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Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points

PainSci » bibliography » Hanten et al 2000
Tags: treatment, self-treatment, massage, stretch, muscle pain, manual therapy, exercise, muscle, pain problems

Two articles on PainSci cite Hanten 2000: 1. The Complete Guide to Trigger Points & Myofascial Pain2. Trigger Point Doubts

PainSci commentary on Hanten 2000: ?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.

This study is the earliest study of trigger point massage that I have found. I cannot locate the full text of this paper, so my summary is based on the abstract alone. This was a test of both ischemic pressure and stretching in 40 people with “one or more trigger points in the neck or upper back.” Everyone participated in a 5-day program of either simple range of motion exercises, or ischemic pressure followed by “general sustained stretching.” The sensitivity of the putative trigger points was measured before and after, as well as self-reported average pain intensity and the amount of time in pain in a 24-hour period before and after. “Differences” of unspecific magnitude were found between the treatment and control groups for pain intensity and.

Failing to specify the size of the effect in the abstract is a near guarantee that it was trivial. Large effects get bragged about. Numerous weaknesses plague this trial, especially the presumed lack of blinding.

But the authors concluded that “ischemic pressure and sustained stretching was shown to be effective.” Probably not, but their optimism is nice.

~ 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.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs.

SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study.

METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable.

RESULTS: Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain.

CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

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