PainSci commentary on Ravichandran 2016: ?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 is one of the few clearly negative trials of ischemic pressure for trigger points. In 30 patients with neck pain, they compared the effects of pressure+stretch to ultrasound+stretch, and “there was no statistical significance between groups,” and that should be the end of it: that’s a negative result. Ultrasound is well-known to be largely useless for pain — which is why they used it for a control group — and ischemic pressure had the same results.
But the authors didn’t give up that easily! They awkwardly try to make hay from statistically significant changes in both groups. That is, there were modest improvements no matter what the treatment was — which is what we should expect from any intervention, and so it doesn’t really tell us much. Any time you do anything for someone in pain, it goes down a bit.
Another possibility — unlikely, but possible — is that stretching was actually the active ingredient here, and it worked a bit for both groups of patients. It’s inclusion muddies the waters thoroughly, because the value of stretching for trigger points is just as unclear and in need of (independent) testing as ischemic pressure.
~ 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: Neck pain is a common disorder prevailing among individuals of different populations. The myofascial pain syndrome is a disorder related to myofascial trigger points. It is defined as a hyperirritable locus in skeletal muscle and that is associated with a hypersensitive palpable nodule in a taut band of muscle. Manual therapy has got a profound role in treating and ischemic compression technique has been researched widely. Thus the study intends to analyse the effectiveness of Manual Therapy (Ischemic Compression) on functional outcome in neck pain.
METHODS: A single blinded randomized control study was conducted for subjects of sample size 30 who met the inclusion criteria and random allocation was made. The baseline parameters as like pain severity using VAS, pain pressure threshold using pressure Algometer, active cervical lateral flexion using 360 degree goniometer and disability using NDI were recorded. Study group received ischemic compression followed by myofascial stretches while the control group received ultrasonic therapy of 1.4watts/cm2. Both received Cryotherapy post session. After 2 weeks the baseline parameters were again recorded for t-test analysis.
RESULT: There was no statistical significance between groups (p≥0.05). But active cervical lateral flexion showed improved mobility in study group and a high statistical significance within groups (p≤0.01) in relation to all parameters.
CONCLUSION: Both ultrasonic therapy and Ischemic compression technique was found to show better improvement in pain pressure threshold and functional outcome in neck pain.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.
- Sudden amnesia resulting in pain relief: the relationship between memory and pain. Choi 2007 Pain.