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ObjectiveTo explore the possible peripheral analgesic mechanism of electroacupuncture （EA） at promimal and distal acupoints in treatment of myofascial pain syndrome （MPS）. MethodsTwenty-four SD rats were randomly divided into blank group， model group， proximal group， and distal group， with six rats in each group. MPS model was prepared by “strike combined with centrifugal exercise” in all groups except for the blank group. After modeling， the rats in the proximal group received EA at the local myofascial trigger points （MTrPs）， namely the Ashi points， with dilatational waves of frequency of 2/100 HZ and voltage of 2-4 V， current intensity depending on a slight trembling of the left lower limbs， once a day， 15min each time，for 14 days. The rats in the distal group received EA at “Yanglingquan” （GB 34） and “Yinlingquan” （SP 9）， with the same operations as the proximal group. The rats in the blank group and the model group were only grasped and hedged， without other interventions. After intervention， the paw withdrawl mechanical threshold （PWMT） was measured， and variability between the left and right hind paws was calculated. Musculoskeletal ultrasound imaging and electromyography monitoring were performed on the left lower extremity vastus medialis. The morphological changes of vastus medialis muscle of the left lower extremity were observed by HE staining. The positive expression of substance P （SP）， calcitonin gene-related peptide （CGRP）， CD68 and CD206 in muscle tissue was detected by immunohistochemistry. Abdominal aortic serum interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）， and interleukin-8 （interleukin-8） were detected by ELISA. ResultsCompared to those in the blank group， the fibers of the vastus medial muscle of the rats in the model group were broken and distorted with thickness in variation， and the myofascia was broken， with fibrillation potential， enlarged muscle cells， inward moved nucleus， and widened muscle space； the variability of PWMT between the left and right hind paws significantly increased， as well as the levels of SP， CGRP， CD68， and CD206 in the vastus medialis muscle （P＜0.01）， and the serum IL-8 and TNF-αlevels were significantly elevated （P＜0.05 or P＜0.01）. Compared to those in the model group， the muscle fibers in the proximal and distal group were complete in shape and arranged in an orderly manner， with continued non-broken myofascia， regular shape of muscle cells， and significantly reduced level of IL-8 （P＜0.01）； the amplitude and frequency of spontaneous discharge in the proximal group significantly decreased， as well as the variability of PWMT between the left and right hind paws， and the levels of SP， CGRP， and CD68 in the vastus medialis muscle， while the CD206 level increased significantly （P＜0.05 or P＜0.01 ）； there was complex discharges in the distal group， with significantly decreased level of CD68 in the vastus medialis muscle and increased level of CD206 （P＜0.01）. Compared to the proximal group， the level of IL-8 in the distal group was significantly higher （P＜0.05）. ConclusionsEA at proximal acupoints can significantly improve the pain threshold and local muscle tissue morpho-logy in rats， and its mechanism may be related to reducing the levels of pain-causing substances and related inflammatory factors and promoting the polarization of macrophages. The analgesic effect of EA at distal acupoints is not obvious， and the mechanism is still unclear.
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Objective:To observe any effect of dry needling of myofascial trigger points on substance P and synaptophysin expression in the spinal dorsal horn.Methods:Sixty-four Sprague-Dawley rats were randomly divided into a control group ( n=16) and a model group ( n=48). Myofascial trigger points were induced in the model group by a blunt strike and eccentric running. That group was then randomly divided into a no-treatment group ( n=15), a massage group ( n=16), and a dry needling group (16 rats). The rats in the two treatment groups received 4 weeks of dry needling or Chinese massage. Pressure pain thresholds were recorded before the experiment and after the 4 weeks. The content of substance P and synaptophysin in the spinal dorsal horn were measured using immunoblotting and immunohistochemistry. Results:After the treatment 14 rats (93%) in the model group had trigger points, significantly higher than the 8 rats (50%) in the massage group and the 7 rats (44%) in the dry needling group. After treatment, the average pressure pain thresholds of the no-treatment and massage groups was significantly lower than the control group′s average, while the difference between the dry needling group and the control group was not significant. The average pressure pain threshold had improved significantly in the no-treatment group, the massage group and the dry needling group, and the averages of the massage group and the dry needling group were significantly higher than that of the no-treatment group. The level of substance P was significantly higher in the no-treatment group than in the other three groups and the ratio of substance P to Glyceraldehyde 3-phosphate dehydrogenase (GAPDH)was significantly higher. The substance P: GAPDH ratio of the massage group was significantly higher than that of the control group.Conclusions:Dry needling and massage are effective in relieving myofascial pain, at least in rats. Both can reduce the content of substance P in the spinal dorsal horn.
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Background: Shoulder pain due to its high prevalence has great significance in its contribution to morbidity. It’s the third most common musculoskeletal problem.There are two types of trigger points found they are active and latent trigger points.Active trigger points are the one which when palpated causes spontaneous pain or referred pain and latent trigger points are the one which do not cause any pain except they are present either in form of taut band or nodules. MyofascialTrigger points (MTrPs) cause a local pain syndrome. The main cause of myofascial pain syndrome are trigger points. Purpose of the study: The purpose of the study was to determine the exact muscles that have the tendency for developing trigger points in acute shoulder pain pathologies and to see the trigger points developed are due to the shoulder pathology. Materials and Methods: A observational study was performed. Patients were selected by convenient sampling. 70 people participated within the age of 18-65, pain duration within 3 months, males and female included with no history of recent trauma, neurovascular injuries, degenerative pathology and shoulder dislocation. Patients were assessed for myofascial trigger points (MTrPs) on both affected and non-affected side. MTrPs were assessed on different muscles by manual palpation method. Results: The result shows that the muscle affected maximum is upper trapezius with 84.28% and pectoralis major with 71.42%. Also on the affected side, upper trapezius with 37.14% and pectoralis major and subscapularis with 20.00%. Conclusion: This study showed the prevalence of trigger points in acute shoulder pain pathologies is66.59% . Each patient of any acute pathology had the presence of more than 3 trigger points in the affected side proving trigger points to be of significant importance and it is due to underlying shoulder pathology.
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Background: Myofascial pain syndrome is a common multifactorial condition that presents with key manifestations and comorbid with many systemic diseases and regional pain syndromes. Objective:This study aims to concisely review clinical, diagnostic and integrative therapeutic aspects of myofascial pain syndrome. Methods:E-searches (2000-2019) using keywords and Boolean operators were made and using exclusion and inclusion criteria, 50 full articles that focused on myofascial pain syndrome were retained for this review. Results: Myofascial pain syndrome is a multidimensional musculoskeletal disorder with ill-understood etiopathogenesis and pathophysiology and characterized by tender taut muscle with myofascial trigger points, muscle twitch response, specific pattern of referred pain and autonomic symptoms. A variety of pharmacological and nonpharmacological therapies with variable efficacy are used in myofascial pain syndrome, the latter modalities such as education, stretching and exercises, moist hot and cold packs, dry needling and myofascial massage or myofascial trigger point massage are used as first line options. Conclusion:Myofascial pain syndrome and trigger points initiated by repeated strains and injuries co-occur with diverse physical diseases and regional pain syndromes, which need comprehensive diagnostic evaluation using multiple methods. Several interventions are used in patients with myofascial pain syndrome who effectively respond to myofascial massage. This study calls for exploring etiopathogenesis and basic pathophysiological mechanisms underlying myofascial pain syndrome in future.
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Objective: To explore the clinical effect of ultrasound-guided dry needling of myofascial trigger points in treatment of plantar fasciitis. Methods: Totally 48 patients with plantar fasciitis were randomly divided into 2 groups. Patients in the simple treatment group (n=24) received sole non-weight-bearing plantar fascia stretching training, and the ones in the combined treatment group (n=24) received ultrasound-guided dry needling for myofascial trigger points combined with stretching training. The numeric pain-rating scale (NPRS) of the first move, American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS), physical component summary (PCS) and mental component summary (MCS) of 36-item short-form health survey were evaluated before (T0) as well as 1 month (T1) and 3 months (T2) after treatment respectively. Results: The overall differences of NPRS, AOFAS, PCS and MCS were significant before and after treatment in both two groups (all P0.05). Conclusion: Ultrasound-guided dry needling for myofascial trigger points combined with stretching training and sole non-weight-bearing plantar fascia stretching training are both effective for treatment of plantar fasciitis, while the former is better for relieving pain and improving ankle function.
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OBJECTIVE: To observe the impact of acupuncture on myofascial trigger points(MTrPs),low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint on perinatal period separation of symphysis pubis.METHODS: Totally 100 cases of perinatal separation of pubic symphysis in Huai'an Women and Children Health Hospital from January 2013 to July 2016 were selected.They were randomly divided into comprehensive treatment group,electrical stimulation group,manipulative reduction group,pelvic belt group and control group,20 cases in each group.The comprehensive treatment group was given acupuncture on myofascial trigger points,low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint,the other three treatment groups were treated with their respective monotherapy,and the control group only received the brake observation.The NRS pain score and clinical efficacy were compared among the groups.RESULTS: Six days after treatment,18 cases,7 cases,4 cases,0 case and 0 case were cured in the five groups,respectively.Six weeks after treatment,20 cases,13 cases,11 cases,4 cases and 0 case were cured in the five groups,respectively.Six months after treatment,20 cases,18 cases,15 cases,13 cases and 9 cases were cured in the five groups,respectively.The treatment effect of the comprehensive group was the best,followed by the electric stimulation group,and then manipulation reduction group.CONCLUSION: acupuncture on myofascial trigger points and electrical stimulation combined with manipulative stretch reduction can not only quickly relieve the pain of patients in a short time,but also quickly make the pubic symphysis form return to normal.It has a high treatment efficiency and is less painful.So it has a high clinical value.
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Objective To assess the effectiveness of Kinesio taping on intensity of pain from myofascial pain syndrome(MPS)or myofascial trigger points(MTrPs). Methods The randomized controlled trials(RCTs)about the Kinesio taping for pain from MPS or MTrPs were retrieved from PubMed,EBSCO,Science Direct,Web of Science,Physiotherapy Evidence Database,Cochrane Library un-til October,2017.The assessment tools of the bias of risk and Revman 5.3 of the Cochrane Collaboration were used for the methodological quality assessment and meta-analysis,respectively.The heterogeneity and the poten-tial publication bias were analyzed with Stata 12.0. Results Twelve RCTs were included,involving 584 patients.Kinesio taping group was superior to the control group in relieving pain both after intervention (MD=-1.14, 95% CI-1.88 to-0.40, P=0.002) and in follow-up (MD=-0.69,95%CI-1.16 to-0.22,P=0.004).The time of intervention and follow-up were the main causes to heterogeneity in follow-up. Conclusion Kinesio taping is effective on pain of MPS or MTrPs.The longer the intervention and follow-up,the better the effect.
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Objective To observe the clinical efficacy of triple needling at myofascial trigger points plus warm needling in treating periarthritis of shoulder. Method Eighty patients with periarthritis of shoulder were randomized into a treatment group of 44 cases and a control group of 40 cases. The treatment group was intervened by triple needling at myofascial trigger points plus warm needling, while the control group was by warm needling alone. The two groups were treated once a day, 10 times as a treatment course. The Pain Rating Index (PRI), Visual Analogue Scale (VAS), Present Pain Intensity (PPI), and motion of shoulder joint were observed before the treatment and after 2 treatment courses, and the clinical efficacies were compared between the two groups.Result In the treatment group, the PRI, VAS, and PPI scores respectively after 1 and 2 treatment courses were significantly different from those before the treatment (P<0.05,P<0.01). In the control group, the scores after 2 treatment courses were significantly different from those before the treatment (P<0.05). After 2 treatment courses, the scores in the treatment group were significantly different from those in the control group (P<0.01). In both groups, the motions of shoulder joint respectively after 1 and 2 treatment courses were significantly changed compared with those before the treatment (P<0.01). The motions of shoulder joint in the treatment group were significantly different from those in the control group respectively after 1 and 2 treatment courses (P<0.05,P<0.01). The recovery plus markedly-effective rate and total effective rate were respectively 70.5% and 95.5% in the treatment group, versus 52.5% and 90.0% in the control group, and the between-group differences were statistically significant (P<0.01,P<0.05).Conclusion Triple needling at myofascial trigger points plus warm needling is an effective approach in treating periarthritis of shoulder.
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Objective To study the effects of acupuncture at myofascial trigger points on spastic foot drop and inversion after stroke. Methods From May, 2014 to May, 2016, 50 stroke patients were randomly divided into control group (n=25) and observation group (n=25). Both groups accepted routine rehabilitation, while the observation group accepted acupuncture at myofascial trigger points per day in addi-tion. They were assessed with Visual Analogue Scale (VAS) of pain, modified Ashworth Scale (MAS), range of motion (ROM) of ankle, sim-plified Fugl-Meyer Assessment (FMA) for lower limbs and maximum walking speed (MWS) in ten metres before and six weeks after treat-ment. Results The scores of VAS, MAS, and FMA, the ROM of ankle, and MWS improved after treatment (t>6.845, P5.586, P<0.001). Conclusion Acupuncture at myofascial trigger points can release spasm to reduce foot drop and inversion in patients with stroke.
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This article demonstrated the myofascial trigger points theory and the application of related techniques in the clinical prac-tice of sports rehabilitation, such as the treatment of athletes injury pain, rehabilitation of movement function limitation, elimination of sports fatigue and so on. The clinical treatments based on the myofascial trigger points theory are simple, effective, noninvasive, and with short recovery time and low recurrence rate. It provides scientific theoretical and practical foundation for the prevention, diagnosis, treat-ment and rehabilitation for sport injury.
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Myofascial pain syndrome (MPS) is one of the common musculoskeletal conditions of the shoulder which may develop sensory-motor and autonomic dysfunctions at the various level of the neuromuscular system. The pain and dysfunction caused by MPS were primarily treated with physical therapy and pharmacological agents in order to achieve painfree movements. However, in recent years intramuscular electrical stimulation (IMES) with conventional electrode placement was used by researchers to maximise therapeutic values. But, in this study an inverse electrode placement was used to deliver electrical impulses intramuscularly to achieve neuro-modulation at the various level of the nervous system. Nine patients with MPS were treated with intramuscular electrode stimulation using inversely placed electrodes for a period of three weeks. All nine subjects recovered from their shoulder pain and disability within the few weeks of intervention. So, this inverse electrode placement may be more appropriate for chronic pain management.
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Humanos , Dor Crônica , Estimulação Elétrica , Eletrodos , Síndromes da Dor Miofascial , Sistema Nervoso , Dor de Ombro , OmbroRESUMO
A 42 years old female presented with the complaints of pain and stiffness of right elbow with limited elbow extension, since 8 months, due to fracture of head of the radius. She was receiving conventional physical therapy treatment for pain relief and functional improvement since eight months. The limitation in Elbow extension caused difficulty in carrying household works. Later the patient was treated with dry needling to myofascial trigger points in brachioradiallis, common flexor, and extensor muscles of elbow and upper trapezius of shoulder, dry needling for tendons were added for further muscle relaxation. The interventions were carried out for three sessions, alternatively for one week. Pain (VAS score from 8/10 to 1/10), elbow extension range of motion (from 120º -35º to 120º-05º) and the patient’s upper limb functions (Qu ick DASH score from 63.36 to 13.63) were improved after one week of intervention. This case report results suggest that overall neuro-musculoskeletal function was improved due to dry needle induced myofascial trigger points deactivation and further muscle relaxation caused by tendon needling. This case report may helpful in formulating further treatment tool for better and faster recovery from pain and joint dysfunction in post immobilization pain and stiffness of elbow and other joints.
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El dolor miofascial es una patología muscular regional no inflamatoria que en el territorio craneocervical se encuentra clasificada dentro de los Trastornos Temporomandibulares. Afecta al 95% de las personas con trastornos de dolor crónico y es un hallazgo común en pacientes en tratamiento en centros de dolor. Se revisaron 121 fichas de pacientes atendidos en el policlínico de Trastornos Temporomandibulares y Dolor Orofacial de la Universidad de La Frontera, Temuco-Chile, identificando la prevalencia de dolor miofascial y su asociación con la edad y sexo de los pacientes. El 80,99% de los pacientes presentó dolor miofascial, el músculo masetero fue el más afectado, seguido por los músculos temporal y trapecio superior, siendo frecuente la afectación bilateral y simultánea de diferentes músculos. La presencia de dolor miofascial no se asocia a la edad de los pacientes pero si al sexo de estos, donde las mujeres presentan más frecuentemente esta patología. Es importante realizar un correcto diagnóstico de dolor miofascial en pacientes que acuden por dolor en este territorio y más aún es trascendental tomar conciencia de su elevada prevalencia.
Myofascial pain is a noninflammatory regional muscle pathology, in craniocervical territory it is classified as temporomandibular disorder. Myofascial pain affects 95% of people with chronic pain disorders and is a common finding in pain centers. One hundred twenty-one charts of patients seen at the clinic of Temporomandibular Disorders and Orofacial Pain at the Universidad de La Frontera Temuco-Chile, were reviewed, identifying the prevalence of myofascial pain and its association with age and sex of the patients. In 80.99% of patients myofascial pain was present, the masseter muscle was the most affected, followed by the temporal and upper trapezius muscles, with frequent bilateral and simultaneous involvement of different muscles. The presence of myofascial pain is not associated with patient age but it is associated with the sex of these, where women have this condition more often. It is important to make a correct diagnosis of myofascial pain in patients presenting with pain in this area and it is even more crucial to be aware of its high prevalence.