جستجوی مقالات مرتبط با کلیدواژه "trigger point" در نشریات گروه "پزشکی"

This study aimed to investigate the therapeutic effect of trigger point (TrP) injection of paravertebral muscle to control postoperative lumbar pain.

The medical records of 46 patients who underwent lumbar surgery in our hospital between January 2013 and January 2020 were retrospectively analysed. The patients included in the study were divided into an observation group (n=26) and a control group (n=20) based on the certainty of their myofascial pain TrP diagnosis. The TrPs were found and injected with a 1:5 mixture of compound betamethasone/lidocaine (2 mL). The Visual Analogue Scale (VAS) scores and Patient Satisfaction Index (PSI) scores of the two groups were recorded before injection, on the day after injection, and one and two weeks after injection. The two groups’ postoperative bedridden time and analgesic medication treatment duration were calculated. All the scores were then compared.

The VAS scores of the observation group and the control group before injection were 7.00 ± 0.63 and 6.85 ± 0.59, respectively, and no significant difference was observed between the two groups (P>0.05). The VAS scores on the day and one and two weeks after injection were 2.65 ± 0.63, 3.46 ± 0.51, and 2.62 ± 0.50 in the observation group and 3.75 ± 0.44, 4.70 ± 0.47 and 4.95 ± 0.51 in the control group. Within the same group, the difference in patients at different time points was statistically significant (P<0.01), and the difference between the two groups at the same time point after injection was also statistically significant (P<0.01). The PSI score of the observation group was significantly lower than that of the control group (P<0.01). The bedridden time of the observation group was 2.71 ± 0.45 d, which was shorter than the bedridden time of the control group (4.42 ± 0.49 d; P<0.01). The duration of non-s teroidal drug use was also shorter in the observation group than in the control group (P<0.01).

Accurate injection of compound betamethasone/lidocaine mixture at the pain TrP can effectively control the early pain response after lumbar surgery. It is also beneficial to the early recovery of postoperative function and improves the patient’s satisfaction with the surgery.

The purpose of the present study was to investigate the effects of single-session intramuscular electrical stimulation (IMES) on pain and dysfunction following active trigger points in the upper trapezius muscle.

Volunteers (30 females) with active trigger points in the upper trapezius muscle were randomly divided into two IMES and placebo groups. For the IMES group, a needle was inserted into the trigger point, and electrical stimulation was applied to generate a pain-free contraction. For the placebo group, the intervention procedure was exactly the same, but there was no electrical stimulation. Pain by visual analog scale (VAS), pain pressure threshold (PPT), range of motion (ROM), and disability by neck disability index (NDI) were assessed as main outcome measures before, immediately after, and one week after conducting intervention by another blinded researcher.

The VAS scales were improved in both groups but were significantly lower in the IMES group one week after treatment. The PPT and ROM scores were substantially higher in the IMES group one week after the treatment. The NDI indexes significantly reduced for both groups, with no significant differences between them.

IMES effectively improves pain, PPT, ROM, and NDI, following trigger points in the upper trapezius muscle. Further studies are required to investigate the IMES’s long-term effects.

In sports activities, the structure of the upper body plays a very important role and is often the target of various kinds of injuries that harm the body. This study aimed to determine the effect of combined therapy manipulation on upper extremity injuries.

Materials & Methods: 

This experimental study with a randomized pre-test and post-test design was conducted on 60 people who experienced upper extremity injuries from February 14 to March 14, 2022. Subjects were divided into four groups, including three treatment groups (sports massage manipulation, trigger point manipulation, and chiropractic manipulation) and one control group. The treatment was carried out at the Gauging Massage Medical Manual Therapy practice in Yogyakarta. The degree of strain was measured using a Visual Analogue Scale . Multivariate Analysis of Variance was used to determine the effect of giving combined therapy manipulation on pain intensity in all groups of research subjects.

The administration of the combined therapy manipulation significantly reduced the intensity of strain-induced pain in all treatment groups of sports massage, trigger point, and chiropractic compared to the control group (p=0.001).

All combined massage manipulation groups, including sports massage, trigger point, and chiropractic can reduce pain intensity 15 minutes after treatment, and there is no significant difference between these three groups in reducing pain intensity.

Myofascial pain syndrome is one of the most common disorders of the musculoskeletal system with skeletal muscle origin. It is characterized by the presence of trigger points, which are very sensitive points in the muscle and are often found in the tight band of skeletal muscle; they are sensitive to stimulation (pressure or use of dry needles) and create a referral pain in an area far from that points. The prevalence of trigger points is higher in the postural muscles of the upper quarter, especially the trapezius muscle. The aim of this study was to compare the short-term effects of transcutaneous electrical nerve stimulation (TENS) with dry needling on pain, disability, and pressure pain threshold in subjects with trigger points in upper trapezius muscle.

In this clinical trial, 45 patients with upper trapezius muscle trigger points were randomly divided into three groups: TENS and stretching exercise (group A), dry needling and stretching exercise (group B), and stretching exercise alone (group C, control). The joint program between the three groups was to perform trapezius muscle stretching exercises at home for two weeks. In addition to stretching exercise training, group A was treated with TENS for ten sessions during two weeks (5 days a week). Group B, besides stretching exercise training, was treated with three sessions of dry needling for two weeks. Group C was the control group and was trained only in stretching exercises. The outcomes were pain intensity, disability, and pressure pain threshold that were measured using Visual Analog Scale (VAS), Neck Disability Index (NDI), and digital algometer. Paired t-test was used to compare before and after treatment in each group and one-way analysis of variance (ANOVA) test was used to compare mean changes between the three groups.

After treatment, significant improvement was seen in pain intensity and NDI in all three groups (P < 0.001), but there was no significant difference in pressure pain threshold in any of the three groups before and after the intervention (P > 0.05). Moreover, there was no significant difference between the three groups in mean changes of pain, pressure pain threshold, and NDI scores after the intervention compared to before the intervention (P > 0.05).

Although the use of TENS and dry needling along with stretching exercises in subjects with upper trapezius muscle trigger points helps to reduce pain and disability, but it has no additional effect and only stretching exercise in these patients helps to reduce pain and disability to the same extent.

Myofascial pain syndrome (MPS) is one of the most frequent causes of chronic musculoskeletal pain which is characterized by myofascial trigger points (MTrPs). Hence, it is of crucial importance to identify practical approaches for the treatment of these points. Upper trapezius muscle (UT) is highly susceptible to the development of MTrPs that are commonly resulted from overuse and micro-trauma.

The present study aimed to compare the effects of dry needling (DN) and low-level laser therapy (LLLT) regarding the reduction of pain and muscle thickness and improvement of the range of motion (ROM) and pressure pain threshold (PPT) in patients with latent MTrPs (LTrPs) in their UT muscles.

In total, 60 patients with LTrPs in UT muscle participated in this randomized clinical trial. The subjects were randomly divided into two treatment groups of DN and LLLT. The PPT was evaluatedby visual analog scale (VAS) and algometer while ROM and muscle thickness were assessed using goniometer and ultrasonography, respectively. It should be noted that the variables were evaluated before the first and after the sixth sessions. Finally, the collected data were analyzed using independent and paired t-tests.

Based on the results, the VAS and muscle thickness significantly reduced, while the PPT and cervical ROM increased in both groups after treatment (P<0.001). The independent t-test revealed a statistically significant improvement in the DN group in terms of PPT (9.9-14.17, P=0.009) and ROM (37.33-42.67, p=0.005), compared to the LLLTgroup. Nevertheless, no significant difference was found between the two groups regarding VAS and muscle thickness variables (P>0.05).

The DN and LLLT effectively improved symptoms in the UT muscles of patients with LTrPs. However, the DN was more effective in the improvement of ROM and PPT variables

Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients’ age as well as pain severity and duration. Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, P<0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient’s age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients’ disability and the latter variable. Level of evidence: II

Myofascial pain syndrome is a chronic syndrome that occurred in a local or focal part of the body. The basis for myofascial pain syndrome is the presence of myofascial trigger point or points, producing pain in clinical examinations.

This study aimed to compare the effect of injection of bicarbonate, hyaluronidase, and lidocaine on myofascial pain syndrome.

The patients were randomly allocated to three groups of bicarbonate, hyaluronidase, and lidocaine. The injection was done at two painful regions of trapezius muscle with a sonography guide for each patient. The values of visual analogue scale (VAS), pre-injection range of motion (ROM), immediately after injection, second and fourth week were measured.

The analysis showed that there were no significant differences between the three groups for age, gender, BMI, and height (P > 0.05). Repeated measures one-way ANOVA (week * group) 4 * 3 was used to compare the effect of bicarbonate, hyaluronidase, and lidocaine on VAS and range of motion (ROM) before injection, immediately after injection, second and fourth week. The results showed that the main effect of group and week is significant for VAS (P < 0.05). This study showed that the values of VAS were significantly different between the three groups during the fourth weeks of the study. Moreover, the patients experienced more pain decline in the hyaluronidase group during weeks before injection, after injection, second and fourth week, which indicated the permanent effect of this medication on pain decline.

Injection of lidocaine leads to a significant reduction in pain immediately after injection; however, the decline was not permanent and disappeared in the following four weeks. But VAS reduction in hyaluronidase group more than bicarbonate and lidocaine groups.

To evaluate the effects of dry needling (DN) on pain and function in patients with concurrent carpal tunnel syndrome (CTS) and forearm muscles myofascial trigger point (MTrP).

This randomized controlled trial evaluated fifty affected hands with the clinical and electrodiagnostic diagnosis of mild and moderate CTS with the presence of MTrP in their forearm muscles. Patients were randomized to intervention and control groups. In the intervention group, one session forearm MTrP DN was performed in addition to wrist splint. Then, pain and function were assessed using the visual analogue scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) at the baseline, one week, and six weeks after the intervention in both groups. The outcomes in this study were pain reduction (VAS) and improvement in hand function (BCTQ).

The co-occurrence of mild and moderate CTS with forearm muscle MTrP was observed in 61% of cases. In addition, improvement in pain severity, VAS, a mean difference of 1.44 (with a 95% CI of 0.96, 1.92, P < 0.001), the BCTQ total score, and a mean difference of 0.21 (with a 95% CI of 0.10, 0.32, P < 0.001) were observed in the DN group compared with the control group at one-week follow-up.

In general, forearm MTrP should be considered when examining patients with CTS since MTrP therapy in patients with CTS can enhance the effectiveness of physical therapy on symptom improvement in short terms

Plantar fasciitis (PF) is an overuse syndrome as it develops over time. It is most frequently seen in both the non-athletic and athletic populations. PF is a multifactorial and self-limiting disorder that several factors are involved in its onset. Many well-established treatments are available for plantar heel pain. The purpose of this review is to determine the effectiveness of dry needling for the management of PF.

This article is a review study, in which we present the studies that compare dry needling with other treatments for the management of plantar heel pain. We included all of the studies on patients with plantar heel pain and plantar fasciitis that investigated the effects of dry needling. Finally, seven articles were included in this review. The study designs were randomized controlled, quasi-experimental, and case-control. The Physiotherapy Evidence-based Database (PED) scale was used to measure the methodological quality of the studies.

The PEDro scoring of the articles ranged between 2.10-7.10. The results of this review show that dry needling may be useful in improving the pain of individuals with plantar heel pain and plantar fasciitis.

Further high-quality research studies are needed to determine the effectiveness of dry needling in the management of plantar heel pain. Because a variety of protocol treatments of dry needling were used in the studies, we cannot recommend dry needling schedule prescriptions for the management of individuals with plantar heel pain and plantar fasciitis.

Myofascial Pain Syndrome (MPS) is a common disorder of musculoskeletal system. About one third of the people with musculoskeletal disorders have been diagnosed as having MPS. It is a painful condition caused by trigger points. A variety of treatment approaches are used to cure MPS and its associated disorders. This study aimed to investigate the effects of single session Intramuscular Electrical Stimulation (IMES) through dry needling on pain and Range Of Motion (ROM) following trigger points in upper trapezius.
Material and Sixteen volunteers with active trigger points in upper trapezius were randomly divided into two groups: 1) the IMES treatment group (8 females) and 2) placebo group (8 females). In the IMES group, trigger points of the affected side were injected through dry needling, then a burst current (2 Hz) was applied on the muscle while the electrical stimulation steadily increases to form a pain free contraction for the patient. In placebo group, the procedure was exactly the same but there was no applied electrical stimulation through dry needling. Pain sensation by Visual Analog Scale (VAS) and cervical flexion ROM were measured before treatment, immediately after treatment and one week later by another blinded researcher.
VAS scores showed improvement in both groups at the end of the treatment session and also one week later. There was no significant difference between the groups; IMES and placebo in terms of the VAS after treatment session. However, the pain scores were substantially decreased in the IMES group one week after the intervention. The ROMs were significantly lower in placebo group one week after treatment. There was no significant correlation between improvement and duration of symptoms.
Both IMES and placebo methods might be effective in relieving symptoms of patients with the MPS in upper trapezius; however, patients following the IMES treatment showed higher level of improvement during one week after the intervention. Further relevant studies with higher number of volunteers and different treatment protocols are necessary to get high quality evidence.

Myofascial trigger points (MTrPs) are one of the main characteristics of musculoskeletal disorders. The main purpose of this study was to compare the long-term effects of dry needling (DN) and physical therapy modalities (PT) on the MTrPs of upper trapezius muscle.
Material and A total of 34 subjects with upper trapezius MTrP participated in this study. Subjects were randomly assigned into two groups of DN (N = 17) and PT (N = 17). DN group was treated two sessions per week, and PT group was treated three sessions per week. Pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), and function of upper limbs were assessed every session.
Significant decrease of pain (P = 0.002), increase of CROM (P = 0.002), PPT (P = 0.003), and functional improvement of upper limbs (P = 0.001) after treatment occurred in both groups. DN group revealed more improvement than the PT group (P = 0.001).
Although both of PT and DN are effective treatments for MTrP, the DN seems to be more effective.

Lateral epicondylitis, also known as tennis elbow, is the most common overuse syndrome of the elbow. The severity of pain may not be directly caused by tendinopathy of wrist extensors since trigger points of the shoulder muscles have a referral zone in the arm and elbow. Therefore the aim of this study was to evaluate the effect of dry needling of shoulder myofascial trigger points on wrist extensors muscles pain and function.
Fourteen female patients with tennis elbow (aged 20 - 45 years old) were recruited after primary evaluation by an orthopedist. They entered the study if they had pain in the lateral aspect of elbow of the dominant hand for more than 3 months along with the presence of myofascial trigger points in any muscles of supra spinatus, infra spinatus, sub scapularis or scalenes. Pain pressure threshold, maximal grip force and pain intensity of the hand extensors on lateral epicondyle of elbow were measured before and after treatment. Pain intensity was measured on a one to ten scale of visual analogue scale (VAS). A hand dynamometer used to measure the maximal grip force value of the affected hand in 0˚shoulder flexion/abduction, 90˚ elbow extension and mid-poison of forearm in sitting position .A pressure algometer was applied on hand extensor muscles to define their trigger point sensitivity. For the control group, treatment regimens consisted of routine physical therapy of tennis elbow. This regime was accompanied by dry needling of mentioned muscles for the intervention group. Wilcoxon and Mann-Whitney non-parametric tests were used for statistical analysis.
Comparison of the results after intervention showed that the patients’ pain significantly decreased in both groups (P Dry needling of affected shoulder muscles along with routine physical therapy has a more significant effect on improvement of pain, sensitivity and grip power of patient’s with tennis elbow syndrome.

Musculoskeletal pain is a common problem among athletes. Apart from sport injuries, the myofascial pain syndrome is another important problem that affects performance of the athlete.. The aim of this study was to evaluate the effects of therapeutic sequences of the hot pack in combination with ultrasound on the physiological responses over the latent myofascial trigger point (LMTrP) of upper trapezius muscle.. Thirty subjects with a latent myofascial trigger point (LMTrP) in both sides of the upper trapezius muscle participated in the study (age 27.33 ± 4.34 years, weight 58.11 ± 7.47 kg, height 161.50 ± 5.82 cm, pressure pain threshold 2.28 ± 0.24 kg/cm2, pain intensity 7.17 ± 2.25 VAS). All subjects received both treatments (hot pack followed by ultrasound: HP + US; and ultrasound followed by hot pack: US + HP) by randomization with a 24 to 48-hour interval between sessions. Outcome measures, including the tissue blood flow (TBF), pressure pain threshold (PPT), supra-thermal threshold (STT) and visual analog scale (VAS) were evaluated at baseline, immediately, after 30 minutes and after 60 minutes.. The TBF and PPT significantly increased from baseline in both treatment conditions (i.e. HP + US and US + HP), while the HP + US condition showed a trend toward significant difference in VAS and STT in 45°C.. The application of HP and US treatment induces physiological responses (especially, TBF and PPT) on the LMTrP. This finding provides the direction toward the management of MTrPs condition..