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The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle

PainSci » bibliography » Hodgson et al 2006
Tags: treatment, self-treatment, massage, muscle pain, neck, manual therapy, muscle, pain problems, head/neck, spine

Two articles on PainSci cite Hodgson 2006: 1. The Complete Guide to Trigger Points & Myofascial Pain2. Trigger Point Doubts

PainSci notes on Hodgson 2006:

A test of treating trigger points with direct pressure for 60 seconds. Thirty-seven subjects received either a single dose of thumb pressure on their upper trapezius trigger points for 60 seconds, or a sham treatment using pressure that was deliberately off target. Sensitivity was measure before and after, and they report a “significant increase in mean pressure pain tolerance” after real treatment, but not the sham treatment.

As usual when, the actual size of the difference is not shared in the abstract, which is a near guarantee that it wasn’t impressive. Unfortunately, I can’t verify that, because I cannot find the full text of this paper.

The study was blinded — an unusual strength. In most such studies, the group that doesn’t treatment is aware that they aren’t getting the real thing, which poses a very real risk of skewing the results (“frustrebo effect”).

Interestingly, rather than using a traditional algometer for measuring pressure, the researchersused a special one that directly measured the pressure applied by a thumb (rather than measuring pressure applied by a rubber-tipped probe). It’s not clear to me what the points of this was. It doesn’t seem to do much more than to raise doubts about the validity of the results.

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.

INTRODUCTION: Sustained manual pressure has been advocated as an effective treatment for myofascial trigger points (MTrPs). This study aimed to investigate the effect of manual pressure release (MPR) on the pressure sensitivity of latent MTrPs in the upper trapezius muscle, using a novel pressure algometer.

DESIGN: Randomised blinded clinical trial.

PARTICIPANTS: Thirty-seven subjects (mean age 23.1 years±3.2; M=12, F=23) were screened for the presence of latent MTrPs in the upper trapezius muscle (tender band that produced referred pain to the neck and/or head on manual pressure).

INTERVENTION: Subjects were randomly allocated into either treatment (MPR pressure sustained for 60 s) or control (sham myofascial release) group.

OUTCOME MEASURES: The pressure pain threshold (PPT) was recorded pre- and post-intervention using a digital algometer, consisting of a capacitance sensor attached to the tip of the palpating thumb. Changes in pressure sensitivity were also measured during the application of MPR via a verbal analogue pain scale (0–10, 0=no pain, 10=severe pain).

RESULTS: There was a significant increase in mean PPT following MPR (P<0.001), but not following the sham treatment. Pressure was monitored and maintained during the application of MPR, and a reduction in perceived pain and significant increase in tolerance to treatment pressure (P<0.001) appeared to be caused by a change in tissue sensitivity, rather than an unintentional reduction of pressure by the examiner.

CONCLUSIONS: The results suggest that MPR may be an effective therapy for MTrPs in the upper trapezius muscle.

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