Is Exercise Rehabilitation an Effective Adjuvant to Clinical Treatment for Myofascial Trigger Points? A Systematic Review and Meta-Analysis

Abstract

Purpose To systematically evaluate the effect of exercise rehabilitation as an adjuvant to clinical treatment for myofascial trigger points (MTrPs). Patients and Methods ESBCO, PubMed, Science Direct, Web of Science, China Knowledge Network (CNKI), and Wanfang databases were comprehensively searched from database inception date through July 2022. Randomized controlled trials comparing MTrPs treatments that included exercise rehabilitation with a single clinical treatment. Two researchers independently screened articles using inclusion/exclusion criteria, scored methodologic quality, and extracted data including patient demographics, interventions, and outcomes. Results We included 14 RCTs (N = 734). Results showed short-term (mean difference [MD], −2.25; 95% confidence interval [CI], −4.08 to −0.41; Z = 2.40; P = 0.02) and long-term (MD = −0.47; 95% CI: −0.80 to −0.17; Z = 3.05; P = 0.02) adjuvant exercise rehabilitation treatments were superior in reducing musculoskeletal pain intensity to single clinical treatment in controls, but long-term versus short-term effectiveness was not significantly different. The exercise rehabilitation group more effectively increased the range of motion (ROM) (standardized mean difference [SMD], 1.04; 95% CI: 0.32 to 1.77; Z = 2.84; P = 0.005) and decreased dysfunction (SMD = −0.93; 95% CI: −1.82 to −0.05; Z = 2.06; P = 0.04) than controls; no significant difference was observed in the pressure pain threshold (PPT) between two groups. Conclusion Exercise rehabilitation as an adjuvant to clinical treatment for MTrPs was moderately effective in relieving pain intensity, increasing ROM, and improving dysfunction versus single clinical intervention. These findings must be validated by larger, higher-quality studies.

Extracorporeal ShockWave Treatment vs. mesotherapy in the treatment of myofascial syndromes: a clinical trial

“…Our results showed that focal ESWT and mesotherapy are two valuable therapeutic proposals in the management of patients with myofascial pain syndrome. In fact, the treatment of myofascial syndrome is multimodal; we make use of pharmacological therapy (anti- inflammatories, muscle relaxants, local anesthetics, antidepressants and weak opioids), ( 14 , 15 ) often in association with rehabilitative treatment with active and constant exercise, stretching exercises and postural rehabilitation ( 16 ).…”

“…The treatment of myofascial syndrome is varied and heterogeneous; pharmacological therapy with muscle relaxants, antidepressants, weak opioids, local anesthetics, and anti-inflammatories taken orally or topically (in the form of a patch or by mesotherapy) is often used for the management of algic symptoms and painful “PTs” ( 14 , 15 ). Rehabilitative treatment with active and constant exercise is an effective strategy in the treatment of myofascial pain: it improves joint ROM, mood, and pain threshold, promoting a better quality of life for patients; one of the prescribed exercises is stretching, which stretches myofascial compartments containing PTs and prevents their further occurrence; postural rehabilitation is another rehabilitation option ( 16 ). Patients also often undergo massage therapy and manual therapy sessions.…”