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Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects a randomized controlled study

PainSci » bibliography » Aguilera et al 2009
Tags: treatment, self-treatment, massage, muscle pain, neck, devices, manual therapy, muscle, pain problems, head/neck, spine

Four articles on PainSci cite Aguilera 2009: 1. Does Massage Therapy Work?2. The Complete Guide to Trigger Points & Myofascial Pain3. The Complete Guide to Low Back Pain4. Trigger Point Doubts

PainSci commentary on Aguilera 2009: ?This page is one of thousands in the 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.

Sixty-six volunteers with latent (asymptomatic) trapezius trigger points were divided into two treatment groups — ischemic pressure and ultrasound — and a third control group that received only sham ultrasound. Each subject received only a single dose of treatment, and before and after measurements were taken of the sensitivity of the trigger point to pressure, electrical activity in the trapezius muscle, and range of motion of the neck (sidebending, which is limited by the upper trapezius).

Researchers found that both ultrasound and ischemic pressure caused “an immediate decrease” in electrical activity and trigger point sensitivity. Only ischemic pressure improved range of motion.

They report “statistically significant” changes compared to sham, but do not discuss the effect size or clinical significance other than describing the changes as “satisfactory short-term results.” They do not report their before and after numbers (a bit of a red flag), but they do report the (mean) differences between the before and after measurements. The reductions in sensitivity from ischemic pressure are less than a single point on a 10-point pain scale, and the improvement in ROM was just 4.5˚ (roughly 10% of normal). The changes in electrical activity are measured in millivolts, which is not possible to interpret without extensive context.

These modest results are only from a single dose of treatment, and they do differ from sham ultrasound by a measurable (statistically significant) amount. That is interesting, and does suggest that something useful is happening. But the changes are really quite small, and for all we know they only last a few minutes (they only measured immediately after treatment).

A significant limitation of the study is that they subjects were all asymptomatic, and studies of “treatments” for people without a clinical problem is probably not relevant to people with actual pain.

~ 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.

OBJECTIVE: The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle.

METHODS: Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent (asymptomatic) MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm(2) of pressure using a pressure analog algometer.

RESULTS: The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained.

CONCLUSION: In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC.

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