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Myoglobin in plasma after trigger point massage

PainSci » bibliography » Danneskiold-Samsoe et al 1986
Tags: muscle pain, muscle, pain problems

One article on PainSci cites Danneskiold-Samsoe 1986: The Pressure Question in Massage Therapy

PainSci notes on Danneskiold-Samsoe 1986:

In 1983 and 1986, a Scandinavian research group published two studies of the effect of massage on trigger points. Their findings may constitute evidence of the efficicacy of trigger point massage. It was not conclusive, but many years later those papers are still among the more interesting evidence available.

Simons and Mense, writing in their 2001 text, “Muscle Pain,” interpret the studies like so: “Two experimental studies showed that vigorous massage ... did disrupt muscle fibers sufficiently to release intracellular myoglobin. Comparable massage of normal muscle caused no such elevation of serum myoglobin. As the tenderness and tension of the ‘nodule’ subsided with repeated treatments, the post-treatement increase of serum myoglobin became successively less and finally failed to appear when symptoms had abated. This finding strongly supports the concept that dysfunctional endplates may be more susceptible to mechanical trauma than are normal endplates, and that properly placed local tissue stretch can inactivate them” and “enough pressure to mechanically disrupt the endplate can totally inactivate that endplate and eliminate the cycle.”

That strikes me as too much interpretation from too little evidence. Simon and Mense are too enthusiastic in my opinion, making more of the evidence than is reasonable. I prefer the researchers’ just-the-facts conclusion, which is simply that “the observed increase in myoglobin in plasma after massage indicates a leak of myoglobin from the muscle fibres.”

Nevertheless, that finding is significant. Their study subjects did experience significant relief from pain, which was associated with myoglobin spilled from muscle cells in trigger points than elsewhere, and that finding did fade as symptoms resolved. I think the importance of this evidence is simply that it connects relief from symptoms with an objective finding, establishing more clearly that trigger points are pathological, and that one of the signs of this fades along with the symptoms. But pathological how? The presence of myoglobin outside of muscle cells indicates only what the authors said, that “myofascial pain seem to be linked with a muscle fibre disease.”

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.

The plasma myoglobin concentration was measured before and after massage of 26 patients with myofascial pain. Twenty-one patients had a successful treatment and a significant increase was observed in the plasma myoglobin concentration (median 125 micrograms/l, range 35-439) within a maximum of 2 hours after the first massage treatment (p less than 0.0001). A positive correlation was found between the degree of muscle tension and pain, and the increase in plasma myoglobin concentration. After repeated massage treatment a gradual decline in the increase in plasma myoglobin concentration could be demonstrated parallel to a reduction in the muscle tension and pain. Five patients did not benefit from massage treatment and no significant increase in the myoglobin in plasma was measured. These patients were in pain and had a high degree of muscle tension. The observed increase in myoglobin in plasma after massage indicates a leak of myoglobin from the muscle fibres in 21 patients, whose myofascial pain seem to be linked with a muscle fibre disease. It is suggested that 5 patients with the same muscle symptoms have another, still unknown muscle disease.

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