Treatment of myofascial trigger-points with ultrasound combined with massage and exercise – a randomised controlled trial

Abstract

The effect of treatment with ultrasound, massage and exercises on myofascial trigger-points (MTrP) in the neck and shoulder was assessed in a randomised controlled trial. The outcome measures were pain at rest and on daily function (Visual Analogue Scale, VAS), analgesic usage, global preference and index of MTrP. Long-term effect for treatment and control groups was assessed after 6 months using a questionnaire. The patients were randomised to three groups. The first group was treated with ultrasound, massage and exercise (A), the second group with sham-ultrasound, massage and exercise (B), while the third group was a control group (C). The duration of the study was 6 weeks. Treatment was given twice a week from the second to the fifth week. The number and index of MTrPs were recorded at each treatment session in groups A and B but only at entry as well as end of study in group C. VAS and analgesic usage was recorded in all three groups throughout the study period. Six months after the last treatment session a questionnaire was send to the patients. A total of 67 patients were included. Nine patients dropped-out during the study, which left 58 patients that could be included in the final analysis. Twenty patients were randomised to group A, 18 to group B and 18 to group C. A significant reduction in index were found between treatment groups (A and B) and control group (C), but no difference between group A and B. VAS scores, analgesic usage or global preference showed no difference between group A, B or C. The patients in the group C were offered treatment (ultrasound, massage, exercise) after the 6 weeks treatment period. At the questionnaire after 6 month 44 (87%) of the 52 patients from all three groups who had treatment responded. Sixty-four percent answered that they had had good or some effects, 68 percent were still doing the exercise programme and 17 percent had received other forms of therapy after they had completed the study. No difference between groups given ultrasound or sham ultrasound were found. It is concluded that US give no pain reduction, but apparently massage and exercise reduces the number and intensity of MTrP. The impact of this reduction on neck and shoulder pain is weak.

Comparison of the Effectiveness of Transcutaneous Electrical Nerve Stimulation and Interferential Therapy on the Upper Trapezius in Myofascial Pain Syndrome

“…Participants were asked to attend the clinic two times per week resulting in a total of eight treatment sessions. 9 A protocol and a study operation manual were developed and a pre-study was conducted to verify whether the measurement procedures and delivery of interventions were feasible. This pre-study involved 15 patients with myofascial pain syndrome with at least one upper trapezius MTrP and they were not included in the main trial.…”

“…7,8 Exercises are used to reduce muscle tightness and fear of movement, thereby enhancing confidence in independent movements. 9,7,10,11 These include stretching, strengthening and exercises to improve scapular stability and active range of motion (AROM). 7,12 Exercises to improve AROM are believed to restore normal length and flexibility of muscles.…”

Effects of Strain Counter-Strain and Stretching Techniques in Active Myofascial Pain Syndrome

“…The STR group had 3 subjects with MTrP in the left and 7 subjects with MTrP in the right upper trapezius muscles, while the other group had 5 subjects with MTrP in the left and 5 subjects with MTrP in the right upper trapezius muscles. All subjects were selected according to the following criteria: a) complaints of constant pain or altered sensation in the expected distribution of the referred pain zone of the upper trapezius muscle 1,22) ; b) presence of a palpable taut band in the muscle identified by comparison with the other side and of at least one point exquisite spot tenderness at along its length 1,13,22) ; c) and presenting some degrees of restriction of neck movement or regular stretching pattern 15,16) . The subjects were excluded from the study if they had any of the following criteria: a) signs of nerve root irritation 12) ; b) a history of systemic disease or injury in the upper quarter musculoskeletal system which may cause instability or limitation of the movement 15) .…”

“…The subjects were excluded from the study if they had any of the following criteria: a) signs of nerve root irritation 12) ; b) a history of systemic disease or injury in the upper quarter musculoskeletal system which may cause instability or limitation of the movement 15) . c) or any other physical therapy treatments or medication that might have affected the symptoms during the last 48 hours before participation 13) .…”

“…The results are still controversial. Some studies have reported significant improvement through use of STR in combination with other modalities as a part of MTrP treatment [12][13][14][15][16] . The combination treatment has been proved to be effective in treating MTrP rather than STR alone 14,16) .…”