Earticle

Purpose: This study aimed to identify whether cutaneous sensory (CS) changes induced by mechanical and electrical interventions increase the trigger point threshold of the same spinal segment. Methods: The participants were randomly divided into three groups with 10 participants each: the mechanical intervention (MI) group, electrical intervention (EI) group, and control group. Mechanical intervention was applied through Graston, and EI was applied through the transcutaneous electrical nerve stimulator for 5 min to induce CS changes. The sensory test measured CS changes using Von Frey filament and pressure pain threshold (PPT) changes estimated using an algometer. To observe changes in sensory and pain threshold with time, the test was conducted three times: pre-, post-, and 15 min post-intervention . Results: The results showed significant changes in CS in the MI and EI groups (p<0.05). Furthermore, changes in the PPT of the right infraspinatus were observed in the same spinal segment (p<0.05). Conclusion: CS changes induced by MI and EI changed the PPT in the same spinal segment. Therefore, it can be useful for pan control and for increasing the PPT in the clinical field.

Objective To investigate the effects of trigger point injection with or without ischemic compression in treatment of myofascial trigger points in the upper trapezius muscle.Methods Sixty patients with active myofascial trigger points in upper trapezius muscle were randomly divided into three groups: group 1 (n=20) received only trigger point injections, group 2 (n=20) received trigger point injections with 30 seconds of ischemic compression, and group 3 (n=20) received trigger point injections with 60 seconds of ischemic compression. The visual analogue scale, pressure pain threshold, and range of motion of the neck were assessed before treatment, immediately after treatment, and 1 week after treatment. Korean Neck Disability Indexes were assessed before treatment and 1 week after treatment.Results We found a significant improvement in all assessment parameters (p<0.05) in all groups. But, receiving trigger point injections with ischemic compression group showed significant improvement as compared with the receiving only trigger point injections group. And no significant differences between receiving 30 seconds of ischemic compression group and 60 seconds of ischemic compression group.Conclusion This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point.

Objective: This study aimed to investigate the effects of ischemic compression treatment (ICT) or low-level laser therapy (LLLT) applied to the trigger points of the infraspinatus muscle on shoulder pain and function in patients with shoulder pain. Design: A randomized clinical trial Methods: Thirty patients with shoulder pain were randomly allocated into the ICT group (n=15) or LLLT groups (n=15). ICT was performed on three myofascial trigger points (MTrPs) of the infraspinatus muscle twice a week for 4 weeks (eight sessions), with 5 minutes of treatment per trigger point. LLLT was performed similarly. Shoulder pain was assessed using the visual analogue scale (VAS) and pain pressure threshold (PPT), and shoulder function was assessed using the Korean Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, rotator cuff strength, and range of motion (ROM) of shoulder flexion and abduction. Results: Significant changes in VAS score and PPT were found after the intervention in both groups (p<0.05). Significant changes were observed in the Korean DASH score, rotator cuff strength, and ROM of shoulder flexion (p<0.05) but not in the ROM of shoulder abduction (p<0.05). There were no significant differences between the two groups. Conclusions: This study showed that both ICT and LLLT applied on the MTrPs of the infraspinatus muscle were effective for relieving shoulder pain and improving shoulder functions in patients with shoulder pain.

Objective: The objective of this study is to evaluate the effects of radial shock wave therapy (RSWT) targeting multiple myofascial trigger points (MTrPs) along myofascial chains on shoulder pain, function, range of motion, and muscle strength in patients with bicipital tendinopathy. While traditional treatments primarily focus on a single MTrP, this study aims to achieve better clinical improvement by simultaneously treating multiple MTrPs along the myofascial chains. Design: A randomized controlled trial. Methods: Twenty-eight patients with bicipital tendinopathy were randomly assigned to either an experimental group (n=14) or a control group (n=14). The experimental group received RSWT targeting multiple MTrPs along myofascial chains, while the control group received RSWT focused on a single MTrP in the biceps brachii. Both groups underwent three treatment sessions over a nine-day period, with one session every three days. Outcomes, including shoulder pain, function, range of motion, and muscle strength, were measured before and after treatment to assess therapeutic effects. Results: Both groups showed significant improvements in shoulder pain, function, range of motion, and muscle strength (p<0.05). However, the experimental group demonstrated significantly greater improvements in all outcome measures compared to the control group (p<0.05). Conclusions: RSWT targeting multiple MTrPs along myofascial chains showed significantly greater effects in relieving shoulder pain, improving function, enhancing range of motion, and strengthening muscles in patients with bicipital tendinopathy compared to treatment targeting a single MTrP. Therefore, this study proposes that a comprehensive treatment strategy considering the entire myofascial pathway may be more effective in the rehabilitation of patients with bicipital tendinopathy.

Objective To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. Methods Sixty subjects aged 18?24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). Results Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). Conclusion Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

Purpose: This study was designed to investigate possibilities for quantitative analysis using the electromyography and sonography. For better understanding, we evaluated the correlation between the pressure pain threshold and sonography, spontaneous electrical activity in trigger points located in the upper trapezius muscle. Methods: Thirty three active subjects volunteered to participate in this study (n=33). They had a palpable taut band, exquisite spot tenderness of a nodule in a taut band, spontaneous pain, referred pain, jump sign, local twitch response, and a painful limit to full stretch range of motion. We measured Pressure pain threshold, density, white area index, root mean square, and reaction. Pearson’s correlation coefficient was calculated to estimate the relationship between the pressure pain threshold and other variables including density, white area index, root mean square, and reaction time. Results: There were significant correlations between pressure pain threshold and density (r=-0.75, p<0.01), and between pressure pain threshold and white area index (r=-0.74, p<0.01). A significant correlations between pressure pain threshold and root mean square (r=-0.59, p<0.01). The significant correlation was found between pressure pain threshold and reaction time (r=-0.64, p<0.01). Conclusion: These should indicate whether quantitative analysis can be done using the characteristics of electromyography and sonography.

Background Myofascial trigger points in upper trapezius are common in people with shoulder pain. However, there are few studies that have observed the shoulder abduction range of motion in glenohumeral joint in individuals who have upper trapezius pain with myofascial trigger points. Purpose The purpose of this study was to compare the glenohumeral joint abduction range of motion between individuals with and without upper trapezius pain. Study design Cross-sectional study. Methods Twenty-four subjects who had upper trapezius pain with myofascial trigger points and 24 sex-, age-, and weight- matched subjects who had no upper trapezius pain and myofascial trigger points participated. The shoulder abduction range of motion was measured with and without restricted scapular motion in both groups. Smart KEMA strength measurement system was used to restrict scapular motion. Results The glenohumeral joint abduction range of motion measured with restricted scapular motion was significantly decreased in the upper trapezius pain group compared to the control group (p<0.05). However, the general shoulder abduction range of motion had no significant difference between groups (p>0.05). Conclusions It was investigated that individuals with upper trapezius pain accompanied by myofascial trigger points had decreased shoulder abduction range of motion in the glenohumeral joint. This finding suggests that abduction range of motion in the glenohumeral joint with restricted scapular motion should be considered in evaluating and treating people with upper trapezius pain.

Purpose: The objective of this study was to offer primary clinical data examining whether change of imaging structure and quantitative evaluation of muscle activity on myofascial trigger points can lead to implementation of an analytical technique for evaluation of myofascial pain diagnoses. In addition, we examined the effect of a variety of mediation techniques, in order to examine neuromuscular physiological characteristics of myofascial trigger points muscle by comparing differences in pressure pain threshold and ultrasound imaging. Methods: Participants in the study included 30 adults in their twenties. The subjects were divided into the normal and myofascial trigger points groups. Clinical outcomes were evaluated by pressure pain threshold for pain and ultrasound imaging was performed for evaluation of the structural characteristics of muscle. Independent t-test was used for statistical analysis. Results: The two groups showed statistical significance in the change in pressure pain threshold (p<0.05). Findings of ultrasound imaging analysis showed no significant differences, increased muscle thickness was observed (p>0.05). Findings of ultrasound imaging analysis showed significant differences, increased muscle echodensity was observed (p<0.05). Findings on ultrasound imaging analysis showed significant differences, increased muscle white area index was observed (p<0.05). Conclusion: From these results, active myofascial trigger points muscle showed quality deterioration on ultrasound imaging. Thorough evaluation of imaging structure and physiological characteristics can be useful quantitative analytical techniques for diagnosis of myofascial pain syndrome and a primary factor reflected in physical therapy intervention.

어깨의 근 통증으로 생긴 근육의 압통역치(PPT)에 미치는 영향을 온열요법, 기치유요법 그리고 두 요법을 병행 적용하여 102명의 임상자에대한 사전사후 효과를 연구하는 것이 목적이었다. 1. 시각적 통증척도 평균은 온열요법의 치유 후에는 전에 비해 39%, 기치유요법의 치유 후에는 66.5%, 온열과 기치유요법의 병행치유 후에는 72.3%가 감소 되어 개선 효과를 보였으며, 모두 유의성이 있었다(p<.05). 2. 견갑거근, 승모근, 전삼각근, 극상근, 대흉근과 흉쇄유돌 근의 압통역치 평균은 온열요법 치유 후에는 전에 비해 4.3~11.3%, 기치유요법 치유 후에는 5.9~19.9%, 병행치유 후 에는 9.3~25.3%가 증가되어 개선효과가 있었고, 모두 유의성이 있었다(p<.05). 3. 근육 8군데의 압통역치는 상·하부 승모근에서 기치유요법, 온열요법과 기치유 병행요법 간에는 차이의 유의성이 없었고, 온열요법과는 유의한 차이가 있었으며, 견갑거근, 전·후삼각근, 극상근, 대흉근과 흉쇄유돌근에서는 온열요법 보다는 기치유요법이 기치유요법보 다는 온열과 기치유 병행요법이 유의성이 있었다. 본 연구에서 통증치료에 온열요법과 기치유요법이 모두 통증의 개 선에 효과 있었고, 특히 병행치유가 더 효과적이었다. 이러한 자연치유요법을 적용하여 인체의 통증치료로 건강과 복 지 향상에 기여하기를 바란다.

In this study, we wanted to understand the influence of thermotherapy, Qi-therapy, and their combination therapy on the oppressive muscular pains in shoulders. For the clinical study, 102 subjects were divided into 3 groups of thermotherapy, Qi-therapy, and the combination therapy to see the differences in the therapeutic effects. The treatments were taken 5 times for 2 weeks in 3-day intervals and pre- and post-treatment assessments were undertaken for the visual pain assessment (VAS, visual analogue scale) and experimental pressure threshold in 8 points in the relevant muscles (PPT). VAS score was decreased by 39% after thermotherapy, 66.5% after Qi-therapy, and 72.3% after combination therapy, all with significance (p<.05). The experimental pressure thresholds of shoulder muscles, the upper trapezius muscles, the lower trapezius muscles, the anterior trapezius muscles. the supraspinous muscles, the greater pectoral muscles, and the sternocleidomastoid muscles were increased by 4.3~11.3% after thermotherapy, 5.9~19.9% after Qi-therapy, and 9.3~25.4% after combination therapy. The experimental pressure thresholds in the 8 points in the relevant muscles did not show a significant difference between the Qi-therapy and combination therapy in the upper and lower trapezius muscles, however, did show a significant difference to the thermotherapy. In the shoulder muscles, anterior and posterior trapezius muscles, supraspinous muscles, supraspinous muscles, greater pectoral muscles, and sternocleidomastoid muscles, there were significant superiorities in Qi-therapy over thermotherapy, and in the combination therapy over Qi-therapy. In conclusion, it could be understood that both thermotherapy and Qi-therapy have been effective in the improvement of pains, and especially combination therapy showed better effectiveness. It is expected to apply these natural therapies to the pain treatment of human body to contribute to the improvement of health and welfare.

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Purpose: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. Materials and Methods: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularisand/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis musclefor diagnostic and therapeutic purpose by the newly developed US-guided method. Results: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. Conclusion: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.

The purpose of this study was to investigate the distribution of trigger points(TrPs) on athletes with various sporting background. To achieve the purpose, a study was carried out through a survey from 180 athletes involved in 6 selected sports at Yong-In University. Selected sports included Judo, Taekwondo, Kendo, Ssi-reum(Korean traditional wrestling), Boxing, and Golf. An interview type survey and physical examination were conducted with each thirty athletes from each of the selected sports groups. Technical statistic(SPSS 15.0) was used to analyze the distribution of TrPs on these athletes. The most common TrPs observed in muscles of Trapezius, Quadratus Lumborum, Quadriceps in Judo. In Taekwondo, it was on the trapezius and triceps surae. Kendo athletes had TrPs at sites of trapezius, brachioradialis and triceps surae. Ssirem athletes were found to have TrPs on trapezius, deltoid and quadrates lumborum. In boxers, TrPs appearing at trapezius and brachioradialis were observed. Finally, Golf players were seen to have TrPs at trapezius, quadrates lumborum and brachioradialis. Hence, the analysis shows that there are significant differences of the distribution of TrPs according to the different sport items of the athlete.

Objectives : The purpose of this study is to find out relationship between Trigger points and Acupoints. Methods : We have researched some of oriental and western medical books about Trigger points and Acupoints from head to trunk. Conclusions : 1. In the head, there are 46 trigger points Among them, 19 trigger points correspond to Acupoints and 25 trigger points are similar to them 2. In the thorax, there are 33 trigger points Among them, 17 trigger points correspond to Acupoints and 20 trigger points are similar to them 3. In the upperimb, there are 20 trigger points Among them, 9 trigger points correspond to Acupoints and 13 trigger points are similar to them. 4 In the trunk, there are 11 trigger points. Among them, 5 trigger points correspond to Acupoints and 11 trigger points are similar to them.

Objectives : The purpose of this study is to find out relationship between Trigger points and Acupoints. Methods : We have researched some of oriental and western medical books about Trigger points and Acupoints from Quadratus lumborum to Deep intrinsic foot muscles. Conclusions : 40 acupoints correspond to trigger points among 67, which approximately accounts for 59 7% Including similar trigger points anatomically, it will show a doser correspondence between acupoints and trigger points.

Background: This study investigates whether intramuscular electrical stimulation (IMES) with inverse electrode placement (IEP) or conventional electrode placement (CEP) more effectively modulates pain. The current study's aim was to compare the effects of IMES using IEP and CEP, and sham-IMES on the pressure pain threshold (PPT), EMG activity, upper trapezius (UT) muscle length and pain severity among adults with UT myofascial trigger points (MTrPs). Methods: Thirty-six male adults with UT-MTrPs were allocated into three groups. IEP, CEP and sham groups were respectively treated with a single IMES session using IEP, CEP, and sham-IMES. Pain intensity, PPT, EMG activity (root mean square, RMS) and UT muscle length were measured on day one before the treatment, day one post treatment and at a day three follow-up to determine the immediate and short-term effectiveness of IMES. Results: IMES using both IEP and CEP methods produced significant higher changes in UT-PPT (median, interquartile-interval, IEP group: 3.25, 2.56-3.50 and CEP group: 2.75, 1.75-3.00, vs. sham group: 1.07, 0.89-1.71 kg/cm²), RMS (IEP: 0.31, 0.26-0.35 and CEP: 0.36, 0.23-0.38, vs. sham: 0.21, 0.16-0.25 mV), and UT muscle length (IEP: 9.50, 8-12.75 and CEP: 8, 7-10, vs. 1.5. 1-2.75 degrees) and UT-pain severity (IEP: 3.00, 2.25-4 and CEP: 3, 3-3, vs. sham: 2, 2-2.75 points on VAS) compared to the score change in sham-IMES at day three follow up. Conclusions: Pain modulation can be effectively achieved using IMES regardless of electrode placement method, with different electrode configurations.

Thermography는 신체 체표면에서 발생되는 온도를 정량화하는 다양한 방법에 대한 일반적인 표현이다. Electrothermography는 의학분야에서 사용이 증가되고 있는 술식이다. 인체를 포함한 모든 물체는 적외선을 방출한다. 그래서, Wien의 법칙에 따르면, 방출되는 최대에너지에서의 주파수는 체온에 의존한다는 것을 알 수 있다. 따라서, 피부 표면에서 방출되는 적외선을 측정하는 것에 의해 온도가 측정될 수 있다. 최근에는, electrothermography가 만성 구강안면동통 환자의 진단에 있어서 새로운 진단 기기로서 각광을 받고 있다. 본 연구에서는 측두하악관절장애의 증상이 있는 교근, 측두근, 그리고 측두하악관절의 발통점의 피부 온도와 증상이 없는 대측의 피부 온도를 디지틀 적외선 체열 촬영으로 비교하고자 하였다. 측두하악관절장애를 주소로 하고 편측성의 구강안면동통을 호소하는 21명의 내원환자를 선택하였다. 디지틀적외선 체열촬영은 DTI-16-DOREX21(Dorex Inc., U.S.A) 기기를 사용하였다. 발통점 피부에 marker를 부착하고, 좌측과 우측의 color thermogram을 $0.1^{\circ}C$ 해상도로 측정하였다. 본 실험에서 측정한 발통점은 masseter inferior, masseter anterior, temporalis anterior 그리고 TMJ이었다. 증상이 있는 부위와 증상이 없는 대측의 피부온도 차이를 알아보기 위해 paired t-test를 사용하였으며, 실험 결과는 다음과 같다. 1. 급성 근육장애 환자에 있어서는 증상이 있는 부위와 증상이 없는 대측과의 피부온도 차이가 통계학적으로 유의한 차이가 있었다(p<0.0075). 2. 만성 근육장애 환자에 있어서는 증상이 있는 부위와 증상이 없는 대측과의 피부온도 차이가 통계학적으로 유의한 차이를 볼 수 없었다. 3. 측두하악관절 내장증 환자에 있어서는 증상이 있는 부위와 증상이 없는 대측과의 피부온도 차이가 통계학적으로 유의한 차이를 볼 수 없었다. 결론적으로 적외선 체열촬영은 급성저작근장애의 진단에 있어서 유용한 진단방법의 한가지로 사료되며, 앞으로 임상적으로 더욱더 심화된 연구가 필요할 것으로 사료된다.

구강안면통증환자에서 저출력 레이저의 임상 효과는 많은 임상가에 의해 연구되었으나 그 결과에 대해서는 아직도 논란중이다. 이에 본 연구는 두 가지 방법으로 시행하여 구강안면부위의 발통점에 대한 저출력 레이저의 효과를 평가하였다. 첫 번째 방법은 저작근 중 교근, 측두근과 경부근육 중 승모근에 발통점을 가진 부산대학교 치과대학생 69명중 37명은 레이저 조사군, 32명은 레이저 모의 조사군으로 무작위로 분류하여 저출력 레이저의 치료효과를 평가하였다. 둘째 방법으로 동일 근육에 발통점이 있는 19명의 환자와 발통점이 전혀 없는 20명의 정상인을 무작위로 환자군과 정상 대조군으로 분류하고, 각 군을 다시 레이저 조사군과 모의 조사군으로 나누어 실제 저출력 레이저의 치료효과와 위약효과를 평가하였다. 50mW, 820nm의 GaAlAs 반도체 레이저를 이용하여 4주 동안 첫 주는 2회, 이후 3주 동안 각 1회씩 총 5회를 조사하였고, 레이저 모의 조사군에서도 동일한 방법으로 시행하였다. 치료반응은 전자통각계를 이용하여 압력통각역치를 치료 전, 치료 2주 및 4주에 측정하여 이를 비교한 바 다음과 같은 결과를 얻었다. 1. 레이저 조사군의 각 근육에서 측정한 압력통각역치는 치료 2주 후부터 유의하게 높아졌으며(P<0.05), 모의 조사군과의 차이는 이후 점점 더 증가하였다(P<0.001). 모의 조사군에서는 압력통각역치의 유의한 변화가 없었다. 2. 레이저 조사-환자군에서 측정한 압력통각역치는 레이저 모의조사-환자군의 압력통각역치보다 그 증가폭이 더 크게 나타났다(P<0.05). 정상 대조군은 레이저 조사와 관계없이 압력통각역치에 유의성이 없었다. 3. 약간의 위약 반응이 레이저 모의조사 환자군과 정상 대조군에서 관찰되나, 레이저 조사 환자군의 실제 레이저 치료효과가 위약 반응보다 우세하였다.

구강안면동통환자의 발통점에 대한 보존적 치료방법중 저출력레이저의 효과를 평가하기 위해 교근, 측두근과 승모근에 발통점을 가진 치과대학생 69명을 무작위로 분류하여 37명에게는 GaAlAs 반도체 레이저를 조사하였고 나머지 32명은 레이저를 실제로 조사하지 않고 대조군으로 삼았다. 50mW, 820nm의 GaAlAs 반도체 레이저를 이용하여, 4주 동안 첫 주는 2회, 이후 3주 동안 1회씩 총 5회 조사하였고 전자통각계를 이용하여 압력통각역치를 측정한 후 이를 대조군과 비교한 바 다음과 같은 결과를 얻었다. 1. 남녀 및 조사군과 비조사군의 치료 전 압력통각역치는 차이가 없었다. 2. 조사군의 각 근육에서 측정한 압력통각역치는 레이저 치료 2주 후부터 유의하게 높아졌으나 비조사군에서는 차이가 없었다, 3. 비조사군의 치료 전, 후 압력통각역치에는 성 차가 없었다. 반면 종사군의 압력통각역치는 치료 전에는 성 차가 없었으나 치료 후에는 남성이 여성보다 유의하게 높았다.