Triggerpunkte – Diagnose und Behandlungskonzepte unter besonderer Berücksichtigung extrakorporaler Stoßwellen

Abstract

The 70-year-old trigger point theory has experienced a growing scientific confirmation and clinical significance as a consequence of recent muscle pain research. The trigger point pain formation is caused by high levels of vasoneuroactive substances. Depending on intensity and duration of the muscle stimulus the central pain processing is modified and leads to characteristic referred pain patterns. The most effective conventional forms of treatment are aimed at a direct mechanical manipulation of the trigger point as are new forms of therapy with focused and radial shockwaves. By using high pressures the focused shockwaves in particular are suitable to provoke local and referred pain and thus simplify the trigger point diagnosis. The empirically found therapeutic effect of shockwaves on muscles is hypothetical and can be explained in analogy with validated reactions of shockwaves in non-muscle tissues. Overall, the shockwave therapy on muscles represents a confirmation and extension of the existing trigger point therapy. It seems to be suitable for treating functional muscular disorders and myofascial pain syndromes within the locomotor system.

Return to play after treating acute muscle injuries in elite football players with a multimodal therapy approach that includes a specific protocol of (almost) daily radial extracorporeal shock wave therapy

“…There were no adverse reactions or complications to treatment observed apart from occasional, temporary reddening of the skin at the treatment site that disappeared within 24 hours following rESWT. Moreover, there were no observed cases of local hematoma following the application of rESWs - as has been previously reported in the literature following the application of rESWs for the treatment of the gluteus maximus muscle with a rESWT device that differed from the one that was used in this study 16 . In addition, none of the players that were treated suffered from myositis ossificans (MO) - a proliferative mesenchymal response following soft tissue trauma that causes localised ossification.…”

Historical ESWT Paradigms Are Overcome: A Narrative Review

“…In a next step, rESWT was applied to treat more complex musculoskeletal symptoms associated with trigger points. The underlying mechanism of action is explained by the concept of myofascial pain [ 25 ]. Recently and inspired by traditional Chinese medicine, ESWT acupuncture has been invented [ 26 ].…”

“…Actually, focusing by biofeedback is also the cornerstone for myofascial trigger point ESWT [ 25 ]. However, the treatment of bone lesions like nonunions and osteochondrosis dissecans still needs image guided application, for example, by fluoroscopy.…”

Shock Wave Therapy for Osteoarthritis of the Knee

“…[9,10,11,12]. Как показывают исследования, эффективность ударных волн при лечении миофасциального болевого синдрома складывается из разных компонентов -гиперстимуляционного обезболивания, противовоспалительного, метаболического и сосудистого элементов [5,13,14]. Локальные мышечные гипертонусы в периартикулярных тканях чаще всего становятся причинами болезненных спазмов или вызывают стабильное мышечное напряжение и в итоге превращаются в триггерные зоны, нарушая нормальное взаимодействие фасций и окруженных ими тканей [6].…”