trigger points

Cervicogenic dizziness is non-specific sensation of disequilibrium in space. Abnormal proprioceptive input from cervical spine and neck muscles may induce Cervicogenic dizziness. Trigger point activation of suboccipital muscles may be related to Cervicogenic dizziness.

Present case report describe a 38-year-old patient was refereed to physiotherapy to restore motion of right shoulder after surgery of humerus fracture. Patient reported dizziness after shoulder surgery. Patient had no medical problems induced dizziness. Physical examination revealed trigger point activation of suboccipital muscles. Myofascial release and chin tuck exercise were done and patient reported improvement for dizziness. Trigger point activation of suboccipital muscles in this patient may be related to abnormal head posture during shoulder surgery and/or impaired scapulohumeral rhythm and overactivity of cervical muscles to participate in shoulder elevation.

It is suggested to consider possibility of existence of Cervicogenic dizziness in patients seeking physiotherapy after shoulder surgery.

The study was conducted to compare the immediate effect of high-power pain threshold ultrasound (HPPTUS) and deep transverse friction massage (DTFM) as a traditional technique on the treatment of upper trapezius active myofascial trigger points in male patients with mechanical neck pain.

In this parallel single-blind randomized clinical trial study, 60 men with mechanical neck pain (mean age: 30.57±6.19 years) who met the inclusion and exclusion criteria were randomly assigned to HPPTUS and DTFM as the control group. A visual analog scale (VAS), pain pressure threshold (PPT), and range of motion (ROM) of cervical lateral flexion (CLF) were assessed before and after treatment.

Analysis of pre- and post-treatment findings showed that the VAS (P<0.01), PPT (P<0.01), and ROM of CLF (P<0.01) improved significantly in both groups while ROM of CLF increased significantly more in the HPPTUS group. An indirect correlation was found between the pre-treatment ROM of CLF and ROM of CLF improvement in both groups. A significant indirect correlation was observed between pre-treatment VAS and ROM of CLF improvement in the HPPTUS group. In the DTFM group a significant indirect correlation was found between pre-treatment ROM of CLF and VAS improvement.

The results showed that HPPTUS can be used as an effective treatment for active trigger points (TP). It seems that this method is more effective than deep transverse friction massage.

We investigated the combined effect of Radial Shockwave Therapy (RSWT) and muscle energy technique (MET) on pain, range of motion (ROM), and neck function in people with active trigger points (ATrPs) of the upper trapezius muscle.

Fifty-four participants with ATrPs of the upper trapezius muscle were randomly divided into three groups. Group A (n=18) received only MET, group B (n=18) received only RSWT, and group C (n=18) received both RSWT and RSWT. Pain intensity using the Visual Analog Scale (VAS), pressure pain threshold (PPT), neck function using the Neck Disability Index (NDI) questionnaire, and lateral-flexion range of movement (LF ROM) were measured before and after the intervention. The participants were treated for three sessions in one week with at least two days of rest between sessions.

All three intervention groups showed pain reduction (p<0.001), an increase in PPT (p<0.001), counter-lateral flexion (CLF) (p<0.001), and also improvement in neck function (p<0.001). The combined group showed a more obvious improvement than the other two groups in PPT (p<0.001). There was no difference between the three groups in terms of VAS and NDI scores and CLF (p>0.05).

The results of this study showed that all three interventions used in the upper trapezius trigger points therapy were effective; however, the combined group showed a significant difference in PPT. Therefore, combined therapy is superior to MET and RSWT alone in improving pressure pain relief in individuals with upper trapezius trigger points.

Migraine patients often have painful trigger points, especially in the area of head and neck. Thus, we aimed to investigate the effect of myofascial release and stretching techniques in the management of migraine headache.

This was a randomized controlled trial study on 40 migraine patients. The subjects in the experimental group received three sessions with a duration of 20 min per session techniques. Databases were analyzed using 2 × 3 repeated‑measures analyses of variance (P < 0.05).

Experimental group showed a significant reduction in pain intensity (P < 0.001) and the neck disability index score (P < 0.001) and an increase in cervical range of motion (P < 0.001) in all time points after the intervention as compared with baseline and control group (P < 0.001).

Myofascial release and stretching techniques were effective in improving symptoms in patients with migraine headache.

The most critical clinical presentation in myofascial pain syndrome is trigger points. Trigger points are the main problem in 30% of the patients presenting to general internal medicine practice. One of the treatments used for trigger points is ultrasound therapy. The high-power pain threshold ultrasound (HPPTUS) technique is one of the therapeutic ultrasound modifications used to treat trigger points. The present randomized clinical trial aimed to investigate the immediate effect of high-power pain threshold ultrasound on treating active trigger points of the upper trapezius muscle in men with mechanical neck pain.

Fourteen men with mechanical neck pain (Mean±SD age: 34.50±5.24 years) who met the inclusion and exclusion criteria participated in this study. The visual analog scale (VAS), pressure pain threshold (PPT), and range of motion of cervical lateral flexion (CLF) were assessed before and after the treatment. The ultrasound probe was placed on the trigger point. The frequency was set to 1 MHz, and the intensity increased from 0.5 to 2 until the patient reported an unpleasant sensation. The probe was held there for 4 seconds. Then, the intensity was reduced by 50%, and the probe was moved over and around the trigger point. This process was done several times for three minutes.

Analysis of pre-treatment and post-treatment findings showed that the VAS (P<0.001), PPT (P=0.001), and CLF (P<0.001) improved significantly after applying the HPPTUS to trigger points.

Ultrasound significantly improved the muscular symptoms of the trigger points.

 Tension type headache is the most common type of headache that is associated with myofascial pain syndrome and trigger points. The aim of this study was to evaluate the efficacy of deep dry needling into trigger points of temporalis, sternocleidomastoid and upper trapezius muscles of females with episodic tension type headache.

 The study was a clinical randomized, single-blind, parallel-group trial in which 24 participants were allocated into two groups. The first group received dry needling with passive stretching treatment and the second group (control group) received only passive stretching. Subjects were asked to record headache indices (headache intensity and frequency) for 4 weeks before treatment. Headache intensity and frequency and quality of life (SF-36) were measured at baseline and 4 weeks after the intervention.

 In the dry needling group, the intensity and frequency of headache and physical functioning scores of quality of life questionnaire were significantly improved after treatment (p <0.05).

 Due to the positive effects of deep dry needling and passive stretching in females with episodic tension type headache, the use of deep dry needling into trigger points of head and neck musculature is recommended in the presence of episodic tension type headache.

The purpose of this article is to provide a brief overview on trigger points and tender points and to briefly describe their similarities, differences and treatments.

This study aimed to compare the effects of Low-Level Laser Therapy (LLLT) combined with Dry Needling (DN) with DN alone on pain and neck disability index following myofascial pain syndrome.

Sixteen women with active Trigger Points (TrPs) in their upper trapezius muscles participated in this study. They were divided into two groups: Experimental and control. The experimental group received one session of the DN plus the LLLT with 6 j/cm2 energy at their TrPs. The patients in the control group were under a similar procedure, but they did not receive any energy by the LLLT (placebo). The pain score was assessed before, immediately, and 48 hours after the treatment. Neck Disability Index (NDI) was assessed before and 48 hours after the treatment.

There was a significant improvement in pain intensity and NDI scores 48 hours after the treatment in both groups compared with the baseline scores (P<0.05). The pain was also significantly reduced at the patients following laser therapy immediately after the treatment (P=0.01).

A combination of the LLLT and DN might be more effective compared with using DN alone, and reduce immediate pain at the patients with the active TrPs. There was no difference between the groups 48 hours after the treatment. It seems that LLLT has no considerable effect on NDI and pain intensity 48 hours after the treatment.

Musculoskeletal disorders are among the main causes of disability in modern life. Myofascial trigger points are very common among musculoskeletal disorders and may occur through ordinary common activities. This study aimed to determine the combined effects of laser therapy and Ischemic Compression (IC) on the treatment of Myofascial Trigger Points (MTrPs) at the upper trapezius muscle.

Twenty men with at least one active trigger point at their upper trapezius muscle voluntarily participated in this study. Trigger points were under treatment of laser irradiation (6 Joules per point) and also ischemic compression. Treatment approaches were applied over the pain point every other day for 5 sessions in 10 days. Neck disability index, pain intensity by visual analog scale, pressure pain threshold by algometry, and cervical lateral flexion by goniometer were assessed and recorded before the intervention, and immediately after the last session.

At the end of treatment, statistically significant improvements were seen in the neck disability index, VAS value, pressure pain threshold, and cervical lateral flexion. VAS values of the treatment and control groups were compared with the baseline (P<0.001).

Application of combined laser and compression therapy was effective on the pain and level of disability of patients with trigger points in the upper trapezius muscle.

Myofascial Pain Syndrome (MPS) is a common muscular disorder characterized by a referral pain to a particular area after irritating the myofascial trigger point. This study aimed to determine the combined treatment effect of laser therapy and ischemic compression of an active myofascial trigger point in the upper trapezius muscle.

This is a clinical trial study conducted on 15 subjects with Active Trigger Points (ATPs). In one session, 15 subjects received laser therapy and ischemic compression. The assessment was done immediately after the treatment. We used the visual analog scale for the measurement of pain intensity, algometry (FG-5020, Taiwan made) for pressure pain threshold, and goniometer for cervical lateral flexion.

The cervical lateral flexion after the intervention was significantly higher than that before the intervention (P<0.001). Also, the post-operative pressure pain threshold was significantly higher than that before the intervention (P<0.001). The level of pain decreased after the intervention, but this difference was not statistically significant (P=0.90).

according to this study, the laser therapy combined with ischemic compression can significantly change the pressure pain threshold and cervical lateral flexion in patients with active trigger points in their upper trapezius muscles.

Myofascial trigger points are known as the main reasons for the neck pain. Myofascial trigger points may change the coordination of cervical muscles and cause impaired proprioception.

The aim of this study was to investigate the onset of shoulder and cervical muscles activity and muscles recruitment pattern in patients with an active myofascial trigger point in the upper trapezius.

15 patient subjects (aged 26.80 ± 2.67 years) with one active myofascial trigger point in the upper trapezius and 15 control subjects (aged 27.73 ± 3.43 years) participated in this study. The subjects flexed their arms in response to a sound stimulus. The onset time of anterior deltoid was chosen as the initial point in showing the onset time of cervical paraspinal, lumbar paraspinal, upper trapezius, sternocleidomastoid, and medial head of gastrocnemius muscles.

The patient group represented a delay in the onset of muscles activity and altered muscle recruitment pattern compared to the control subjects (P < 0.001). However, the sternocleidomastoid muscle showed no delay in this group (P = 0.67).

These results showed latency in the onset of muscles activity and altered muscles recruitment patterns. The altered muscles recruitment pattern may lead to changes in motor control strategies and poor control of movement. Finally, these changes can cause a poor control of movement and increase the possibility of damage to the shoulder and cervical muscles in patients with an active myofascial trigger point in the upper trapezius.