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Can trigger point therapy improve restricted ankle joint motion?

PainSci » bibliography » Grieve et al 2013
updated
Tags: treatment, self-treatment, massage, stretch, TrPs, study_rct, study_trial, manual therapy, professions, exercise, muscle, pain problems

Two pages on PainSci cite Grieve 2013: 1. The Complete Guide to Trigger Points & Myofascial Pain 2. Trigger Points on Trial 

PainSci commentary on Grieve 2013: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Can trigger point therapy help immediately to improve a restricted ankle joint? The answer is a highly qualified yes: “This study identified an immediate significant improvement in ankle range of motion after a single intervention of trigger point pressure release on latent soleus trigger points. These findings are clinically relevant, although the treatment effect on ankle ROM is smaller than a clinically significant ROM (5°).”

Statistically but not clinically significant means “the increase was real but small.” In many cases, the effect on ankle ROM was so small that it probably made no noticeable difference to the patient. But Rob Grieve, the author, pointed out in an email to me that “some of the individual scores post intervention were considerably higher than 5˚,” which patients probably did notice. The real story, though, is that any positive result from such a quick, simple treatment is noteworthy and promising. If an isolated trigger point treatment makes a difference in the extensibility, that certainly bodes well for more thorough treatment.

See my trigger points tutorial for a detailed analysis.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVES: To investigate the immediate effect on restricted active ankle joint dorsiflexion range of motion (ROM), after a single intervention of myofascial trigger point (MTrP) therapy on latent triceps surae MTrPs in recreational runners.

DESIGN: A crossover randomised controlled trial.

PARTICIPANTS: Twenty-two recreational runners (11 men and 11 women; mean age 24.57; ±8.7 years) with a restricted active ankle joint dorsiflexion and presence of latent MTrPs.

INTERVENTION: Participants were screened for a restriction in active ankle dorsiflexion in either knee flexion (soleus) or knee extension (gastrocnemius) and the presence of latent MTrPs. Participants were randomly allocated a week apart to both the intervention (combined pressure release and 10 s passive stretch) and the control condition.

RESULTS: A clinically meaningful (large effect size) and statistically significant increase in ankle ROM in the intervention compared to the control group was achieved, for the soleus (p = 0.004) and the gastrocnemius (p = 0.026).

CONCLUSION: Apart from the statistical significance (p < 0.05), these results are clinically relevant due to the immediate increase in ankle dorsiflexion. These results must be viewed in caution due to the carry-over effect in the RCT crossover design and the combined MTrP therapy approach.

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