Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature.
Vernon H, Schneider M.
Canadian Memorial Chiropractic College, Ontario, Canada.
OBJECTIVES: Myofascial pain syndrome (MPS) and myofascial trigger points (MTrPs)
are important aspects of musculoskeletal medicine, including
chiropractic. The purpose of this study was to review the most commonly
used treatment procedures in chiropractic for MPS and MTrPs.
METHODS: The Scientific Commission of the Council on Chiropractic
Guidelines and Practice Parameters (CCGPP) was charged with developing
literature syntheses, organized by anatomical region, to evaluate and
report on the evidence base for chiropractic care. This article is the
outcome of this charge. As part of the CCGPP process, preliminary drafts
of these articles were posted on the CCGPP Web site www.ccgpp.org
(2006-8) to allow for an open process and the broadest possible
mechanism for stakeholder input. PubMed, Excerpta Medica Database,
Cumulative Index to Nursing and Allied Health Literature, and databases
for systematic reviews and clinical guidelines were searched. Separate
searches were conducted for (1) manual palpation and algometry, (2)
chiropractic and other manual therapies, and (3) other conservative and
complementary/alternative therapies. Studies were screened for relevance
and rated using the Oxford Scale and Scottish Intercollegiate
Guidelines Network rating system.
RESULTS: A total of 112 articles were identified. Review of these
articles resulted in the following recommendations regarding treatment:
Moderately strong evidence supports manipulation and ischemic pressure
for immediate pain relief at MTrPs, but only limited evidence exists for
long-term pain relief at MTrPs. Evidence supports laser therapy
(strong), transcutaneous electrical nerve stimulation, acupuncture, and
magnet therapy (all moderate) for MTrPs and MPS, although the
duration of relief varies among therapies. Limited evidence supports
electrical muscle stimulation, high-voltage galvanic stimulation,
interferential current, and frequency modulated neural stimulation in
the treatment of MTrPs and MPS. Evidence is weak for ultrasound therapy.
CONCLUSIONS: Manual-type therapies and some physiologic therapeutic
modalities have acceptable evidentiary support in the treatment of MPS
Journal of Manipulative and Physiological Therapeutics. 2009 January. 32 (1):14-24. PMID: 19121461
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Therapeutic effects of peripheral repetitive magnetic stimulation on myofascial pain syndrome.
Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M.
Centro di Rieducazione Funzionale Policlinico G.B. Rossi, Verona, Italy. email@example.com
OBJECTIVE: To evaluate short- and medium-term effects of peripheral repetitive magnetic stimulation (rMS) on myofascial pain.
METHODS: Eighteen patients who presented with myofascial trigger
points (TPs) at the level of the superior trapezius were separated into
two groups according to a restricted randomization scheme. Group 1 (n=9)
underwent treatment with rMS that consisted of a total of 10 sessions,
each lasting 20min, in which 4000 magnetic stimuli were administered in
5s trains at 20Hz at the TP. Group 2 (n=9) received a placebo treatment
that consisted of the application of a non-functioning ultrasound
therapy device to the TP. Patients were evaluated before treatment, at
the end of treatment, and again 1 week and 1 month after the conclusion
of the treatment. Clinical evaluation included parameters for measuring
pain levels (VAS, NPDVAS and algometry), the myofascial TP
characteristics and the range of cervical movement (ROM).
RESULTS: The rMS group showed a significant improvement in VAS,
NPDVAS, algometry, as well as in the characteristics of the TP after
conclusion of treatment. Improvements in the ROM were also present in
rotation and controlateral bending. This improvement persisted after 1
month. On the other hand, the placebo group did not show any significant
improvement in the tests considered.
CONCLUSIONS: The results of this study show that peripheral rMS may
have positive short- and medium-term therapeutic effects on myofascial
Randomized Controlled Trial
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