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Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial

PainSci » bibliography » Takamoto et al 2015
Tags: treatment, self-treatment, massage, muscle pain, back pain, manual therapy, muscle, pain problems, spine

PainSci commentary on Takamoto 2015: ?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 is the only trial of compression for acute low back pain, as opposed to chronic. It’s a fairly good design, testing six consecutive treatment sessions (three times per week for 2 weeks), on 63 patients divided into three groups: patients that got direct pressure on their (putative) trigger points, pressure on non-trigger points, or superficial massage. However, patients in the control groups were aware that they were not getting real massage therapy, which is a serious flaw, common in studies like this.

The authors report in their abstract that the treatment group was “significantly improved” compared to the other groups for about a month, but with no specific numbers and no mention of effect size or clinical significance — which practically guarantees that the effect size is damningly small. More damningly, the full text also fails to discuss effect size and clinical significance. Since they didn’t, I will.

Sticking to the primary outcome (pain), all groups improved, but the treatment group improved more on a 100-point scale: about 32 and 22 points more for the sham points and superficial massage groups. (Differences were very similar for pain with movement.) Even taken at face value, a 22 point lead over superficial massage is already on the edge of disappointing: it’s better, but it’s not very much better. However, the statistical elephant in the room here is the lack of blinding: these differences are almost certainly exaggerated, because of “frustrebo” or disappointment effects in the control groups, patients who knew they weren’t getting the “real” treatment. This would likely suppress their improvements, making them look worse by comparison. If you adjust for that … there’s not much left. The difference may be statistically significant, but it’s clinical significance is quite uncertain.

I suspect these researchers are very biased in favour of trigger point therapy, and it shows in many ways in their paper. Also, the study is summarized in a completely uncritical commentary in the same issue of European Journal of Pain. Author Ruth Defrin accepts the premises and results at face value.

~ 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: Although there is some evidence that massage therapy, especially compression at myofascial trigger points (MTrPs), is effective for sub-acute and chronic low back pain, the effectiveness of massage therapy with compression at MTrPs for acute low back pain has not been studied.

METHODS: To evaluate the effectiveness of compression at MTrPs for acute low back pain, 63 patients with acute low back pain were randomly assigned to one of three groups: the MTrP group who received compression at MTrPs (N = 23), the non-MTrP group who received compression at non-trigger points (N = 21), and the effleurage massage group who received superficial massage (N = 19). The patients received the assigned treatment 3 times/week for 2 weeks. The subjective pain intensity in static and dynamic conditions and disability caused by low back pain were measured by the visual analogue scale (VAS) and Roland-Morris questionnaire (RMQ), respectively; along with the range of motion (ROM) at the lumbar region and pressure pain threshold (PPT) at trigger points before treatment (baseline), 1 week after the start of treatment, and 1 month after the end of treatment (follow-up).

RESULTS: Static and dynamic VAS score, PPT and ROM were significantly improved in the MTrP group compared with those in the non-MTrP and effleurage groups.

CONCLUSIONS: These results indicate that compression at MTrPs is effective to treat acute low back pain compared with compression at non-MTrPs and superficial massage.

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