ABSTRACT
Objective: To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points (MTrPs) by observing the effects of An-Pressing manipulation on adenosine triphosphate (ATP), adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)/peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats. Methods: Forty-eight male Sprague-Dawley rats were randomly divided into a blank group, a model group, a lidocaine group, and an An-Pressing manipulation group, with 12 rats in each group. The model group, lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method. After modeling, the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation, once every other day; the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs, once every 6 d. The blank group and the model group were fed normally without intervention. After the intervention, local muscle tissue was taken to detect the content of ATP and the expression of AMPK, phosphorylated AMPK (phospho-AMPK), PGC-1α, and glucose transporter 4 (GluT4), and the ultrastructure of mitochondria was observed under an electron microscope. Results: Compared with the blank group, the ATP content in the model group was decreased (P<0.05), the protein expression levels of phospho-AMPK, PGC-1α, and GluT4 and the ratio of phospho-AMPK to AMPK were decreased (P<0.05); under the electron microscope, the number of mitochondria decreased, and they were deformed, small in volume, and had deformed cristae. Compared with the model group, the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased (P<0.05), and the protein expression levels of phospho-AMPK, PGC-1α, and GluT4 and the ratio of phospho-AMPK to AMPK were increased (P<0.05); under the electron microscope, the number of mitochondria increased, the shape and size of the mitochondria were basically normal, and the cristae could be seen. Compared with the lidocaine group, phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased (P<0.05); under the electron microscope, the numbers of mitochondria were similar, and the shape and size of the mitochondria were basically normal without swelling, and the cristae could be observed. Conclusion: An-Pressing manipulation can increase the ATP content in MTrPs tissue, improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK; its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.
ABSTRACT
Objective:To explore the clinical efficacy of myofascial trigger point electric stimulation based on mirror therapy on phantom limb pain after lower limb amputation. Methods:From May to November, 2020, 50 patients with phantom limb pain after lower limb amputation were randomly divided into control group (n = 25) and experiment group (n = 25). Both groups accepted mirror therapy, while the experiment group received myofascial trigger point electric stimulation before mirror therapy, for four weeks. They were assessed with short-form of McGill Pain Questionnaire (SF-MPQ), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), Timed 'Up & Go' Test (TUGT) and 6-minute walk test (6MWT) before and after treatment. Results:All the indexes improved in both groups after treatment (|t| > 8.210, P < 0.001), and improved more in the experiment group than in the control group (|t| > 5.103, P < 0.001), except the present pain intensity of SF-MPQ. Conclusion:Mirror therapy is effective on phantom limb pain after lower limb amputation in terms of pain, sleep, anxiety and walking, and the effect could be stronger after myofascial trigger point electric stimulation.
ABSTRACT
Based on the modern anatomy and physiology, the referred pain of myofascial trigger points of each muscle is integrated; compared with the twelve meridians as well as conception vessel and governor vessel, the similarity of their position and running course is observed. With the current research progress of myofascial trigger points and fasciology, based on the running course of referred pain of trigger points, combined with fascia mechanics, nerve and vascular, the location of acupoints and meridians, as well as the relationship between acupoints and meridians, are discussed.
Subject(s)
Humans , Acupuncture Points , Meridians , Muscles , Pain, Referred , Trigger PointsABSTRACT
OBJECTIVE@#To evaluate the clinical effect of acupuncture at tendon blockage point of quadriceps femoris muscle belly for mild to moderate patella femoral arthritis.@*METHODS@#A total of 76 patients with mild to moderate patella femoral arthritis were randomly divided into an observation group and a control group, 38 cases in each group. The patients in the observation group were treated with acupuncture at tendon blockage point of quadriceps femoris muscle belly, and the needles were stayed for 20 min each time for twice a week; while the patients in the control group were treated with sodium hyaluronate injection into articular cavity, once a week, and both groups were treated for 4 weeks. The pain symptoms and joint function of the patients were evaluated with pain visual analogue scale (VAS) score, tenderness value of the most obvious pain point in front of the knee, and Lysholm knee function score before and one week after treatment, and the clinical effect was observed.@*RESULTS@#After treatment, VAS scores, tenderness value of the most obvious pain point in front of the knee and Lysholm knee function scores of the two groups were improved compared with before treatment (<0.05); the improvement of VAS score and tenderness value of the most obvious pain point in front of the knee in the observation group was more obvious than that in the control group (<0.05). The total effective rate in the observation group was 94.7% (36/38), which was higher than 81.6% (31/38) in the control group (<0.05).@*CONCLUSION@#Acupuncture at tendon blockage point of quadriceps femoris muscle belly can relieve pain and improve the function of patella femoral joint for patients with patella femoral arthritis, and the clinical effect is better than that of sodium hyaluronate injected into articular cavity.
ABSTRACT
OBJECTIVE@#To compare the effect of floating needle therapy on myofascial trigger point (MTrP) and conventional electroacupuncture on the recovery of shoulder joint function after surgical neck fracture of humerus on the basis of drugs and rehabilitation training.@*METHODS@#A total of 72 patients with unilateral surgical neck fracture of humerus were randomly divided into a floating needle group (35 cases) and an electroacupuncture group (37 cases). At the same time of the basic treatment, both groups were intervened on the 2nd day after operation. Touched the MTrP at the affected limb, and the floating needle was used to sweep around it in the floating needle group. In the electroacupuncture group, electroacupuncture was applied at Hegu (LI 4), Quchi (LI 11), Waiguan (TE 5) on the affected side, the dilatational wave (4 Hz/20 Hz) was selected. The treatment was given once every day for 2 weeks. Pain visual analogue scales (VAS) score, constant shoulder joint score, and changes in the number of MTrP were used to evaluate the pain and functional status of the shoulder joints before, after treatment, and 3 months after treatment.@*RESULTS@#Compared with that before treatment, the VAS scores were decreased, the constant scores were increased, and the numbers of MTrP were decreased in the two groups after treatment and 3 months after treatment (<0.05), but the improvement in the floating needle group was better than that in the electroacupuncture group (<0.05). Compared with that after treatment, the VAS scores were decreased and the constant scores were increased 3 months after treatment in the floating needle group (<0.05), and the VAS scores in the electroacupuncture group were decreased (<0.05).@*CONCLUSION@#Floating needle therapy is helpful for the rehabilitation of shoulder joint function after surgical neck fracture of the humerus, and its curative effect is better than conventional electroacupuncture.
Subject(s)
Humans , Acupuncture Points , Electroacupuncture , Humerus , Physical Therapy Modalities , Treatment OutcomeABSTRACT
Objective To investigate and compare the clinical efficacies of acupuncture at myofascial trigger points and extracorporeal shock wave and their effects on the quality of life in patients with myofascial pain syndrome. Method Seventy-eight patients with myofascial pain syndrome were allocated, using a random number table, to acupuncture and shock wave groups, 39 cases each. The two groups received acupuncture at myofascial trigger points and extracorporeal shock wave, respectively. The clinical therapeutic effects were compared between the two groups of patients after 20 consecutive days of treatment. The quality of life score was recorded in the two groups of patients before and after one month of treatment. Result The VAS score (1.57±0.83), the PRI score (1.87±1.06) and the PPI score (0.94±0.72) in the acupuncture group were lower than the VAS score (2.16±0.95),the PRI score (2.68±1.14) and the PPI score (1.53±0.81) in the shock wave group. All had a statistically significant difference (P<0.05). The VAS score, the PRI score and the PPI score decreased significantly in the two groups of patients after treatment compared with before. Eight scaled scores: physical functioning, physical role functioning, bodily pain, social role functioning, vitality, general health perceptions, emotional role functioning and mental health increased significantly in the two groups of patients after treatment compared with before (P<0.05) and increased more in the acupuncture group (P<0.05). The marked efficacy rate was 84.6% in the acupuncture group, which was significantly higher than 61.5% in the shock wave group (P<0.05). Conclusion Both acupuncture and extracorporeal shock wave therapy have a marked clinical effect on myofascial pain syndrome. It can further improve the quality of life in the patients.
ABSTRACT
The conception and the history ofpoint, tender point and myofascial trigger point are described in the paper. All of three kinds of point are the reaction of musculoskeletal pain and visceral diseases. Theoretically,point originates from the theory of muscle region of meridian, tender point from the theory of soft tissue and muscles and myofascial trigger point from the theory of muscular fasciae. Anatomically,point is localized in the muscle region of meridian, on the boundary between muscles, tender point is on the muscular attachment to skeleton (the starting and ending points) and myofascial trigger point is on the motor point of neuromuscles. Pathologically,point reflects the disorders of soft tissue and internal organ, tender point reflects the disorders of soft tissue and myofascial trigger point reflects the disorders of soft tissue and few disorders of internal organ. To identify the relationship among them is very significant in the target treatment with acupuncture.
ABSTRACT
<p><b>OBJECTIVE</b>To study clinical treatment effects of inactivating myofascial trigger points with needling and muscle stretching for the treatment of knee osteoarthritis(OA).</p><p><b>METHODS</b>Retrospective analyses were made to investigate the clinical data of pain clinic outpatient in our hospital from 2010 to 2014, and 108 patients with knee OA, including 35 males and 73 females, were treated with acupuncturing of myofascial trigger points and stretching of muscles and structure around knee. The puncturing of trigger points, and the back and forth movement of needle were required to elicit local twitch response of muscle. After acupuncture treatment, muscle stretch around the knee joint was performed by a therapist. All patients must do homework of self stretching exercise. The extent of stretching should be to gradually increased under a tolerable pain. The ROM and walking pain VAS scores were measured before and after whole therapy and were statistically analyzed during 1 year of follow up.</p><p><b>RESULTS</b>All the patients were followed up, and 95 patients had no pain after 1 year. The VAS scores were improved from preoperative severe 7.6±0.5, moderate 4.9±0.7, to mild 1.9±0.6 and painless 0.3±0.2.</p><p><b>CONCLUSIONS</b>The walking pain of knee OA might be alleviated by the acupuncture and stretch to inactivate the myofascial trigger point.</p>
ABSTRACT
Objective To compare the efficacies of transverse needling versus perpendicular needling at myofascial trigger points in treating cervical spondylosis and sift out a needling direction for a better improving effect on myofascial pain syndrome such as cervical spondylosis. Method One hundred and six patients with cervical spondylosis were randomly allocated to two groups. The transverse needling group received transverse needling at myofascial trigger points and the perpendicular needling group, perpendicular needling at myofascial trigger points. The symptoms and signs of cervical spondylosis were scored and the VAS score was recorded in the two groups before and after treatment. Result In the two groups, the VAS score had a statistically significant pre-/post-treatment difference (P0.05). In the two groups, the cervical spondylotic symptom and sign score had a statistically significant pre-/post-treatment difference (P<0.05) and decreased after treatment. The cervical spondylotic symptom and sign score was significantly lower in the transverse needling group than in the perpendicular needling group after treatment; there was a statistically significant difference between the two groups (P<0.05). The total efficacy rate was 94.0% in the transverse needling group, which was higher than 79.6% in the perpendicular needling group; there was a statistically significant difference between the two groups (P<0.05). Conclusion Both transverse needling and perpendicular needling can remove myofascial trigger points and treat cervical spondylosis, but transverse needling at myofascial trigger points is superior to perpendicular needling at myofascial trigger points.
ABSTRACT
Objective To observe the therapeutic efficacy of acupuncture at myofascial trigger points (MTrPs) in treating cervical spondylosis of vertebral artery type. Methods Ninety-eight patients with cervical spondylosis of vertebral artery type were randomized into a treatment group of 51 cases and a control group of 47 cases. The treatment group was intervened by acupuncture at the MTrPs, while the control group was by injection of medical solution for anti-inflammation and analgesia. The positive rate of rotate-cervix test, dizziness score, and visual analogue scale (VAS) of the head and neck pain were compared before and after intervention. Results After intervention, the positive rate, dizziness score, and VAS score were significantly changed in both groups (P＜0.05). There were significant differences in comparing the positive rate, dizziness score, and VAS score between the two groups after intervention (P＜0.05). The total effective rate was 96.1%in the treatment group versus 76.6%in the control group, and the difference was statistically significant (P＜0.05). Conclusion Acupuncture at the MTrPs can improve the dizziness and head-neck pain in patients with cervical spondylosis of vertebral artery type.
ABSTRACT
Los puntos gatillo miofaciales (Pgs) son puntos hiperirritables en un músculo esquelético asociado a un nódulo palpable causado por una banda muscular tensa. Los Pgs miofaciales presentan dentro de sus signos y síntomas alteraciones motoras, sensoriales y autonómicas. En este artículo reportamos un caso en el que se presenta un fenómeno autónomo referido a partir de un punto gatillo miofacial y se plantean las vías neuroanatómicas involucradas en esta respuesta, analizando la hipótesis que las respuestas autónomas referidas asociadas al dolor pueden considerarse eventos neuropáticos del sistema nervioso autónomo.
Myofascial trigger points (MTP) are hyperirritable points in skeletal muscle associated with a palpable lump caused by a strained muscle band. MTP presented within signs and symptoms of motor, sensory and autonomic impairment. In this article we report a case in which an autonomous referred phenomena from a myofascial trigger point and raises the neuroanatomical pathways involved in this response, considering the hypothesis that self-related responses associated with neuropathic pain can be regarded as events of the autonomic nervous system. Clinical and experimental evidence discussed in this article indicates that myofascial trigger point pain is an autonomic phenomena associated, that can be systemic and localized, and must be considered in evaluating patients with these diagnosis.
Subject(s)
Humans , Adult , Female , Autonomic Nervous System , Pain Measurement/methods , Hyperemia , Myofascial Pain Syndromes , Temporal Muscle/physiopathology , Temporal Muscle/innervation , Palpation , Sympathetic Nervous SystemABSTRACT
Os pontos gatilhos miofasciais (PGMs) são manifestações comumente encontradas na prática clínica e estão relacionados à alteração de tônus e à síndrome dolorosa miofascial (SDM). OBJETIVO: Avaliar a capacidade da EMG de superfície e detectar alterações da atividade neuromuscular no PGM, em situações de repouso e de contração isométrica voluntária máxima. MÉTODO: Participaram do estudo 56 indivíduos distribuídos em dois grupos: grupo Saudável com 28 indivíduos, que necessariamente não possuíam PGM, e o grupo Dor, constituído de 28 indivíduos que possuíam necessariamente PGM no músculo escolhido. O grupo Dor apresentava indivíduos com PGM latente e ativo, e com e sem fenômenos autonômicos (FA). RESULTADOS: O sinal EMG da porção muscular com PGM mostrou-se significativamente maior quando comparado com a porção muscular sadia do grupo Dor, e do grupo Saudável durante o repouso (26,56 ± 44,54, 5,39 ± 6,29 e 1,56 ± 0,76, respectivamente, p = 0,0001). Os indivíduos com PGM ativo obtiveram maior intensidade do sinal EMG do que aqueles que apresentaram PGM latente (17,85 ± 30,25 versus 3,74 ± 1,52, p = 0,04). Além disso, os indivíduos que apresentaram fenômenos autonômicos tiveram maior intensidade do sinal EMG do que aqueles que não os apresentaram (16,78 ± 28,44 versus 3,51 ± 3,65), na condição de repouso. CONLUSÃO: A EMG de superfície é capaz de mensurar a atividade do PGM, principalmente na condição de repouso.
There are examples of common clinical conditions that clinical signals are related to alterations in muscle tone, including myofascial pain syndrome. OBJECTIVE: to discuss the application of surface EMG to detect effect of miofascial trigger point (MTP) on neuromuscular activity at rest and maximum voluntary contraction of the trapezoid muscle. METHODS: Fifty-six subjects participated in the study and were divided into two groups: Healthy group (n = 28), with subjects who necessarily did not present MTP, and PAIN group (n = 28), with subjects who necessarily had MTP. RESULTS: The EMG signal was significantly higher in the muscle portion containing MTP than in the healthy muscle portion in PAIN group and than Healthy group (26,56 ± 44,54, 5,39 ± 6,29 and 1,56 ± 0,76, respectively, p = 0,0001) during rest. In addition, a higher intensity of the EMG signal was observed in subjects with active MTP than in latent MTP (17,85 ± 30,25 versus 3,74 ± 1,52, p = 0,04. Besides, the subjects who presented autonomic phenomena had higher EMG signal than those who had no autonomic phenomena (16,78 ± 28,44 versus 3,51 ± 3,65. CONCLUSION: The surface EMG is reliable to measure the muscular activity of the MTP, mainly at rest condition.
Subject(s)
Humans , Male , Female , Electromyography , Muscle Tonus , Myofascial Pain SyndromesABSTRACT
@#ObjectiveTo investigate the therapeutic effectiveness of low-power laser on myofascial pain syndrome. Methods73 self-controlled patients with myofascial pain syndrome were irradiated on myofascial trigger points with Nd:YAG laser in wavelength 830nm, power 500mW, 20 minutes per day for 5 times. At pre-and post-treatment,pain intensity and pressure pain of myofascial trigger points were checked. ResultsAfter treatment, score of pain intensity was reduced signficantly from (7.24±2.41) to (2.21±1.22) (P<0.001). The pressure pain of myofascial trigger points were improved . Conclusions Low-power laser can reduce the pain intensity and increase the pressure pain threshold of myoficial trigger points.
ABSTRACT
Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findin gs, which is yery subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algometer and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response (SSR), and to evaluate the electrophysiologic characteristics of MFTrP. 21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTP with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrodiagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed. SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism. Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not, Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result. In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP. although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.