NCC) are painful contractions of the lower limbs at night, most commonly in the calf muscles. Many trials demonstrated that dry needling (DN) effectively treats various musculoskeletal conditions. This study aimed to examine the effectiveness of DN in treating NCC. Materials and Methods: Forty-two patients were randomized into two groups. The first group received stretching exercises, and the second group received stretching exercises and DN to trigger points in the gastrocnemius muscle. The cramp duration (CD), the number of cramps (NOC), cramp intensity (CI), algometric measurements of pressure pain threshold (PPT), and Pittsburgh sleep quality index (PSQI) values were recorded before, after, and three months after treatment. Results: There was no difference between the groups regarding the parameters investigated before intervention. Investigated before intervention. Both groups had a significant decrease in NOC, CI, and PSQI scores and an increase in PPT values after treatment and the third month (p

Objective: The aim of the study is to examine the effectiveness of extracorporeal shockwave therapy in reducing pain, improving functionality, joint range of motion, quality of life, fatigue, and health status self-perception in people with myofascial pain syndrome. Methods: PubMed, the Cochrane Library, CINAHL, the Physiotherapy Evidence Database, and SPORTDiscus were systematically searched for only randomized clinical trials published up to June 2, 2022. The main outcome variables were pain, as reported on the visual analog scale and pressure pain threshold, and functionality. A quantitative analysis was conducted using the inverse variance method and the random effects model. Results: Twenty-seven studies were included (N = 595 participants in the extracorporeal shockwave therapy group). The effectiveness of extracorporeal shockwave therapy for relieving pain was superior for the extracorporeal shockwave therapy group compared with the control group on the visual analog scale (MD = −1.7 cm; 95% confidence interval = −2.2 to −1.1) and pressure pain threshold (mean difference = 1.1 kg/cm2 ; 95% confidence interval = 0.4 to 1.7) and functionality (standardized mean difference = −0.8; 95% confidence interval = −1.6 to −0.04) with high heterogeneity. However, no differences were found between extracorporeal shockwave therapy and other interventions as dry needling, exercises, infiltrations, and lasers interventions. Conclusions: Extracorporeal shockwave therapy is effective in relieving pain and improving functionality in patients with myofascial pain syndrome compared with control and ultrasound therapy. [ABSTRACT FROM AUTHOR]

Objectives: Muscle performance is an essential component of an individual that is influenced by physiological, anatomical, psychological, and biomechanical factors. It includes flexibility, muscle strength, agility, and cardiovascular and aerobic endurance. Treatment approaches like stretching and myofascial decompression help improve flexibility and thereby muscle performance. This study explores the effects of static and dynamic myofascial decompression on gastro soleus trigger point pain and power. Materials and Methods: 105 healthy normal women in the age group of 20‑30 yrs were enrolled in the study. The subjects were divided into three groups by simple random sampling using the chit method. Group A received static myofascial decompression, dynamic stretching, and cryotherapy. Group B received dynamic myofascial decompression, dynamic stretching, and cryotherapy whereas Group C received dynamic stretching and cryotherapy. Lower extremity muscle power and functional performance were tested by Vertical jump height. The Gastrosoleus muscle’s myofascial trigger point pain sensitivity was measured with a pressure algometer. Statistical Analysis: Data was analyzed using SPSS. The difference in the mean Vertical jump height and pain pressure threshold values between the groups were analyzed using one‑way ANOVA. Intra‑group analysis was done using Repeated Measures ANOVA. Statistical significance was set at P < 0.05, at a 95% confidence interval. Results: Participants in all three groups showed clinical improvement, however, the differences in the three groups were not statistically significant. In the dynamic myofascial decompression group, a significant (P < 0.05) carry‑over effect was seen in the vertical jump height test post 5 days of intervention. Conclusion: Static and Dynamic myofascial decompression are equally effective in reducing pain and improving gastro soleus muscle power in subjects with latent trigger points. There was a sustained carry‑over effect was seen in the vertical jump height test in the dynamic myofascial decompression group after 5 days of intervention. [ABSTRACT FROM AUTHOR]

Background: Trapezitis is one of the common inflammatory conditions seen among college going students due to prolonged poor posture stressful neck movement. Students with Trapezitis usually complaints of pain and difficulty in activities of daily living. Myofascial release technique can be defined as a soft tissue mobilization technique that reduce trapezius spasm and ultimately pain is reduced. Cupping is ancient medical technique it is general utilise a glass cup to create suction over a painful area. Need of study: There are few literatures or research work available on this. No comparison is done on above techniques. So, this study was done to compare both the techniques. Objective: To compare the Myofascial Release Technique and Cupping therapy on pain intensity and neck disability index in Trapezitis among college going students. Methodology: A total of 50 students with Trapezitis meeting the inclusion and exclusion criteria were allocated into two groups of 25 each. Group A (MFR) and Group B (Cupping) to receive 6 sessions of MFR and cupping therapy Pre and Post intervention scores of Visual analogue Scale (VAS), Cervical ROM (CROM) and Neck disabil- ity index (NDI) were measured. Results: Data was analysed by SPSS21, t-test were applied. Statistically significant improvements were observed in both groups but more pronounced in Group B. VAS (t = 6.3257) P<0.0001. NDI (t = 9.0547) P<0.0001 Conclusion: The results suggested that cupping therapy showed better results than myofascial release in reliev- ing Trapezitis in college going students. [ABSTRACT FROM AUTHOR]

Objectives: To observe the effect of the acupuncture of myofascial trigger points (MTrPs) in the treatment of lower extremity varicose veins (LEVVs). Methods: Overall, 260 patients with LEVVs participated in this study. LEVVs were selected based on diagnostic criteria of Clinical, Etiology, Anatomy, and Pathophysiology levels 2–5 and classified into six types on the basis of their anatomical positions. The MTrPs in the lower extremities were localized in accordance with the classification of LEVVs and treated by MTrPs acupuncture combined with self-massage and self-stretching. The interval between each treatment was 2 weeks to 1 month, depending on needling pain tolerance of each patient. An in-house evaluation was used to estimate the proportion of varicose veins in the lower limbs and their accompanying symptoms. The treatment effect was evaluated before each treatment and at 1-year follow-up. Results: The mean evaluation score of LEVVs before the treatment course was 3.66 ± 1.19. After the course, this reduced to 1.18 ± 0.97, with the following response rates: 85% for excellent and good and 15% for medium. After 1-year follow-up, the mean evaluation score of all patients was 1.11 ± 0.92, with the following response rates: 87% for excellent and good, and 13% for medium. Conclusions: In some patients, MTrP acupuncture could cure LEVVs and its accompanying symptoms. These LEVVs are probably caused by fascia tension as a pre-pathology induced by the MTrPs. [ABSTRACT FROM AUTHOR]

Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case–control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) – Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.

AbstractThis study systematically reviewed the published literature on the objective characterization of myofascial pain syndrome and myofascial trigger points using imaging methods. PubMed, Embase, Ovid, and the Cochrane Library databases were used, whereas citation searching was conducted in Scopus. Citations were restricted to those published in English and in peer-reviewed journals between 2000 and 2021. Of 1762 abstracts screened, 69 articles underwent full-text review, and 33 were included. Imaging data assessing myofascial trigger points or myofascial pain syndrome were extracted, and important qualitative and quantitative information on general study methodologies, study populations, sample sizes, and myofascial trigger point/myofascial pain syndrome evaluation were tabulated. Methodological quality of eligible studies was assessed based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Biomechanical properties and blood flow of active and latent myofascial trigger points assessed via imaging were found to be quantifiably distinct from those of healthy tissue. Although these studies show promise, more studies are needed. Future studies should focus on assessing diagnostic test accuracy and testing the reproducibility of results to establish the best performing methods. Increasing methodological consistency would further motivate implementing imaging methods in larger clinical studies. Considering the evidence on efficacy, cost, ease of use and time constraints, ultrasound-based methods are currently the imaging modalities of choice for myofascial pain syndrome/myofascial trigger point assessment.

Objectives: Muscle performance is an essential component of an individual that is influenced by physiological, anatomical, psychological, and biomechanical factors. It includes flexibility, muscle strength, agility, and cardiovascular and aerobic endurance. Treatment approaches like stretching and myofascial decompression help improve flexibility and thereby muscle performance. This study explores the effects of static and dynamic myofascial decompression on gastro soleus trigger point pain and power. Materials and Methods: 105 healthy normal women in the age group of 20-30 yrs were enrolled in the study. The subjects were divided into three groups by simple random sampling using the chit method. Group A received static myofascial decompression, dynamic stretching, and cryotherapy. Group B received dynamic myofascial decompression, dynamic stretching, and cryotherapy whereas Group C received dynamic stretching and cryotherapy. Lower extremity muscle power and functional performance were tested by Vertical jump height. The Gastrosoleus muscle’s myofascial trigger point pain sensitivity was measured with a pressure algometer. Statistical Analysis: Data was analyzed using SPSS. The difference in the mean Vertical jump height and pain pressure threshold values between the groups were analyzed using one-way ANOVA. Intra-group analysis was done using Repeated Measures ANOVA. Statistical significance was set at P < 0.05, at a 95% confidence interval. Results: Participants in all three groups showed clinical improvement, however, the differences in the three groups were not statistically significant. In the dynamic myofascial decompression group, a significant (P < 0.05) carry-over effect was seen in the vertical jump height test post 5 days of intervention. Conclusion: Static and Dynamic myofascial decompression are equally effective in reducing pain and improving gastro soleus muscle power in subjects with latent trigger points. There was a sustained carry-over effect was seen in the vertical jump height test in the dynamic myofascial decompression group after 5 days of intervention.

Background: Lower Back Pain (LBP) with radiculopathy is a potentially more serious form of mechanical low back pain. A paucity of literature exists about the effect of the gross myofascial release (MFR) technique on the management of LBP. Objective: The study aimed to evaluate the effect of gross MFR when given as an adjunct to conventional physical therapy in subjects with low back pain with radiculopathy. Methods: Forty subjects ([Formula: see text]) clinically diagnosed with LBP with radiculopathy were enrolled and randomly allocated to either the control group ([Formula: see text]) or the experimental group ([Formula: see text]). Both study groups received 5 sessions of intervention. The control group received conventional physical therapy while the experimental group received gross MFR of the trunk and lower limb along with conventional physical therapy. The outcome measures included were pressure pain threshold for the lower back and lower extremity, lumbar flexion and extension range of motion (ROM), percentage disability, and patient satisfaction towards the treatment which were measured pre-intervention (day 1) and post-treatment (day 5). The interaction between group and time was analysed using two-way mixed ANOVA. Results: The results suggested that the experimental group was statistically significant over the control group in terms of pressure pain threshold in the lower back ([Formula: see text]) and lower limb ([Formula: see text]), disability ([Formula: see text]), and patient satisfaction ([Formula: see text]) and lumbar flexion ([Formula: see text]) except lumbar extension ROM ([Formula: see text]). Conclusion: When given as an adjuvant to conventional physical therapy, gross myofascial release proved to provide a significant and faster short-term improvement over conventional treatment alone in subjects diagnosed with low back pain with radiculopathy.

Objective: To determine the effects of positional release technique in comparison to myofascial release technique on gluteus medius trigger point along with exercises to manage patellofemoral pain syndrome. Method: The single-blind, two-arm, randomised clinical trial was conducted at the Department of Physiotherapy, Sindh Institute of Physical Medicine, Karachi, from December 7, 2020, to March 24, 2021, and comprised patellofemoral pain syndrome of either gender with gluteus medius trigger point. They were randomly allocated to positional release technique group A and myofascial release technique group B. The intervention comprised 3 sessions per week for 6 weeks for a total of 18 sessions, with each session lasting 45 minutes. Function through anterior knee pain scale, pain through visual analogue scale, strength via hand-held dynamometer, and quality of life via World Health Organisation quality of life brief questionnaire were assessed alongside pressure pain threshold via algometer which was taken as the gluteus medius trigger point. All measurements were taken at baseline and 6 week post-intervention. Data was analysed using SPSS 21. Results: Of the 64 participants, 38(59.4%) were females and 26(40.6%) were males. There were 32(50%) subjects in group A with mean age 29.50+5.84 years and 32(50%) in group B with mean age 29.50+5.43 years (p>0.05). Both the groups showed a significant reduction in pain, improvement in function, pressure pain threshold, strength, and quality of life (p0.05). Conclusion: Treating myofascial trigger points of gluteus medius muscle, using either positional release technique or myofascial release technique together with exercise therapy was found to be equally beneficial. ClinicalTrials.gov ID: NCT04667091 Key Words: Anterior knee pain, Exercise therapy, Trigger points, Manual therapy.

MacLennan, M, Ramirez-Campillo, R, and Byrne, PJ. Self-massage techniques for the management of pain and mobility with application to resistance training: a brief review. J Strength Cond Res 37(11): 2314-2323, 2023--Fascial restrictions that occur in response to myofascial trigger points (MTrP), exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) cause soft tissue to lose extensibility, which contributes to abnormal muscle mechanics, reduced muscle length, and decrements in joint range of motion (ROM) and actively contributes to musculoskeletal pain. Resistance training and in particular, weightlifting movements have unique mobility requirements imperative for movement efficacy and safety with ROM restrictions resulting in ineffective volume and intensity tolerance and dampened force output and power, which may lead to a failed lift or injury. Self-massage (SM) provides an expedient method to promote movement efficiency and reduce injury risk by improving ROM, muscular function, and reducing pain and allows athletes to continue to train at their desired frequency with minimal disruption from MTrPs-associated adverse effects. Thus, the aim of this review was to determine the efficacy of various self-massage tools in managing pain and mobility and to explore the potential benefits of SM on resistance training performance. Many SM devices are available for athletes to manage ROM restrictions and pain, including differing densities of foam rollers, roller massagers, tennis balls, and vibrating devices. To attenuate adverse training effects, a 10-to-20-minute bout consisting of 2-minute bouts of SM on the affected area may be beneficial. When selecting a SMdevice, athletes should note that foam rollers appear to be more effective than roller massagers, with vibrating foam rollers eliciting an increased reduction to pain perception, and tennis balls and soft massage balls were shown to be efficacious in targeting smaller affected areas. [ABSTRACT FROM AUTHOR]

Objective: Nocturnal calf cramps (NCC) are painful contractions of the lower limbs at night, most commonly in the calf muscles. Many trials demonstrated that dry needling (DN) effectively treats various musculoskeletal conditions. This study aimed to examine the effectiveness of DN in treating NCC. Materials and Methods: Forty-two patients were randomized into two groups. The first group received stretching exercises, and the second group received stretching exercises and DN to trigger points in the gastrocnemius muscle. The cramp duration (CD), the number of cramps (NOC), cramp intensity (CI), algometric measurements of pressure pain threshold (PPT), and Pittsburgh sleep quality index (PSQI) values were recorded before, after, and three months after treatment. Results: There was no difference between the groups regarding the parameters investigated before intervention. Investigated before intervention. Both groups had a significant decrease in NOC, CI, and PSQI scores and an increase in PPT values after treatment and the third month (p<0.001). At post-treatment measures, between the groups, there was a significant decrease in CI (p<0.001) and PSQI (p=0.002), and increase in PPT (p=0.001) in the DN group, and no difference in NOC (p=0.545) and CD (p=0.140). At the 3-month follow-up, between the groups, there was a significant decrease in NOC (p=0.016), CI (p<0.001), and increase in PPT (p=0.003) in the DN group and no difference in PSQI (p=0.229) and CD (p=0.175). Conclusion: DN in the treatment of NCC in the short and medium term is an effective method of reducing pain, decreasing the duration and intensity of cramps, and improving sleep quality. [ABSTRACT FROM AUTHOR]

Background: Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN. Methods: A randomized clinical trial is conducted with 80 participants in two groups: the DN group (n = 40) and IC group (n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment. Results: Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group (p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group. Conclusions: In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy. [ABSTRACT FROM AUTHOR]

Conservation practitioners commonly work together in management teams, contributing expertise to the planning and decision‐making associated with threatened species management. These groups may include individuals with different perspectives around if, when and how to implement management. Yet, rarely do we consider the value of discussion in shaping these perspectives, and thus management.Decision triggers can be used to formalise decisions around management and encourage teams to explore these decisions proactively. Previous research has identified how individual experts set decision triggers but there are no accepted approaches for capturing the expertise that exists across management teams when setting decision triggers. To address this gap, we developed an approach to formalise team deliberations about when and how to intervene if a decline in the condition of a threatened species were to be observed.Using a modified Delphi process, individual experts within a threatened species management team were asked to independently set trigger points and assign actions for the species. Then, as a group, experts discussed anonymised responses, enabling us to understand how group dynamics influenced the decision‐making process. Experts had the opportunity to update their responses based on the group discussion, providing a rationale to support their decisions. We tested the approach with experts from teams managing threatened species across conservation organisations in Australia and New Zealand.We found that experts often updated their responses to incorporate issues raised by the group, demonstrating a willingness to integrate the perspectives of other team members. Experts tended to become more cautious after discussing their responses, setting additional trigger points and actions, and triggering actions sooner.Synthesis and applications: Our approach provides a structured process to formally integrate the range of perspectives and experience of groups of experts when setting trigger points and actions. This can help to address common biases that arise during unstructured decision‐making, and ensure decision‐making processes are transparent. [ABSTRACT FROM AUTHOR]

Background. Dry needling is a therapeutic technique that involves the insertion of fine needles into specific trigger points to alleviate muscle pain and improve function. This review aims to summarize the evidence on the effectiveness of dry needling in the treatment of neurological conditions, with a specific focus on trigger point targeting. Methods. A comprehensive literature search was conducted to identify relevant studies investigating the use of dry needling for neurological conditions. Studies examining the effects of dry needling on trigger points in conditions such as post-stroke spasticity, shoulder pain, and finger flexor spasticity were included. Results. The reviewed studies consistently demonstrated positive outcomes regarding the efficacy of dry needling in targeting trigger points for neurological conditions. Dry needling at specific trigger points, including the infraspinatus, teres minor, posterior deltoid, pectoralis major, and flexor digitorum superficialis muscles, resulted in significant improvements in spasticity and range of motion. Conclusions. The evidence suggests that dry needling targeted at trigger points can be an effective intervention for improving muscle tone and function in neurological conditions. This technique holds promise as an adjunctive treatment option, offering targeted relief and improved outcomes. However, further research is needed to optimize treatment protocols, investigate long-term effects, and compare dry needling with other interventions. Integration of trigger point-focused dry needling into clinical practice has the potential to enhance the management and rehabilitation of neurological conditions, providing patients with improved symptom control and functional outcomes. [ABSTRACT FROM AUTHOR]

The objective of this study was to verify which are the additional effects of the ischemic compression (IC) technique associated with joint mobilization techniques on pain, morphological aspects of myofascial trigger points (MTrPs), function, and psychological aspects in individuals with rotator cuff-related shoulder pain (RCRSP). Sixty individuals with RCRSP were randomly allocated intervention sessions the Mobilization Group (MG, n = 20), only joint mobilizations of the shoulder complex; intervention sessions Compression Group (CG, n = 20), with the same mobilizations associated with the IC over MTrPs; and Placebo Group (PG, n = 20), with the same mobilizations associated with placebo of IC. All interventions performed 2 per week, for 6-weeks. Pain was assessed by Visual Analogue Scale and function by the Disabilities of the Arm, Shoulder and Hand questionnaire. The kinesiophobia, pain catastrophizing, perception of improvement, mobility, pain threshold and area the MTrPs were also evaluated at baseline (week-0), after 6-weeks and after 10-weeks. There were no between-group difference in pain: CG-MG 0.8 (95% CI 0.4 to 1.2), CG-PG 0.5 (95% CI 0.0 to 0.9), MG-PG -0.3 (95% CI -0.8 to 0.1) after 6-weeks and CG-MG 0.1 (95% CI -0.2 to 0.5), CG-PG -0.7 (95% CI -0.9 to −0,4), MG-PG -0,8 (95% CI -1.07 to 0.5) at 10-weeks. Similar effects were observed on function, characteristics of MTrPs and psychological aspects. The IC technique on the MTrPs of the upper trapezius muscle associated with joint mobilization techniques has no additional effect on pain in individuals with RCRSP. RBR-44v8y7. • IC with joint mobilizations decrease pain in individuals with shoulder pain. • IC showed no additional effect on pain and function of shoulder. • IC showed no effect on area and blood flow of upper trapezius muscle MTrPs. [ABSTRACT FROM AUTHOR]

(1) Background: The stiffness of the posterior shoulder muscles has been shown to be related to shoulder pain and range of motion (ROM) restriction in athletes. Specifically, the treatment of the teres major muscle showed promising results in previous studies. The aim of this study was to compare the effects of dry needling (DN) vs. diacutaneous fibrolysis (DF) to improve the stiffness and tone of the teres major muscle, pain intensity, shoulder ROM, and extensibility in the short-term and at one-week follow-up in handball athletes. (2) Methods: A randomized clinical trial with blinded examiners was carried out. Elite handball athletes with shoulder pain and glenohumeral internal rotation deficit (n = 30) were randomly allocated to the DN group or the DF group. Patients in both groups received a single treatment session directly applied to the teres major muscle. The primary outcome variables and instrument were mechanical properties of the teres major muscle (stiffness and tone) measured with myotonometry. The secondary outcome variables were intensity of shoulder pain evaluated with visual analogue scale and shoulder ROM and extensibility recorded with a digital inclinometer. (3) Results: No between-group differences were found after the intervention or at one-week follow-up in the mechanical properties of teres major muscle, pain intensity, shoulder ROM, or extensibility. (4) Conclusions: the DN and DF techniques showed similar results at both timepoints in elite handball athletes with shoulder pain and glenohumeral internal rotation deficits. [ABSTRACT FROM AUTHOR]

Background: Trapezitis is one of the common inflammatory conditions seen among college going students due to prolonged faulty posture, overuse, stressful neck movement, etc. Students with trapezitis frequently report pain, restricted range of motion, and trouble doing regular tasks. The majority of college-bound youngsters have trigger points over their trapezius muscles. Need of study: There Is few Literatures or Research Work Available on This and No Comparison Is Done on Above Techniques.so this study was done to compare both the techniques. Objective: To compare the effectiveness of IASTM and ischemic compression in trapezius trigger points in college going students. Methodology: In this study, 45 participants were recruited based on inclusion and exclusion criteria. They were divided in 2 groups. group-A(n=23) (IASTM) and group-B(n=22) (IC). Each intervention was administered to them for a period of 2 weeks, 3 sessions per week in respective groups. Pre and post assessment was taken using following outcome measures VAS, NDI and cervical range of motion. Result: Data was analysed by SPSS21, t-test was applied. Statistically significant improvements observed in both groups but more pronounced in group A(IASTM). VAS (3.0504) P (0.0042), NDI (6.20) P<0.0001. Conclusion: The results suggested that IASTM gives better result than ischemic compression in relieving trapezius trigger points in college going students. [ABSTRACT FROM AUTHOR]

Dry needling (DN) is an invasive physiotherapy technique employed for reducing myofascial pain. To compare the effectiveness of dry needling (DN) versus manual therapy (MT) in improving pain, active maximal mouth opening (AMMO) and cervical disability in patients with myofascial pain from temporomandibular disorders (TMDs) were investigated against these treatments. A single-blind, randomized controlled trial was carried out. Individuals (n = 50) with TMDs were randomly allocated in a 1:1 ratio to the DN (n = 25) or MT group (n = 25). Each group received three sessions, separated by 4 days, of either DN or MT. Outcomes were assessed according to pain intensity (Numeric Pain Rating Scale), AMMO (cm), disability (Neck Disability Index), and pressure–pain threshold (PPT) (digital algometry) from the active myofascial trigger points. In both groups, pain and neck disability were significantly lower at the end of treatment compared with those measured at baseline (pain: −2.52 with 95% CI: −3.43 to −1.60 for DN group; pain: −2.92 with 95% CI: −3.77 to −2.07 for MT group; disability: −3.2 with 95% CI: −4.31 to −2.09 for DN group; disability: −2.68 with 95% CI: −3.56 to −1.79 for MT group), but not were not lower after the first session, without differences between the groups. AMMO was significantly higher after the first session (0.16 with 95% CI: 0.03 to 0.29 for DN group; 0.30 with 95% CI: 0.20 to 0.41 for MT group) and at the end of treatment in both groups (0.27 with 95% CI: 0.14 to 0.41 for DN group; 0.37 with 95% CI: 0.22 to 0.52 for MT group) compared with the baseline measurements. Finally, PPT results for the masseter and pterygoid muscles were significantly higher at the end of treatment in both groups (without statistically significant differences between groups), but not after the first session. The assessed therapies, DN and MT, are equally effective in improving pain, AMMO, cervical disability, and PPT in the muscles directly involved in the temporomandibular joint biomechanics of patients with myofascial TMDs. [ABSTRACT FROM AUTHOR]

Aim: To investigate and compare satisfaction with the physical therapy in patients with adhesive capsulitis of the shoulder joint and concomitant thoracic myofascial pain syndrome undergoing outpatient and home programs. Materials and Methods: The study involved 76 participants. Shoulder joint mobility and pain in myofascial trigger points were assessed before and after the physical therapy program. Scale to measure patient satisfaction with physical therapy was used after the program. Patients of both groups received physical therapist consultations. The first group of patients received end-range mobilization (performed by a physical therapist) and performed ischemic compression (without any assistance). The second group of patients performed therapeutic exercises and ischemic compression without any assistance at home. The duration of the program in both groups comprised 3 weeks. Results: Mobility and pain indicators were improved in both groups. However, the results of the second assessment were better in the first group. Physical therapy satisfaction scores were high in both groups, but the first group had statistically better results in four questionnaire items and in the total score. Me (25%; 75%) indicators of the total satisfaction score comprised 85 (84.75; 85) points in the first group and 78 (77.75; 79) points in the second group. Conclusions: The patients who received consultations, end-range mobilization, and performed ischemic compression had a higher level of satisfaction as compared to the patients who attended consultations and performed therapeutic exercises and ischemic compression. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of dry needling on the masseter muscle in the perception of tinnitus in patients with temporomandibular disorder. Methods: Twenty-five patients with tinnitus and muscular temporomandibular disorders were randomly assigned to groups study (n = 13) and control (n = 12). Three sessions of dry needling (study) and sham (control) were performed. Follow-up was performed 30, 60 and 90 days after the end of treatment. The Analog Visual Scale and Tinnitus Handicap Inventory (THI) were used to evaluate the treatment. Results: In study group, 76.9% presented a reduction in the intensity and tinnitus discomfort and total THI. In control group, 66.7% presented a decrease in tinnitus intensity and total THI, and 58.3% reported a decrease in tinnitus discomfort. After 90 days, in the study group, 84.6% maintained improvement in pain intensity and reduction in THI score and 69.2% reported improvement in both intensity and discomfort caused by tinnitus. In control group, 75% achieved improvement in pain intensity, 33.2% maintained improvement in tinnitus intensity, and 41.7% maintained improvement in discomfort caused by tinnitus and total THI. In the total THI score, the study group presented improvement (p = 0.041). Conclusion: Dry needling combined with counseling was associated with improvement in pain intensity and tinnitus, decrease in tinnitus discomfort and reduction in total THI score. [ABSTRACT FROM AUTHOR]

Myofascial pain syndrome (MPS) is a painful condition of the muscles and soft tissues having a varied presentation in terms of area of distribution, character of pain and duration of symptoms. This review aims to look at the existing evidence with a view to provide clarity in diagnosis and treatment of MPS. A search of medical databases with keyword of ‘myofascial pain syndrome’ yielded 19 studies pertaining to diagnosis and treatment of this condition. The presence of trigger point seems to be essential for diagnosis of this condition. Treatment with diclofenac patch, topical capsaicin, thiocolchicoside, ultrasound therapy, cryotherapy, aerobic exercises, extracorporeal shock wave therapy, self-exercises, myofascial release and acupuncture techniques seem to offer most significant improvements. The results with more invasive therapy using pharmacological agents were less promising.

Many people experienced neck pain during Covid-19 quarantine period due to prolonged use of electronic devices for academic activities and work from home. The aim of this study was to determine the effects of Graston Technique versus Ischaemic Compression on pain, range of movement (ROM), and functional performance in students with neck pain, due to distance learning during Covid-19 pandemic. A pilot study (randomised clinical trial) was performed. Fifty-four subjects were included in the study on the basis of sample selection criteria and were divided into two groups, Group A and Group B. The outcome measures were pain, range of movement (ROM), and disability assessed by Numeric pain rating scale (NPRS), goniometry and Neck disability index (NDI) respectively. Group A received treatment with hot pack and Graston technique, while Group B received a hot pack and Ischaemic compression. ---Continue

Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine. [ABSTRACT FROM AUTHOR]

Introduction: The study was conducted to compare the immediate effect of high-power pain threshold ultrasound (HPPTUS) and deep transverse friction massage (DTFM) as a traditional technique on the treatment of upper trapezius active myofascial trigger points in male patients with mechanical neck pain. Materials and Methods: In this parallel single-blind randomized clinical trial study, 60 men with mechanical neck pain (mean age: 30.57±6.19 years) who met the inclusion and exclusion criteria were randomly assigned to HPPTUS and DTFM as the control group. A visual analog scale (VAS), pain pressure threshold (PPT), and range of motion (ROM) of cervical lateral flexion (CLF) were assessed before and after treatment. Results: Analysis of pre- and post-treatment findings showed that the VAS (P<0.01), PPT (P<0.01), and ROM of CLF (P<0.01) improved significantly in both groups while ROM of CLF increased significantly more in the HPPTUS group. An indirect correlation was found between the pre-treatment ROM of CLF and ROM of CLF improvement in both groups. A significant indirect correlation was observed between pre-treatment VAS and ROM of CLF improvement in the HPPTUS group. In the DTFM group a significant indirect correlation was found between pre-treatment ROM of CLF and VAS improvement. Conclusion: The results showed that HPPTUS can be used as an effective treatment for active trigger points (TP). It seems that this method is more effective than deep transverse friction massage. [ABSTRACT FROM AUTHOR]

Background: Trigger point (TrP) acupuncture is commonly used to treat chronic non-specific low back pain (CNLBP). Evidence for the efficacy of most TrP acupuncture modalities is weak or lacking. Objective: To assess the effect of TrP acupuncture on pain, disability, gait and muscle activation in patients with CNLBP. Methods: From May 2019 to February 2020, a randomised, single-blind clinical trial was carried out involving 33 participants with CNLBP, divided into one of two intervention groups or a control group (n = 11 per group). The intervention groups received TrP acupuncture or traditional acupuncture treatment three times a week for 4 weeks, and the control group remained on a waiting list and received no treatment. Pain, disability, gait and muscle activation were assessed at baseline and at 4 and 8 weeks of follow-up. Results: At baseline, the three groups showed no significant differences in age, gender, height, weight, body mass index (BMI) or disease course (p ⩾ 0.05). At 4 weeks, pain was relieved (measured by visual analogue scores, p = 0.036) and disability was improved (reflected by lower Oswestry disability index scores, p = 0.029) in TrP acupuncture versus waiting list groups. Moreover, lumbar extension range of motion was increased in TrP acupuncture versus both traditional acupuncture and waiting list groups (p = 0.029 and p = 0.027, respectively). At 8 weeks, there were no significant differences in any parameter between the three groups (p > 0.05). Conclusion: TrP acupuncture had a significant short-term effect on pain relief and disability in patients with CNLBP, but there was no evidence of a long-term influence (at 8 weeks following the intervention). Further high-quality randomised controlled trials are needed for verification in the future. Trial registration number: ChiCTR1900022838 (Chinese Clinical Trial Registry) [ABSTRACT FROM AUTHOR]

Yu Zhou,1 Jiao Lu,2 Lin Liu,2 Hao-Wei Wang2 1School of Sports Sciences, Nanjing Normal University, Nanjing, Jiangsu, People’s Republic of China; 2School of Sport and Health, Nanjing Sport Institute, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Lin Liu, School of Exercise and Health, Nanjing Sport Institute, Linggusi Road No. 8, Nanjing, 210014, People’s Republic of China, Tel +86 18817873543, Email liulinst1989@126.comPurpose: To systematically evaluate the effect of exercise rehabilitation as an adjuvant to clinical treatment for myofascial trigger points (MTrPs).Patients and Methods: ESBCO, PubMed, Science Direct, Web of Science, China Knowledge Network (CNKI), and Wanfang databases were comprehensively searched from database inception date through July 2022. Randomized controlled trials comparing MTrPs treatments that included exercise rehabilitation with a single clinical treatment. Two researchers independently screened articles using inclusion/exclusion criteria, scored methodologic quality, and extracted data including patient demographics, interventions, and outcomes.Results: We included 14 RCTs (N = 734). Results showed short-term (mean difference [MD], − 2.25; 95% confidence interval [CI], − 4.08 to − 0.41; Z = 2.40; P = 0.02) and long-term (MD = − 0.47; 95% CI: − 0.80 to − 0.17; Z = 3.05; P = 0.02) adjuvant exercise rehabilitation treatments were superior in reducing musculoskeletal pain intensity to single clinical treatment in controls, but long-term versus short-term effectiveness was not significantly different. The exercise rehabilitation group more effectively increased the range of motion (ROM) (standardized mean difference [SMD], 1.04; 95% CI: 0.32 to 1.77; Z = 2.84; P = 0.005) and decreased dysfunction (SMD = − 0.93; 95% CI: − 1.82 to − 0.05; Z = 2.06; P = 0.04) than controls; no significant difference was observed in the pressure pain threshold (PPT) between two groups.Conclusion: Exercise rehabilitation as an adjuvant to clinical treatment for MTrPs was moderately effective in relieving pain intensity, increasing ROM, and improving dysfunction versus single clinical intervention. These findings must be validated by larger, higher-quality studies.Keywords: trigger points, exercise, rehabilitation, meta-analysis, randomized controlled trial