Comparison of High Power Pain Threshold Ultrasound and Ischemic Compression Techniques for the Treatment of Latent Myofascial Trigger Points: A Randomized Controlled Study

Abstract

Objective Myofascial trigger points (MTrPs) have been defined as discrete and hyperirritable areas located within a taut band of skeletal muscle or fascia, which when compressed produce pain, tenderness, dysfunction and autonomic phenomena. The treatment techniques aimed to return the fiber groups to their optimum length and end plates to their optimum function. Ischemic Compression (IC) and of High Power Pain Threshold Ultrasound (HPPT-US) are among the treatment techniques used for MTrPs. The aim of the current study is to compare the efficacy of IC and HTTP-US which was applied in different ways on MTrPs treatment.

Patients and Methods This is a randomized prospective study conducted with 153 participants have at least three latent trigger points. Participants received HPPT-US technique in which the intensity is kept constant at the pain level, HPPT-US technique in which the intensity is kept constant at half the pain level or IC. Outcome measures were the Visual Analog Scale, Beck Depression Inventory, Neck Pain and Disability Scale, number of deactivated MTrPs and Pain Pressure Threshold (PPT).

Results Pain, psychological status and disability improved in each group; there was no significant difference between the groups (p>0.05). PPT increased in each group; a significant difference was found between the groups (p<0.05). IC was slightly more effective than HPPT-US.

Conclusion Our results have shown that HPPT-US which was applied in different ways and IC were effective therapies for latent trigger points.

Zusammenfassung

Hintergrund Myofasziale Triggerpunkte (MTrPs) wurden als diskrete und hyperreizbare Bereiche innerhalb eines Spannbandes von Skelettmuskeln oder Faszien bezeichnet, die, wenn sie zusammengedrückt werden, Schmerzen, Druckschmerz, Funktionsstörungen und autonome Phänomene verursachen. Die Behandlungstechniken haben zum Ziel, die Fasergruppen auf ihre optimum Länge und die Endplatten auf ihre optimum Funktion zurückzuführen. Ischämische Kompression (IC) und Hochleistungs-Schmerzschwellen-Ultraschall (HPPT-US) gehören zu den Behandlungstechniken, die bei MTrPs eingesetzt werden. Ziel der vorliegenden Studie ist der Vergleich der Wirksamkeit von IC und HPPT-US, die auf unterschiedliche Weise bei der Behandlung von MTrPs angewendet wurden.

Methode Es handelt sich um eine randomisierte prospektive Studie mit 153 Teilnehmern mit mindestens drei latenten Triggerpunkten. Die Teilnehmer erhielten die HPPT-US-Technik, bei der die Intensität konstant auf dem Schmerzniveau gehalten wird, die HPPT-US-Technik, bei der die Intensität konstant auf der Hälfte des Schmerzniveaus gehalten wird, oder die IC. Die Zielparameter waren die Visuelle Analogskala, das Beck-Depressions-Inventar, die Nackenschmerz- und Behinderungsskala, die Anzahl der deaktivierten MTrPs und die Druckschmerzschwelle (PPT).

Ergebnisse Schmerzen, psychologischer Zustand und Behinderung verbesserten sich in jeder Gruppe; es zeigte sich kein statistisch signifikanter Unterschied zwischen den Gruppen (p<0.05). Die PPT erhöhte sich in jeder Gruppe; es zeigte sich ein statistisch signifikanter Unterschied zwischen den Gruppen (p<0.05). IC war etwas wirksamer als HPPT-US.

Diskussion Unsere Ergebnisse haben gezeigt, dass HPPT-US, das auf unterschiedliche Weise angewendet wurde, und IC wirksame Therapien für latente Triggerpunkte waren.

Key words

high power pain threshold ultrasound - ischemic compression - trigger points - pain - pain pressure threshold

Schlüsselwörter

HESU - Triggerpunkte - Schmerz - ischämische kompressionstherapie - Schmerzdruckschwelle

Publication History

Received: 15 December 2021

Accepted: 27 September 2022

Article published online:
14 November 2022

• References

• 1 Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002; 65: 653-660
• 2 Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin 2007; 25: 841-851 vii-iii DOI: 10.1016/j.anclin.2007.07.003.
• 3 Aguilera FJ, Martín DP, Masanet RA. et al. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther 2009; 32: 515-520 DOI: 10.1016/j.jmpt.2009.08.001.
• 4 Fernández-de-las-Peñas C, Alonso-Blanco C, Fernández-Carnero J. et al. The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: a pilot study. Journal of Bodywork and Movement therapies 2006; 10: 3-9
• 5 Vernon H, Schneider M. Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther 2009; 32: 14-24 DOI: 10.1016/j.jmpt.2008.06.012.
• 6 Simons DG, Travell JG, Simons LS. Myofascial Pain and Dysfunction: The Trigger Point Manual. 1999
• 7 Unalan H, Majlesi J, Aydin FY. et al. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Arch Phys Med Rehabil 2011; 92: 657-662 DOI: 10.1016/j.apmr.2010.11.030.
• 8 Kim Y, Kim J, Kwak K. et al. A preliminary study on the effect of high-power pain threshold ultrasound to desensitize latent trigger points: A double-blinded randomized study. Journal of Musculoskeletal Pain 2014; 22: 7
• 9 Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep 2011; 15: 386-392 DOI: 10.1007/s11916-011-0210-6.
• 10 Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16: 87-101 DOI: 10.1016/0304-3959(83)90088-x.
• 11 Hisli N. Beck depresyon envanterinin universite ogrencileri icin gecerliligi, guvenilirligi. (A reliability and validity study of Beck Depression Inventory in a university student sample). J Psychol 1989; 7: 3-13
• 12 Beck AT, Ward CH, Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571 DOI: 10.1001/archpsyc.1961.01710120031004.
• 13 Wheeler AH, Goolkasian P, Baird AC. et al. Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity. Spine (Phila Pa 1976) 1999; 24: 1290-1294 DOI: 10.1097/00007632-199907010-00004.
• 14 Bicer A, Yazici A, Camdeviren H. et al. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. Disability and rehabilitation 2004; 26: 959-962
• 15 Lew PC, Lewis J, Story I. Inter-therapist reliability in locating latent myofascial trigger points using palpation. Man Ther 1997; 2: 87-90 DOI: 10.1054/math.1997.0289.
• 16 Hou CR, Tsai LC, Cheng KF. et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002; 83: 1406-1414 DOI: 10.1053/apmr.2002.34834.
• 17 Vanderweeën L, Oostendorp RA, Vaes P. et al. Pressure algometry in manual therapy. Man Ther 1996; 1: 258-265 DOI: 10.1054/math.1996.0276.
• 18 Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep 2013; 17: 353 DOI: 10.1007/s11916-013-0353-8.
• 19 da Silva AC, De Noronha M, Liberatori-Junior RM. et al. The Effectiveness of Ischemic Compression Technique on Pain and Function in Individuals With Shoulder Pain: A Systematic Review. J Manipulative Physiol Ther 2020; 43: 234-246 DOI: 10.1016/j.jmpt.2019.10.013.
• 20 Hodgson L, Fryer G. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. International Journal of Osteopathic Medicine 2006; 9
• 21 Bahadir C, Majlesi J, Unalan H. The Effect of High-Power Pain Threshold Ultrasound Therapy on the Electrical Activity of Trigger Points and Local Twitch Response on Electromyography: A Preliminary Study. Journal of Musculoskeletal Pain 2009; 17: 162-172 DOI: 10.1080/10582450902820572.
• 22 Hari Haran R, Singh AK. Effect of High Power Pain Threshold Static Ultrasound Combined with Transverse Friction Massage and Stretching on Upper Trapezius Myofascial Trigger Point. 2013
• 23 Koca I, Tutoglu A, Boyaci A. et al. A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome. Mod Rheumatol 2014; 24: 662-666 DOI: 10.3109/14397595.2013.860001.
• 24 Aridici R, Yetisgin A, Boyaci A. et al. Comparison of the Efficacy of Dry Needling and High-Power Pain Threshold Ultrasound Therapy with Clinical Status and Sonoelastography in Myofascial Pain Syndrome. Am J Phys Med Rehabil 2016; 95: e149-e158 DOI: 10.1097/phm.0000000000000600.
• 25 Fernández-de-Las-Peñas C, Alonso-Blanco C, Fernández-Carnero J. et al. The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: A pilot study. Journal of Bodywork and Movement Therapies 2006; 10: 3-9 DOI: 10.1016/j.jbmt.2005.05.003.
• 26 Menakam PT, Kalaichandran K. MOT Effect of Ischemic Compression Followed by Stretching on Myofascial Trigger Points. International Journal of Scientific and Research Publications 2015; 5(1): ISSN 2250–3153
• 27 Ravichandran P, Ponni H, Leo A. Effectiveness of Ischemic Compression on Trapezius Myofascial Trigger Points in Neck Pain. International Journal of Physiotherapy 2016; 3 DOI: 10.15621/ijphy/2016/v3i2/94883.