Advertisement

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

  • Chuen-Ru Hou
    Affiliations
    Institute of Biomedical Engineering (Hou, Tsai, Chung) and Department of Physical Medicine and Rehabilitation (Hong), National Cheng Kung University, Tainan; and Lin-Jin Shin Hospital, Kaohsiung (Cheng), Taiwan
    Search for articles by this author
  • Li-Chen Tsai
    Affiliations
    Institute of Biomedical Engineering (Hou, Tsai, Chung) and Department of Physical Medicine and Rehabilitation (Hong), National Cheng Kung University, Tainan; and Lin-Jin Shin Hospital, Kaohsiung (Cheng), Taiwan
    Search for articles by this author
  • Kuang-Feng Cheng
    Affiliations
    Institute of Biomedical Engineering (Hou, Tsai, Chung) and Department of Physical Medicine and Rehabilitation (Hong), National Cheng Kung University, Tainan; and Lin-Jin Shin Hospital, Kaohsiung (Cheng), Taiwan
    Search for articles by this author
  • Kao-Chi Chung
    Affiliations
    Institute of Biomedical Engineering (Hou, Tsai, Chung) and Department of Physical Medicine and Rehabilitation (Hong), National Cheng Kung University, Tainan; and Lin-Jin Shin Hospital, Kaohsiung (Cheng), Taiwan
    Search for articles by this author
  • Chang-Zern Hong
    Affiliations
    Institute of Biomedical Engineering (Hou, Tsai, Chung) and Department of Physical Medicine and Rehabilitation (Hong), National Cheng Kung University, Tainan; and Lin-Jin Shin Hospital, Kaohsiung (Cheng), Taiwan
    Search for articles by this author

      Abstract

      Hou C-R, Tsai L-C, Cheng K-F, Chung K-C, Hong C-Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002;83:1406-14. 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. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fishbain DA
        • Goldberg M
        • Meagher BR
        • Steele R
        • Rosomoff H.
        Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria.
        Pain. 1986; 26: 181-197
        • Fricton JR.
        Myofascial pain syndrome: characteristics and epidemiology.
        in: Myofascial pain and fibromyalgia: advances in pain research and therapy. Vol 17. Raven Pr, New York1990: 107-127
        • Skootsky SA
        • Jaeger B
        • Oye RK.
        Prevalence of myofascial pain in general internal medicine practice.
        West J Med. 1989; 151: 157-160
        • Simons DG
        • Travell JG
        • Simons LS.
        Travell & Simons' myofascial pain and dysfunction: the trigger point manual, volume 1. Upper half of body.
        Williams & Wilkins, Baltimore1983
        • Hong CZ
        • Simons DG.
        Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points.
        Arch Phys Med Rehabil. 1998; 79: 863-872
        • Simons DG.
        Myofascial pain syndrome due to trigger points.
        in: Rehabilitation medicine. Mosby, St Louis1988: 686-723
        • Simons DG.
        Referred phenomena of myofascial trigger points.
        in: Pain research and clinical management, new trends in referred pain and hyperalgesia. Elsevier, New York1993: 341-357
        • Gerwin RD.
        The management of myofascial pain syndrome.
        J Musculoskel Pain. 1993; 1: 83-94
        • Melzack R.
        The clinical assessment of myofascial pain syndrome.
        in: Handbook of pain assessment. Guilford Pr, New York1992: 61-70
        • Fricton JR.
        Myofascial pain syndrome.
        Neurol Clin North Am. 1989; 7: 413-427
        • James CP.
        Transcutaneous electrical nerve stimulation and myoneural injection therapy for management of chronic myofascial pain.
        Dent Clin North Am. 1987; 31: 703-723
        • Rachlin ES.
        Trigger point management.
        Mosby, St. Louis1994
        • Williams HL
        • Elkins EC.
        Myalgia of the head.
        Arch Phys Ther. 1942; 23: 14-22
        • Melzack R
        • Wall PD.
        Pain mechanism: new theory.
        Science. 1965; 150: 971-979
        • Hansson P
        • Ekblom A.
        Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain.
        Pain. 1983; 15: 157-165
        • Hay KM.
        Control of head pain in migraine using transcutaneous electrical nerve stimulation.
        Practitioner. 1982; 226: 771-775
        • Lapeer GL.
        High-intensity transcutaneous nerve stimulation at the Hoku acupuncture point for relief of muscular headache pain. Literature review and clinical trial.
        Cranio. 1986; 4: 165-171
        • Melzack R.
        Prolonged relief of pain by brief, intense transcutaneous somatic stimulation.
        Pain. 1975; 1: 357-373
        • Thorsteinsson G
        • Stonnington HH
        • Stillwell GK
        • Elvebeck LR.
        Transcutaneous electrical stimulation: a double blind trial of its efficacy for pain.
        Arch Phys Med Rehabil. 1977; 58: 8-13
        • Dixon HH
        • O'Hara M
        • Peterson RD.
        Fatigue contracture of skeletal muscle.
        Northwest Med. 1967; 66: 813-816
        • Dubner R.
        Neurophysiology of pain.
        Dent Clin North Am. 1978; 22: 11-30
        • Wall PD
        • Sweet WH.
        Temporary abolition of pain in man.
        Science. 1967; 155: 108-109
        • Pomeranz BH
        • Chiu D.
        Naloxone blockade of acupuncture analgesia: endorphin implicated.
        Life Sci. 1976; 19: 1757-1762
        • Abram SE
        • Asiddao CB
        • Reynolds AC.
        Increased skin temperature during TENS.
        Anesth Analg. 1980; 59: 22-25
        • Kaada B
        • Eilsen O.
        In search of mediators of skin vasodilatation induced by TENS: serotonin implicated.
        Gen Pharmacol. 1983; 14: 635-641
        • Owens S
        • Atkinson R
        • Lees DE.
        Thermographic evidence of reduced sympathetic tone with TENS.
        Anesthesiology. 1979; 50: 62-65
        • Nikolova L.
        Treatment with interference current.
        Churchill Livingstone, New York1987
        • Fisher AA.
        Documentation of myofascial trigger points.
        Arch Phys Med Rehabil. 1988; 69: 286-291
        • Delaney GA
        • McKee AC.
        Inter- and intra-rater reliability of the pressure threshold meter in measurement of myofascial trigger sensitivity.
        Am J Phys Med Rehabil. 1993; 72: 136-139
        • Bendtsen L
        • Jensen R
        • Jensen NK
        • Olesen J.
        Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues.
        Pain. 1994; 59: 235-239
        • Fischer AA.
        Pressure tolerance over muscle and bone in normal subjects.
        Arch Phys Med Rehabil. 1986; 67: 406-409
        • Fischer AA.
        Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold.
        Pain. 1987; 30: 115-126
        • Reeves JL
        • Jaeger B
        • Graff-Radford SB.
        Reliability of pressure algometer as a measure of myofascial trigger points sensitivity.
        Pain. 1986; 24: 313-321
        • Jaeger B
        • Reeves JL.
        Quantification of changes in myofascial trigger point sensitivity with pressure algometer following passive stretch.
        Pain. 1986; 27: 203-210
        • McGrath PF
        • Unruh AM.
        Measurement and assessment of paediatric pain.
        in: Textbook of pain. Churchill Livingstone, New York1994: 303-312
        • Graff-Radford SB
        • Reeves JL
        • Baker RL
        • Chiu D.
        Effects of transcutaneous electrical nerve stimulation on myofascial pain and trigger point sensitivity.
        Pain. 1989; 51: 1-5
        • Copper BC
        • Alleva M
        • Copper DL
        • Lucente FE.
        Prevalence of myofascial pain dysfunction: analysis of 476 patients.
        Laryngoscope. 1986; 96: 1099-1106
        • Fricton JR
        • Kroening R
        • Haley D
        • Siegert R.
        Myofascial pain syndrome of the head and neck: a review of the clinical characteristics of 164 patients.
        Oral Surg Oral Med Oral Pathol. 1985; 60: 615-623
        • Patrick DW
        • Melzack R.
        Textbook of pain.
        in: Churchill Livingstone, New York1984: 691
        • Mense S.
        Effects of temperature on the discharges of muscle spindles and tendon organ.
        Pflugers Arch. 1978; 374: 159-166
        • Bendtsen L
        • Jensen R
        • Olesen J.
        Qualitative altered nociception in chronic myofascial pain.
        Pain. 1996; 65: 259-264
        • Hong CZ.
        Persistence of local twitch response with loss of conduction to and from the spinal cord.
        Arch Phys Med Rehabil. 1994; 75: 12-16
        • Hong CZ
        • Torigoe Y.
        Electrophysiologic characteristics of localized twitch responses in responsive bands of rabbit skeletal muscle fibers.
        J Musculoskel Pain. 1994; 2: 17-43
        • Hong CZ
        • Torigoe Y
        • Yu J.
        The localized twitch responses in responsive bands of rabbit skeletal muscle fibers are related to the reflexes at spinal cord level.
        J Musculoskel Pain. 1995; 3: 15-33
        • Hoheisel U
        • Mense S
        • Simons DG
        • Yu X-M.
        Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain?.
        Neurosci Lett. 1993; 153: 9-12
        • Hong CZ
        • Simons DG.
        Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points.
        Arch Phys Med Rehabil. 1998; 79: 863-872
        • Han SC
        • Harrison P.
        Myofascial pain syndrome and trigger-point management.
        Reg Anesth. 1997; 22: 89-101
        • Hsueh TC
        • Cheng PT
        • Kuan TS
        • Hong CZ.
        The immediate effectiveness of electrical nerve stimulation on myofascial trigger points.
        Am J Phys Med Rehabil. 1997; 76: 471-476
        • Manheim CJ
        • Lavett DK.
        The myofascial release manual.
        Slack, Thorofare (NJ)1994