Primary studies included in this systematic review

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Primary study

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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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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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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.

Primary study

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Reduction of spontaneous electrical activity and pain perception of trigger points in the upper trapezius muscle through trigger point compression and passive stretching

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Journal Journal of Musculoskeletal Pain
Year 2008
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVES:Investigate the effects of ischemic compression [IC] technique and passive stretching [PS] in isolation and in combination on the reduction of spontaneous electrical activity [SEA] and perceived pain in trigger points [TrPs] located in the upper trapezius muscle.METHODS:Ninety participants with TrPs in the upper trapezius muscle were randomly assigned to three treatment groups: IC, PS, and IC + PS. TrP compression was applied on the TrP for three applications of 60 seconds each, followed by a 30-second rest period. PS was applied for three 45-second applications, with 30-second rest intervals. All patients received the same amount of therapy.RESULTS:Significant decreases were found in pain perception and on SEA for all study participants. The IC + PS group evidenced greater declines in pain perception and SEA when compared to the IC and PS groups.CONCLUSION:Because of ethical considerations, a control group design was not possible, thereby limiting the robustness of the findings. Although each technique significantly reduced pain perception and SEA, the combination of IC and PS was superior, apparently because of the complementary nature of the therapeutic interventions.

Primary study

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Relative immediate effect of ischaemic compression and activator trigger point therapy on active upper trapezius trigger points: A randomised trial

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Authors Gemmell, Hugh , Allen, Anna
Journal Clinical Chiropractic
Year 2008
Links DOI Google Scholar

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND:Trigger points are a common cause of severe and disabling pain in chiropractic practice. While trigger points may be found in any skeletal muscle the majority are found in the upper trapezius. Relatively few studies have investigated non-invasive treatments for upper trapezius trigger points. Common manual therapy treatments utilized for upper trapezius trigger points in chiropractic include manual pressure and myofascial release. The purpose of this study was to compare the effect of a single treatment of ischaemic compression and activator trigger point therapy on active upper trapezius trigger points.METHODS:Fifty-two subjects with active upper trapezius trigger points met the participation criteria and were randomised to an ischaemic compression or activator trigger point therapy group. The primary outcome measure was Patient Global Impression of Change. Secondary outcome measures were an 11-point numerical rating scale for change in pain, and change in pressure pain threshold using an algometer for trigger point sensitivity. While the treating clinician and subjects were not masked to treatment assignment, the examiner was blind to treatment assignment until data analyses were completed. An independent t-test was used to compare the groups at baseline on the continuous variables. The Mann–Whitney U-test was used to compare the groups at baseline on the non-continuous variables. Relative risk ratios of improvement for the primary and secondary outcome measures were calculated with 95% confidence intervals for clinical significance.RESULTS:Seventy volunteers were screened with 25 subjects randomised to the ischaemic compression group and 27 to the activator trigger point therapy group. There was no significant difference between the groups in any of the baseline variables. On the primary outcome measure both groups improved (78% of those in the activator group and 72% in the ischaemic compression group). Relative risk for improvement of 1.00 suggested that those treated with the Activator instrument were no more likely to improve than those treated with ischaemic compression (95% CI = 0.73–1.37). For the secondary outcome measure of pain reduction 41% of those treated with the Activator instrument improved compared to 36% of those in the ischaemic compression group. Those treated with the Activator instrument were 13% more likely to improve than those treated with ischaemic compression. However this relative risk of 1.13 in favour of the activator group was not significant (95% CI = 0.57–2.26). For the secondary outcome of reduction in trigger point sensitivity 32% of those in the ischaemic compression group improved compared to 30% in the activator group. Those treated with ischaemic compression were 8% more likely to improve; however, the relative risk of 1.08 was not significant (95% CI = 0.48–2.44). As risk of improvement on the outcome measures between the groups was not significantly different, number needed to treat was not calculated.CONCLUSION:Based on the primary outcome measure the results suggest that both ischaemic compression and activator trigger point therapy have an equal immediate clinically important effect on upper trapezius trigger point pain.

Primary study

Unclassified

Immediate effects of inhibitive distraction on active range of cervical flexion in patients with neck pain: A pilot study

Journal The Journal of manual & manipulative therapy
Year 2007
Links Pubmed DOI PubMed Central

This article is included in 1 Systematic review Systematic reviews (1 reference)

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The purpose of this pilot study was to examine the immediate effects of a manual therapy technique called Inhibitive Distraction (ID) on active range of motion (AROM) for cervical flexion in patients with neck pain with or without concomitant headache. A secondary objective of this study was to see whether patient subgroups could be identified who might benefit more from ID by studying variables such as age, pain intensity, presence of headache, or pre-intervention AROM. We also looked at patients' ability to identify pre- to post-intervention changes in their ability to actively move through a range of motion. Forty subjects (mean age 34.7 years; range 16-48 years) referred to a physical therapy clinic due to discomfort in the neck region were randomly assigned to an experimental and a control group. We used the CROM goniometer to measure pre- and post-intervention cervical flexion AROM in the sagittal plane within a single treatment session. The between-group difference in AROM increase was not statistically significant at P<0.05 with a mean post-intervention increase in ROM of 2.4° (SD 6.2°) for the experimental group and 1.2° (SD 5.8°) for the placebo group. We were also unable to identify potential subgroups more likely to respond to ID, although a trend emerged for greater improvement in chronic patients with headaches, lower pain levels, and less pre-intervention AROM. In the experimental group and in both groups combined, subjects noting increased AROM indeed had a significantly greater increase in AROM than those subjects not noting improvement. In conclusion, this study did not confirm immediate effects of ID on cervical flexion AROM but did provide indications for potential subgroups likely to benefit from this technique. Recommendations are provided with regard to future research and clinical use of the technique studied.

Primary study

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The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: A pilot study

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Journal Journal of Bodywork and Movement Therapies
Year 2006
Links DOI Google Scholar

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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The aim of this pilot study was to compare the effects of a single treatment of the ischemic compression technique with transverse friction massage for myofascial trigger point (MTrP) tenderness. Forty subjects, 17 men and 23 women, aged 19-38 years old, presenting with mechanical neck pain and diagnosed with MTrPs in the upper trapezius muscle, according to the diagnostic criteria described by Simons and by Gerwin, participated in this pilot study. Subjects were divided randomly into two groups: group A which was treated with the ischemic compression technique, and group B which was treated with a transverse friction massage. The outcome measures were the pressure pain threshold (PPT) in the MTrP, and a visual analogue scale assessing local pain evoked by a second application of 2.5 kg/cm2 of pressure on the MTrP. These outcomes were assessed pre-treatment and 2 min post-treatment by an assessor blinded to the treatment allocation of the subject. The results showed a significant improvement in the PPT (P=0.03), and a significant decrease in the visual analogue scores (P=0.04) within each group. No differences were found between the improvement in both groups (P=0.4). Ischemic compression technique and transverse friction massage were equally effective in reducing tenderness in MTrPs. © 2005 Elsevier Ltd. All rights reserved.

Primary study

Unclassified

Comparison of connective tissue massage and spray-and-stretch technique in the treatment of chronic cervical myofascial pain syndrome

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Journal The Pain Clinic
Year 2004
Links DOI Google Scholar

This article is included in 1 Systematic review Systematic reviews (1 reference)

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The aim of this study was to investigate whether ischemic pain tolerance changed in patients who had successfully undergone treatment for chronic cervical myofascial pain syndrome (MPS). In a controlled study, patients with the diagnosis of MPS were assessed for pain intensity using a visual analogue scale (VAS), number of trigger points, range of motion (ROM) in cervical region, and ischemic pain threshold and tolerance using a modified tourniquet technique. Patients were randomly allocated into two groups. The first group was treated with connective tissue massage and the second with vapocoolant spray and stretch technique. No difference was found between the groups as regards to the assessed parameters except VAS, which was higher in the group treated with the spray and stretch technique. Following treatment, although there was a significant decrease in pain intensity and number of trigger points, and an increase in ROM in both groups, there was no difference in ischemic pain threshold or tolerance, when compared with pre-treatment values.

Primary study

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Randomised trial of acupuncture compared with conventional massage and "sham" laser acupuncture for treatment of chronic neck pain.

Journal BMJ (Clinical research ed.)
Year 2001
Links Pubmed DOI PubMed Central

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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OBJECTIVES: To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain. DESIGN: Prospective, randomised, placebo controlled trial. Setting: Three outpatient departments in Germany. PARTICIPANTS: 177 patients aged 18-85 years with chronic neck pain. Interventions: Patients were randomly allocated to five treatments over three weeks with acupuncture (56), massage (60), or "sham" laser acupuncture (61). MAIN OUTCOME MEASURES: Primary outcome measure: maximum pain related to motion (visual analogue scale) irrespective of direction of movement one week after treatment. Secondary outcome measures: range of motion (3D ultrasound real time motion analyser), pain related to movement in six directions (visual analogue scale), pressure pain threshold (pressure algometer), changes of spontaneous pain, motion related pain, global complaints (seven point scale), and quality of life (SF-36). Assessments were performed before, during, and one week and three months after treatment. Patients' beliefs in treatment were assessed. RESULTS: One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage (difference 24.22 (95% confidence interval 16.5 to 31.9), P=0.0052) but not compared with sham laser (17.28 (10.0 to 24.6), P=0.327). Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years (n=75) and in patients with myofascial pain syndrome (n=129). The acupuncture group had the best results in most secondary outcome measures. There were no differences in patients' beliefs in treatment. CONCLUSIONS: Acupuncture is an effective short term treatment for patients with chronic neck pain, but there is only limited evidence for long term effects after five treatments.

Primary study

Unclassified

Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

Journal Physical therapy
Year 2000
Links Pubmed

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.