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Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity

PainSci » bibliography » Hou et al 2002
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Tags: treatment, self-treatment, massage, muscle pain, ice heat, stretch, exercise, manual therapy, muscle, pain problems, rehab, injury

One article on PainSci cites Hou 2002: The Complete Guide to Trigger Points & Myofascial Pain

PainSci commentary on Hou 2002: ?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.

This paper reports that ischemic pressure can relieve the pain of myofascial trigger points in the neck, and that it is more effective in combination with a variety of other treatments such as hot pack, active ROM (like Mobilize!), stretch with spray. Unfortunately, it’s not a great experiment. Adjusting the conclusions to account for its several weaknesses, it really tells us nothing except that brief bouts of pressure did suspiciously little to a bunch of putative trigger points.

This paper is discussed in detail in my trigger points book (paywall).

~ 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: To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle.

DESIGN: Randomized controlled trial.

SETTING: Institutional practice.

PATIENTS: One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs).

INTERVENTION: Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release).

MAIN OUTCOME MEASURES: The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect.

RESULTS: In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05).

CONCLUSIONS: Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM.

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