Evaluate the Immediate Effect of High-power Pain Threshold Ultrasound on Treatment of Upper Trapezius Active Myofascial Trigger Points
Abstract
Introduction: 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.
Materials and Methods: 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.
Results: 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.
Conclusion: Ultrasound significantly improved the muscular symptoms of the trigger points.
Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of Electromyography and Kinesiology. 2004; 14(1):95-107. [DOI:10.1016/j.jelekin.2003.09.018] [PMID]
Simons DG, Travell JG. Myofascial origins of low-back-pain. 1. Principles of diagnosis and treatment. Postgraduate Medicine. 1983; 73(2):66-77. [DOI:10.1080/00325481.1983.1169775] [PMID]
Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: A double blind, placebo-controlled study. Clinical Rheumatolo-gy. 2007; 26(6):930-4. [DOI:10.1007/s10067-006-0438-4] [PMID]
Skootsky SA, Jaeger B, Oye RK. Prevalence of myofascial pain in general internal medicine practice. Western Journal of Medicine. 1989; 151(2):157-60. [PMID] [PMCID]
Dommerholt J, Huijbregts P. Myofascial trigger points: pathophysiology and evidence-informed diagnosis and man-agement. Massachusetts: Jones & Bartlett Learning; 2010. https://www.google.com/books/edition/Myofascial_Trigger_Points/PXg7LlJxXgoC?hl=en&gbpv=1&dq=
McPartland JM, Simons DG. Myofascial trigger points: Translating molecular theory into manual therapy. Journal of Manual & Manipulative Therapy. 2006; 14(4):232-9. [DOI:10.1179/106698106790819982]
Ilter L, Dilek B, Batmaz I, Ulu MA, Sariyildiz MA, Nas K, et al. Efficacy of pulsed and continuous therapeutic ultrasound in myofascial pain syn-drome: A randomized controlled study. American Journal of Physical Medicine & Rehabilitation. 2015; 94(7):547-54. [DOI:10.1097/PHM.0000000000000210] [PMID]
Kavadar G, Çağlar N, Özen Ş, Tütün Ş, Demircioğlu D. Efficacy of conventional ultrasound therapy on myofascial pain syndrome: A placebo controlled study. Agri: The Journal of the Turkish Society of Algology. 2015; 27(4):190-6. [DOI:10.5505/agri.2015.48569] [PMID]
Koca I, Tutoglu A, Boyaci A, Ucar M, Yagiz E, Isik M, et al. A comparison of the effectiveness of low-, moderate-and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome. Modern Rheumatology. 2014; 24(4):662-6. [DOI:10.3109/14397595.2013.860001] [PMID]
Manca A, Limonta E, Pilurzi G, Ginatempo F, De Natale ER, Mercante B, et al. Ultrasound and laser as stand-alone therapies for myofascial trigger points: A randomized, double-blind, placebo-controlled study. Physiotherapy Research International. 2014; 19(3):166-75. [DOI:10.1002/pri.1580] [PMID]
Travell JG. Simons DG, Simons LS. Myofascial pain and dysfunction: the trigger point manual the lower extremities. Pennsylvania:Williams and Wilkins; 1983. https://www.google.com/books/edition/Myofascial_Pain_and_Dysfunction/8pGrvso0vnkC?hl=en&gbpv=0
Majlesi J, Ünalan H. High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: A randomized, double-blind, case-control study. Archives of Physical Medicine and Rehabilitation. 2004; 85(5):833-6. [DOI:10.1016/j.apmr.2003.07.023] [PMID]
Yalgin S, Ünalan H, Öztezcan S, Majlesi J, Özkan F, Akarırmak Ü. Experimental study on static ultrasound [high-power pain threshold ultrasound] application: Potential adverse effects on rats. Journal of Musculoskeletal Pain. 2010; 18(3):246-53. [DOI:10.3109/10582452.2010.502615]
Bahadir C, Majlesi J, Unalan H. The effect of high-power pain threshold ultrasound therapy on the electrical activity of trigger points and local twitch response on electromyography: A preliminary study. Journal of Musculoskeletal Pain. 2009; 17(2):162-72. [DOI:10.1080/10582450902820572]
Pecos-Martín D, Montañez-Aguilera FJ, Gallego-Izquierdo T, Urraca-Gesto A, Gómez-Conesa A, Romero-Franco N, et al. Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: A randomized con-trolled trial. Archives of Physical Medicine and Rehabilitation. 2015; 96(5):775-81. [DOI:10.1016/j.apmr.2014.12.016] [PMID]
Rezaei S, Shadmehr A, Tajali SB, Moghadam BA, Jalaei S. The effect of laser therapy and ischemic compression on active trigger points in upper trapezius muscle. Journal of Modern Rehabilitation. 2019; 13(4):221-6. [DOI:10.32598/JMR.13.4.221]
Kim Y, Yang HR, Lee JW, Yoon BC. Effects of the high-power pain threshold ultrasound technique in the elderly with latent myofascial trigger points: A double-blind randomized study. Journal of Back and Musculoskeletal Rehabilita-tion. 2014; 27(1):17-23. [DOI:10.3233/BMR-130414] [PMID]
Hesari S, Attarbashi-Moghadam B, Shadmehr A. Comparison of dry needling and physical therapy in patients with trapezius myofascial pain syndrome. Journal of Modern Rehabilitation. 2016; 1(1):43-7. https://jmr.tums.ac.ir/index.php/jmr/article/view/8
Cohen J. The effect size index: d. Statistical power analysis for the behavioral sciences. Abingdon-on-Thames: Routledge Academic; 1988. http://www.utstat.toronto.edu/~brunner/oldclass/378f16/readings/CohenPower.pdf
Tomczak M, Tomczak E. The need to report effect size estimates revisited. An overview of some recommended measures of effect size. Trends in Sport Sciences. 2014; 21(1):19-25. http://tss.awf.poznan.pl/files/3_Trends_Vol21_2014__no1_20.pdf
Dhawan A, Bhardwaj P. The relative efficacy of high-power pain threshold static ultrasound technique versus inter-ferential currents in the treatment of active myofascial trigger points of upper trapezius. Indian Jouanl of Physio-therapy and Occupational Therapy. 2010; 4(4):12-17. https://www.researchgate.net/profile/Suraj-Kumar-30/publication/262380147_Effect_of_core_stabilization_training_on_dynamic_balance_in_non-professional_sports_players/links/00463537961c9b28bb000000/Effect-of-core-stabilization-training-on-dynamic-balance-in-non-professional-sports-players.pdf#page=16
Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Archives of Physical Medicine and Rehabilitation. 2011; 92(4):657-62. [DOI:10.1016/j.apmr.2010.11.030] [PMID]
Tsui PH, Wang SH, Huang CC. In vitro effects of ultrasound with different energies on the conduction properties of neural tissue. Ultrasonics. 2005; 43(7):560-5. [DOI:10.1016/j.ultras.2004.12.003] [PMID]
Guirro R, Dibai-Filho A, Dias F, Oliveira A. Efficacy static ultrasound and manual therapy in the treatment myofascial trigger points individuals with neck pain: A pilot clinical study. Physiotherapy. 2015; 101:e494-5. [DOI:10.1016/j.physio.2015.03.3291]
Aridici R, Yetisgin A, Boyaci A, Tutoglu A, Bozdogan E, Dokumaci DS, et al. Comparison of the efficacy of dry needling and high-power pain threshold ultrasound therapy with clinical status and sonoelastography in myofascial pain syndrome. American Journal of Physical Medicine & Rehabilitation. 2016; 95(10):e149-58. [DOI:10.1097/PHM.0000000000000600] [PMID]
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Issue | Vol 15 No 3 (2021) | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/jmr.v15i3.7737 | |
Keywords | ||
High-power pain threshold ultrasound Static ultrasound Trigger points Myofascial trigger point Myofascial pain syndrome |
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