Primary studies included in this systematic review

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The Influence of Patient Attitude Toward Massage on Pressure Pain Sensitivity and Immune System after Application of Myofascial Release in Breast Cancer Survivors: A Randomized, Controlled Crossover Study.

Journal Journal of manipulative and physiological therapeutics
Year 2012
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Abstract: OBJECTIVE: The purpose of this study was to evaluate the influence of patient''s attitudes toward massage on pressure pain sensitivity and the immune effects of myofascial release in breast cancer survivors (BCS). METHODS: Twenty BCS participated. They presented to the laboratory at the same time of the day on 2 occasions separated by 2 weeks. At each session, they received either a myofascial release technique or control (special attention) intervention. Salivary flow rate, cortisol and immunoglobulin A (IgA) concentrations, and α-amylase activity were obtained before and immediately after intervention from saliva samples. Pressure pain thresholds (PPT) over the cervical spine and temporalis muscle were assessed bilaterally. The attitude toward massage (ATOM) scale was collected before the first session in all BCS. RESULTS: The analysis of covariance revealed a significant intervention × time interaction for salivary flow rate (P = .010), but not α-amylase (P = .111), IgA (P = .655), and cortisol (P = .363) in favor of the experimental group: BCS exhibited an increase of salivary flow rate after myofascial release intervention. When the ATOM scale was included in the analysis, significant influence on IgA (P = .001) was found: BCS with positive attitude had a significant increase in IgA (P > .05). The analysis of covariance did not find a significant intervention × time interaction for PPT over the cervical spine or temporalis muscle, with no effect of ATOM scales for PPT (P > .05). CONCLUSION: The current study suggests that myofascial release may lead to an immediate increase in salivary flow rate in BCS with cancer-related fatigue. We also found that the effect of myofascial release on immune function was modulated by a positive patient''s attitude toward massage.

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Therapeutic effects of traditional Thai massage on pain, muscle tension and anxiety in patients with scapulocostal syndrome: A randomized single-blinded pilot study

Journal Journal of bodywork and movement therapies
Year 2012
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The purpose of this study was to investigate the therapeutic effects of traditional Thai massage (TTM) on pain intensity, pressure pain threshold (PPT), muscle tension and anxiety associated with scapulocostal syndrome (SCS). Twenty patients were randomly allocated to receive a 30-min session of either TTM or physical therapy modalities (PT: ultrasound therapy and hot pack) for 9 sessions over a period of 3 weeks. Pain intensity, PPT, muscle tension and anxiety were measured before and immediately after the first treatment session, 1 day after the last treatment session and 2 weeks after the last treatment session. Results indicated that the TTM group showed a significant improvement in all parameters after the first treatment session and at 1 day and 2 weeks after the last treatment session (p < 0.05). For all outcomes, similar changes were observed in the PT group except for PPT (p < 0.05). The adjusted post-test mean values of each assessment time point for pain intensity and muscle tension were significantly lower in the TTM group than those of the PT group (p < 0.01). In addition, the values for PPT were significantly higher in the TTM group (p > 0.05). We therefore suggest that TTM could be an alternative treatment for the patient with SCS. © 2011 Elsevier Ltd.

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The immediate effects of traditional Thai massage on heart rate variability and stress-related parameters in patients with back pain associated with myofascial trigger points

Journal Journal of bodywork and movement therapies
Year 2011
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The purpose of this study was to investigate the immediate effects of traditional Thai massage (TTM) on stress-related parameters including heart rate variability (HRV), anxiety, muscle tension, pain intensity, pressure pain threshold, and body flexibility in patients with back pain associated with myofascial trigger points. Thirty-six patients were randomly allocated to receive a 30-min session of either TTM or control (rest on bed) for one session. Results indicated that TTM was associated with significant increases in HRV (increased total power frequency (TPF) and high frequency (HF)), pressure pain threshold (PPT) and body flexibility (p< 0.05) and significant decreases in self-reported pain intensity, anxiety and muscle tension (p< 0.001). For all outcomes, similar changes were not observed in the control group. The adjusted post-test mean values for TPF, HF, PPT and body flexibility were significantly higher in the TTM group when compared with the control group (p< 0.01) and the values for pain intensity, anxiety and muscle tension were significantly lower. We conclude that TTM can increase HRV and improve stress-related parameters in this patient population. © 2009 Elsevier Ltd.

Primary study

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A randomised controlled study examining the short-term effects of Strain-Counterstrain treatment on quantitative sensory measures at digitally tender points in the low back

Authors Lewis C , Khan A , Souvlis T , Sterling M
Journal Manual therapy
Year 2010
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Strain-Counterstrain (SCS) intervention has been claimed to elicit immediate and sustained reductions in tenderness at digitally tender points (DTPs), however, there is little experimental evidence to support this. Twenty-eight volunteer participants with low back pain - LBP (17 females and 11 males with mean [SD] age of 39.2 [11.1] and Oswestry disability index of 15.7 [8.6]) participated in this controlled, within-participants study of the immediate and short-term effects of SCS intervention, on pressure pain threshold (PPT) electrical detection threshold (EDT) and electrical pain threshold (EPT) at DTPs in the low back region. Immediate increases in PPT at DTPs were found following all interventions; control intervention: 30.7 kPa [CI 95% - 3.3-64.8] (p= 0.041), sham-SCS intervention: 48.2 kPa [CI 95% 14.8-81.7] (p= 0.008) and SCS intervention: 93.4 kPa [CI 95% 60.0-126.9] (p< 0.0001). Results suggest that SCS intervention does elicit an immediate quantifiable reduction in tenderness at DTPs but that some of this reduction is attributable to the manual-contact component of the treatment. Increases in PPT at DTPs following SCS intervention did not appear to be maintained between 24 and 96 h after treatment. A further finding was that the control intervention elicited significant increases in both EDT (p= 0.044) and EPT (p= 0.026). The explanation for these findings is unclear. © 2010.

Primary study

Unclassified

The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles.

Journal The Journal of orthopaedic and sports physical therapy
Year 2010
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DESIGN: A randomized controlled trial. OBJECTIVE: To investigate the immediate effects on pressure pain thresholds over latent trigger points (TrPs) in the masseter and temporalis muscles and active mouth opening following atlanto-occipital joint thrust manipulation or a soft tissue manual intervention targeted to the suboccipital muscles. BACKGROUND: Previous studies have described hypoalgesic effects of neck manipulative interventions over TrPs in the cervical musculature. There is a lack of studies analyzing these mechanisms over TrPs of muscles innervated by the trigeminal nerve. METHODS: One hundred twenty-two volunteers, 31 men and 91 women, between the ages of 18 and 30 years, with latent TrPs in the masseter muscle, were randomly divided into 3 groups: a manipulative group who received an atlanto-occipital joint thrust, a soft tissue group who received an inhibition technique over the suboccipital muscles, and a control group who did not receive an intervention. Pressure pain thresholds over latent TrPs in the masseter and temporalis muscles, and active mouth opening were assessed pretreatment and 2 minutes posttreatment by a blinded assessor. Mixed-model analyses of variance (ANOVA) were used to examine the effects of interventions on each outcome, with group as the between-subjects variable and time as the within-subjects variable. The primary analysis was the group-by-time interaction. RESULTS: The 2-by-3 mixed-model ANOVA revealed a significant group-by-time interaction for changes in pressure pain thresholds over masseter (P<.01) and temporalis (P = .003) muscle latent TrPs and also for active mouth opening (P<.001) in favor of the manipulative and soft tissue groups. Between-group effect sizes were small. CONCLUSIONS: The application of an atlanto-occipital thrust manipulation or soft tissue technique targeted to the suboccipital muscles led to an immediate increase in pressure pain thresholds over latent TrPs in the masseter and temporalis muscles and an increase in maximum active mouth opening. Nevertheless, the effects of both interventions were small and future studies are required to elucidate the clinical relevance of these changes. LEVEL OF EVIDENCE: Therapy, level 1b.J Orthop Sports Phys Ther 2010;40(5):310-317, Epub 12 April 2010. doi:10.2519/jospt.2010.3257.

Primary study

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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 Journal of manipulative and physiological therapeutics
Year 2009
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Objective: The purpose of this study was to determine immediate effects of ischemic compression (IC) and ultrasound (US) for the treatment of myofascial trigger points (MTrPs) in the trapezius muscle. Methods: Sixty-six volunteers, all CEU-Cardenal Herrera University, Valencia, Spain, personnel, participated in this study. Subjects were healthy individuals, diagnosed with latent MTrPs in the trapezius muscle. Subjects were randomly placed into 3 groups: G1, which received IC treatment for MTrPs; G2, which received US; and G3 (control), which received sham US. The following data were recorded before and after each treatment: active range of motion (AROM) of cervical rachis measured with a cervical range of motion instrument, basal electrical activity (BEA) of muscle trapezius measured with surface electromyography, and pressure tolerance of MTrP measured with visual analogue scale assessing local pain evoked by the application of 2.5 kg/cm2 of pressure using a pressure analog algometer. Results: The results showed an immediate decrease in BEA of the trapezius muscle and a reduction of MTrP sensitivity after treatment with both therapeutic modalities. In the case of IC, an improvement of AROM of cervical rachis was also been obtained. Conclusion: In this group of participants, both treatments were shown to have an immediate effect on latent MTrPs. The results show a relation among AROM of cervical rachis, BEA of the trapezius muscle, and MTrP sensitivity of the trapezius muscle gaining short-term positive effects with use of IC. © 2009.

Primary study

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Immediate Effects of the Suboccipital Muscle Inhibition Technique in Subjects With Short Hamstring Syndrome

Journal Journal of manipulative and physiological therapeutics
Year 2009
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Objective: The purpose of this study is to identify the effects of the suboccipital muscle inhibition technique in patients with short hamstring syndrome by means of tests designed to evaluate the elasticity of the hamstring muscles and pressure algometry of myofascial trigger points. Methods: Randomized clinical trial (pre and postintervention). The study population comprised young adult students following their studies at the Physiotherapy School at the University of Extremadura (Spain) and footballers from an Extremadura Football Club with short hamstring syndrome. The sample (70 subjects = 47 male and 23 female) was randomly divided into a control group (n = 34) and an intervention group (n = 36). Mean sample age was 23.40 ± 3.82 years. The control group was subjected to a placebo technique, whereas the intervention group was subjected to the suboccipital muscle inhibition technique. Pre and postintervention evaluation was used for the assessment of hamstring elasticity, and pressure algometry was also used (myofascial trigger points). Statistical analyses were performed using the SPSS 14.5 package (SPSS Inc, Chicago, Ill), comparing the sample between groups (Kolmorogov-Smirnov test, Student t test, 2-way analysis of variance [ANOVA], the χ2 test). Results: The distribution of the quantitative variables was normal, and the mean time doing physical activity per week was 2.82 ± 4.03 hours. Two-way ANOVA afforded statistically significant results for the finger-floor test, straight leg raise test-left, straight leg raise test-right, left popliteal angle test (P values < .001), and right popliteal angle test (P = .005). For pressure algometry, only the right semimembranosus muscle afforded statistically significant differences (P = .021). Conclusions: According to the finger-floor distance test, the straight leg raise test, and the popliteal angle test, the suboccipital muscle inhibition technique modified the elasticity of the hamstring muscles for this group of subjects. The suboccipital muscle inhibition technique modifies the pressure algometry of the semimembranosus muscle but does not modify that of the semitendinosus muscle or biceps femoris. © 2009 National University of Health Sciences.

Primary study

Unclassified

Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State, and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache: A Pilot Study

Journal Journal of manipulative and physiological therapeutics
Year 2009
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Objective: The purpose of this study was to investigate the immediate effects of head-neck massage on heart rate variability (HRV), mood states, and pressure pain thresholds (PPTs) in patients with chronic tension-type headache (CTTH). Methods: Eleven patients (8 females), between 20 and 68 years old, with CTTH participated in this crossover study. Patients received either the experimental treatment (massage protocol) or a placebo intervention (detuned ultrasound). Holter electrocardiogram recordings (standard deviation of the normal-to-normal interval, square root of mean squared differences of successive NN intervals, index HRV, low-frequency component, and high-frequency component), PPT over both temporalis muscles, and Profile of Mood States questionnaire (tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue, confusion) were obtained preintervention, immediately after intervention, and 24 hours postintervention. Self-reported head pain was also collected preintervention and 24 hours postintervention. Separate analyses of covariance (ANCOVAs) were performed with each dependent variable. The hypothesis of interest was group × time interaction. Results: The ANCOVA showed a significant group × time interaction for index HRV (F = 4.5, P = .04), but not for standard deviation of the normal-to-normal interval (F = 1.1, P = .3), square root of mean squared differences of successive NN intervals (F = 0.9, P = .3), low-frequency component (F = 0.03, P = .8), or high-frequency component (F = 0.4, P = .5) domains. Pairwise comparisons found that after the manual therapy intervention, patients showed an increase in the index HRV (P = .01) domain, whereas no changes were found after the placebo intervention (P = .7). The ANCOVA also found a significant group × time interaction for tension-anxiety (F = 5.3, P = .03) and anger-hostility (F = 4.6, P = .04) subscales. Pairwise comparisons found that after the manual therapy intervention, patients showed a decrease in tension-anxiety (P = .002) and anger-hostility (P = .04) subscales, whereas no changes were found after the placebo intervention (P > .5 both subscales). No significant changes were found in PPT levels (right F = 0.3, P = .6, left F = 0.4, P = .5). A significant group × time interaction for pain (F = 4.8, P = .04) was identified. No influence of sex was found (F = 1.5, P = .3). Pairwise comparisons showed that head pain (numerical pain rating scale) decreased 24 hours after manual therapy (P < .05) but not after the placebo intervention (P = .9). Conclusions: The application of a single session of manual therapy program produces an immediate increase of index HRV and a decrease in tension, anger status, and perceived pain in patients with CTTH. © 2009.

Primary study

Unclassified

Changes in Neck Mobility and Pressure Pain Threshold Levels Following a Cervical Myofascial Induction Technique in Pain-Free Healthy Subjects

Journal Journal of manipulative and physiological therapeutics
Year 2009
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Objective: The purpose of this study was to investigate if the application of a cervical myofascial induction technique targeted to the ligamentum nuchae resulted in changes in cervical range of motion and pressure pain thresholds (PPT) in asymptomatic subjects. Methods: Thirty-five subjects, 8 men and 27 women (mean age, 21 ± 4 years), without a current history of neck, shoulder, or arm pain participated. Participants were randomly divided into 2 groups: the experimental group, which received a real cervical myofascial induction technique, and the control group, which received a sham-manual procedure. Bilateral PPT levels over C5-C6 zygapophyseal joints and tibialis anterior muscles and neck mobility were assessed preintervention and 5 minutes postintervention by an assessor blinded to the treatment allocation of the subject. Separate mixed-model analyses of variance were used to examined the effects of the treatment on neck mobility and PPT levels as the dependent variable, with group (experimental or control) as the between-subjects variable and time (pre-post test) or side (dominant, nondominant) as the within-subjects variable. The hypothesis of interest was the group × time interaction at an a priori α level equal to .05. Results: The group × time interaction was statistically significant for cervical flexion (F = 5.4; P = .03), extension (F = 3.3; P = .045), and left lateral-flexion (F = 4.6; P = .04), but not for right lateral-flexion (F = 2.5; P = .1), right rotation (F = 0.5; P = .5), and left rotation (F = 0.09; P = .2). Subjects receiving the real cervical myofascial induction technique experienced greater improvement in cervical mobility when compared with the control group. The group × time interaction did not reveal any significance for PPT in the C5-C6 zygapophyseal joints (F = 0.5; P = .5) and in the tibialis anterior muscle (F = 0.2; P = .8). Conclusions: The application of a cervical myofascial induction technique resulted in an increase in cervical flexion, extension, and left lateral-flexion, but not rotation motion in a cohort of healthy subjects. No changes in PPT in either C5-C6 zygapophyseal joint (local point) or tibialis anterior muscle (distant point) were found. © 2009.

Primary study

Unclassified

Immediate effect of ischaemic compression and trigger point pressure release on neck pain and upper trapezius trigger points: A randomised controlled trial

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Journal Clinical Chiropractic
Year 2008
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OBJECTIVE:The purpose of this study was to determine the immediate effect of ischaemic compression, trigger point pressure release and placebo ultrasound on pain, degree of cervical lateral flexion and pressure pain threshold of upper trapezius trigger points in subjects with non-specific neck pain. DESIGN:Randomised, single-blind, placebo-controlled trial.SETTING:Anglo-European College of Chiropractic (AECC) in Bournemouth, England.SUBJECTS:Forty-five subjects from the AECC student body between 18 and 55 years of age with non-specific neck pain of at least 30 mm on a visual analogue scale (VAS) for pain, an upper trapezius trigger point and decreased cervical lateral flexion to the opposite side of the active upper trapezius trigger point were entered into the study.METHODS:The subjects were randomly assigned to one of three treatment groups with 15 subjects in each group: trigger point pressure release, ischaemic compression or sham ultrasound (control group). Neck pain level was determined using a visual analogue scale, degree of lateral flexion was determined using a CROM goniometer and pain pressure thresholds were measured with a pain pressure algometer. All subjects attended one treatment session and outcome measures were repeated within five minutes after treatment.RESULTS:Clinical improvement was considered as a reduction of 20 mm or more on the visual analogue scale. Nine subjects in the ischaemic compression group improved after treatment compared to seven subjects in the trigger point pressure release group and four subjects in the control group. The number needed to treat for one patient to improve with ischaemic compression compared to trigger point pressure release was 7.5 (95% CI −4.53 to 2.05). The number needed to treat for one patient to improve with ischaemic compression compared to sham ultrasound was 2.5 (95% CI 1.39–12.51). The odds ratio for improvement with ischaemic compression compared to trigger point pressure release was 1.68 (95% CI 0.41–6.88). The odds ratio for improvement with ischaemic compression compared to sham ultrasound was 5.01 (95% CI 1.19–21.06). A one-way analysis of variance (ANOVA) indicated there was no statistically significant difference beyond chance in pain level, lateral flexion or pain threshold among the groups (P > 0.05).CONCLUSION:Ischaemic compression is superior to sham ultrasound in immediately reducing pain in patients with non-specific neck pain and upper trapezius trigger points. Further research is needed to determine if there is a difference between ischaemic compression and trigger point pressure release.