Effects of cervical myofascial trigger points release in post-natal females: A randomized controlled trial
Abstract
The aim was to investigate and compare the effectiveness of Ultrasound (US) versus a combination of US and ischemic compression (IC) technique on headache pain intensity and range of motion (ROM) of the cervical region in healthy females with myofascial trigger points (MTrPs) in the cervical muscles, following normal delivery. Forty females (ages 20-35 years) with MTrPs in the muscles of the neck took part in the study. They were assigned into control group (US therapy for the MTrPs of the upper trapezius and sub-occipital muscles) and study group (IC technique on the active MTrPs of the muscles in addition to the US application). They received eight sessions for 4 weeks (2 sessions/week). All patients were evaluated before and after treatment for the intensity of radiating headache by Visual Analogue Scale (VAS) and the universal goniometer to measure cervical ROM. Two-way mixed design MANOVA demonstrated a significant decrease (p<0.05) in headache pain intensity and a significant increase (p<0.05) in neck flexion, extension, right and left side bending, and rotation in both groups when compared to pre-treatment circumstances. Additionally, there was a significant reduction in pain intensity after treatment in the study group compared to the control group (p<0.05). In conclusion, in healthy females after normal delivery, US alone or in combination with the IC technique is effective for releasing cervical myofascial trigger points and has positive effects on radiating headache and cervical ROM. In addition, IC technique was a complement to US in reducing the severity of headache pain, but its effect on improving cervical ROM was practically but not statistically significant.
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References
Agarwal, S., Allison. G. T., & Singer K. P. (2005). Reliability of the spin-T cervical goniometer in measuring cervical range of motion in an asymptomatic Indian population. Journal of Manipulative and Physiological Therapeutics, 28(7), 487–492.
Aguilera, F. J. M., Martín, D. P., Masanet, R. A., Botella, A. C., Soler, L. B., & Morell, F. B. (2009). Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. Journal of manipulative and physiological therapeutics, 32(7), 515-520.
Bijur, P., Wendy, S., & Gallagher, J. (2001). Reliability of the Visual Analog Scale for Measurement of Acute Pain. Journal of the Society for Academic Emergency Medicine, 12(8), 1153-1157.
Borg-Stein, J., & Dugan, S. A. (2007). Musculoskeletal disorders of pregnancy, delivery and postpartum. Physical medicine and rehabilitation clinics of North America, 18(3), 459-476.
Carlsson A. (1983) Assessment of chronic pain. I. Aspects of reliability and validity of the Visual Analogue Scale. Pain, 16(1), 87-101.
Castien, F., Danielle, A., Grooten, A., & Dekker, J. (2010) Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomized clinical trial. Cephalalgia, 31(2), 133-143.
Couppé, C., Torelli, P., Fuglsang-Frederiksen, A., Andersen, K. V., & Jensen, R. (2007). Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study. The Clinical journal of pain, 23(1), 23-27.
De Koning, C. H., Van den Heuvel, S. P., Staal, J. B., Smits-Engelsman, B. C., & Hendriks, E. J. (2008). Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review. European Spine Journal, 17(7), 905-921.
Draper, D. O., Mahaffey, C., Kaiser, D., Eggett, D., & Jarmin, J. (2010). Thermal ultrasound decreases tissue stiffness of trigger points in upper trapezius muscles. Physiotherapy theory and practice, 26(3), 167-172.
Dusunceli, Y., Ozturk, F., Atamaz, S. H. & Durmaz, B. (2009) Efficacy of neck stabilization exercises for neck pain: A randomized controlled study. Journal of Rehabilitation Medicine, 41(8), 626-631.
Farooq, M. N., Bandpei, M. A. M., Ali, M., & Khan, G. A. (2016). Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons. Pakistan journal of medical sciences, 32(2), 457.
Fernandez-de-Las-Penas, C., Cuadrado, M. L., Arendt-Nielsen, L., Simons, D. G., & Pareja, J. A. (2007). Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia, 27(5), 383-393.
Fernández-de-Las-Peñas, C., Ge, H. Y., Alonso-Blanco, C., González-Iglesias, J., & Arendt-Nielsen, L. (2010). Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. Journal of bodywork and movement therapies, 14(4), 391-396.
Ferreira, M., & Herbert, R. (2008). What does 'clinically important' really mean? The Australian Journal of Physiotherapy, 54(4), 229-230.
Gerwin, R. D. (2005). A review of myofascial pain and fibromyalgia–factors that promote their persistence. Acupuncture in medicine, 23(3), 121-134.
Goldszmidt, E., Kern, R., Chaput, A., & Macarthur, A. (2005). The incidence and etiology of postpartum headaches: a prospective cohort study. Canadian Journal of Anesthesia, 52(9), 971-977.
Hsieh, Y. L. (2005). Reduction in induced pain by ultrasound may be caused by altered expression of spinal neuronal nitric oxide synthase-producing neurons. Archives of physical medicine and rehabilitation, 86(7), 1311-1317.
Kavadar, G., Çağlar, N., Özen, S., Tütün, S., & Demircioğlu, D. (2015). Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study. Agri, 27(4), 190–196.
Kumar, G., Sneha, P., & Sivajyothi, N. (2015). Effectiveness of Muscle energy technique, Ischemic compression and strain counterstain on Upper Trapezius Trigger Points: A comparative study. International Journal of Physical Education, Sports and Health, 1(3), 22-26.
Macarthur, A. (2009) Postpartum headache. In: Chestnut, D., Polley, L., Tsen, L., Wong, C., eds. Chestnut's Obstetric Anesthesia Principles and Practice, 4th Ed. Philadelphia: Mosby Elsevier; pp.677-700.
Majlesi, J., & Unalan, H. (2010). Effect of treatment on trigger points. Current pain and headache reports, 14(5), 353-360.
Marcus, D., & Bain, P. (2009). Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide. Humana Press, Springer Science, Business Media, LLC; pp.101-102.
Mars, M., Maharaj, S. S., & Tufts, M. (2005). The effect of compressed air massage on skin blood flow and temperature: cardiovascular topic. Cardiovascular Journal of South Africa, 16(4), 215-219.
Mokri, B. (2013). Spontnaeous low pressure, low CSF Volume Headaches: spontaneous CSF leaks, American Headache Society. Journal of Head and Face Pain,53, 1034-1053.
Moraska, A. F., Schmiege, S. J., Mann, J. D., Burtyn, N., & Krutsch, J. P. (2017). Responsiveness of myofascial trigger points to single and multiple trigger point release massages–a randomized, placebo controlled trial. American journal of physical medicine & rehabilitation, 96(9), 639-645.
Morishita, K., Karasuno, H., Fujiwara, T., Fujimoto, T., & Abe, K. (2011). Effect of the therapeutic ultrasound on muscle hardness and range of motion. J Appl Bio-metrology, 2, 7-10.
Rahmani, N., Amiri, M., Ali Mohseni-Bandpei, M., Mohsenifar, H., & Pourahmadi, M. R. (2013). Work related neck pain in Iranian dentists: An epidemiological study. Journal of back and musculoskeletal rehabilitation, 26(1), 9-15.
Robertson, J., & Baker, G. (2001). A Review of Therapeutic Ultrasound: Effectiveness Studies. Physical Therapy, 81(7), 1339-1350.
Dommerholt, J., & Simons, D. G. (2008). Myofascial Pain Syndrome—Trigger Points. Journal of Musculoskeletal Pain, 16(3), 211-228.
Simons, D. G. (2002). Understanding effective treatments of myofascial trigger points. Journal of Bodywork and movement therapies, 6(2), 81-88.
Simons, D. (2004). Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of Electromyography and Kinesiology, 14. 95-107.
Srbely, J. Z., Dickey, J. P., Lowerison, M., Edwards, A. M., Nolet, P. S., & Wong, L. L. (2008). Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain, 139(2), 260-266.
Watson, T. (2000). The role of electrotherapy in contemporary physiotherapy practice. Manual therapy, 5(3), 132-141.
Williams, M. A., Williamson, E., Gates, S., & Cooke, M. W. (2012). Reproducibility of the cervical range of motion (CROM) device for individuals with sub-acute whiplash associated disorders. European spine journal, 21(5), 872-878.
Yankai, A., & Manosan, P. (2009). Reliability of the universal and invented gravity goniometers in measuring active cervical range of motion in normal healthy subjects. The International Journal of Applied Biomedical Engineering, 2(1), 49-53.
Lin, Y. C., Lai, C. H., Chang, W. H., Tu, L. W., Lin, J. C., & Chou, S. W. (2012). Immediate effects of ischemic compression on neck function in patients with cervicogenic cephalic syndrome. Journal of manipulative and physiological therapeutics, 35(4), 301-307.
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