Treating Myofascial Trigger Points (MTrPs)
Treating Myofascial Trigger Points
Myofascial trigger points (MTrP) are a common source of musculoskeletal pain affecting a variety of ages and occupations. Travell and Simons defined a MTrP as “a hyperirritable spot in skeletal muscle associated with a hypersensitive palpable nodule in a taut band.” The etiology of MTrPs has been correlated with circumstances that include genetics, aging, performing a strenuous activity within a sedentary lifestyle, cumulative microtrauma, and abnormal posture.
Shah et al (2005) identified a histochemical milieu of eight substances in greater concentration in MTrPs than in normal, painfree muscle. These included proton [H+] concentrations, calcitonin gene-related peptide, interleukin-1B, substance P, bradykinin, tumor necrosis factor-α, serotonin, and norepinephrine. Tabatabaiee et al (2019) suggested three hypotheses for the pathogenesis of MTrPs:
The presence of a MTrP has been associated with muscle pain, weakness, and dysfunction. There are a variety of interventions purported to relieve or diminish the symptoms associated with MTrPs. These include topical agents, taping, manual therapies, and modalities. Studies using topical agents are as follows:
There is an assortment of medical/athletic tapes available. Kinesio Tex tape has been used in a few studies for the treatment of MTrPs. One study (Youngsook, 2014) found taping the SCM muscle reduced pain and VAS score with an increase in pain pressure threshold (PPT) and ROM. Two studies (Gulick et al, 2013; Ozturk et al, 2016) used the “star” inhibitory pattern on MTrP. Both reported improvement in VAS, PPT, and manual muscle testing but only one was statistically significant.
Manual compression (MC) has been studied by a large number of researchers using PPT as the outcome measure. Although some studies applied the compression via the clinician’s hand, others used devices such as the Backnobber II. The common theme of these studies was an application of pressure at a level of 7/10 on the VAS scale for 30 to 90 seconds. These parameters resulted in significant improvements in PPT and VAS. To date, the author is only aware of one study using a foam roller on MTrPs (Wilke, Vogt, & Banzer, 2018). There results were consistent with that of manual compression, i.e. static compression for 90-seconds at a 6-7/10 VAS score was better than dynamic compression for 90-seconds at five strokes/minute over the muscle at a 6-7/10 VAS score.
Instrument-assisted soft tissue techniques (IASTT) have also been performed on MTrPs. Treatment was rendered twice per week for three weeks and there was a significant improvement in PPT (Gulick, 2014). Overall, a systemic review by Guzman-Pavon et al (2022) examined a variety of manual interventions across 15,158 studies and concluded manual therapy is an effective therapeutic strategy for MTrPs.
Modalities such as ultrasound and electrical stimulation have also been studied to manage MTrP. Summarizing these studies with a wide range of parameters, the key influence appears to be the impact of the thermal effects of the ultrasound:
Several studies have also used electrical stimulation (ES) to treat MTrPs. Again, the parameters are highly variable.
There have also been two studies using iontophoresis (Kaya et al, 2009; Taha at al, 2021). Kaya et al (2009) used a direct current with/without lidocaine on MTrPs. Ten sessions over a four-weeks using a 30mA-min dosage found improvement in both groups for ROM, PPT, and VAS but none were statistically significant. Whereas, Taha at al (2021) delivered magnesium sulfate via iontophoresis at a 75 mA-min dosage (eight sessions). PPT, Neck Disability Index, ROM, and VAS all improved significantly. The researchers believed magnesium sulfate successfully addressed the energy crisis of the MTrP.
Vibration is a new area being explored for the management of MTrP. My colleagues and I are currently conducting a study using VibraCool. This device utilizes a 200 Hz frequency to impact the Pacinian Corpuscles. We hope to share these results with you very soon.
For more information of MTrP, the following is an evidence-based manuscript published in Physical Medicine & Rehabilitation Research: https://www.oatext.com/Evidence-based-interventions-for-myofascial-trigger-points.php
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