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An investigation into the effect of examiner-training on the inter-examiner reliability of the palpation of myofascial trigger pointsMoodley, Kubashnie January 2011 (has links)
Dissertation submitted in partial compliance with the requirements for the
Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points
(MTrP). It is recognised by unique features which include a tender point in a taut band of
muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the
reproduction of the patient’s usual pain upon examination. A debate exists as to the precise
diagnostic criteria used in identifying trigger points. This has hampered the standardized
assessment and treatment of Myofascial Pain Syndrome and has led to contradictory
findings being reported by various authors due to the lack of a reliable diagnostic tool.
Objectives: The first objective was to determine the inter-examiner reliability of palpation of
MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine
whether training and standardization in palpation techniques would improve inter-examiner
reliability of palpation of MTrPs.
Methods: This study was designed as a quantitative pre and post intervention interexaminer
reliability study. Three examiners (one qualified Chiropractor, one senior
chiropractic intern from the CDC and the researcher) were used to examine sixty patients
(thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two
phases. During the myofascial examination of patients examiners were required to
determine whether a MTrP was present or absent, differentiate whether the MTrP was active
or latent and determine the presence or absence of the five characteristics of MTrP (tender
point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred
pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase
one the researchers were blinded to the characteristics being investigated. Subsequent to
phase one, examiners had to attend two, one hour discussion sessions to reduce individual
variation in the application of palpation techniques.
Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage
agreement and confidence intervals. The results show that three examiners are able to
attain acceptable agreement in the palpation of MTrPs, since the features (described above)
were shown to improve considerably in phase two after the training session in which
standardization of techniques was emphasized.
Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and
therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial
Pain Syndrome.
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Lokální změna diskriminačního čití nad myofasciálním trigger pointem / Myofascial Trigger point and Two point discrimination changes in MTrP regionHomolka, Pavel January 2010 (has links)
The main purpose of this thesis, called The local changes in discriminatory sensation above a myofascial Trigger Point, was to assess the relationship of a local nociception in the form of the myofascial Trigger Point to the local discriminatory sensation. Based on the theoretical information, hypothesis concerning the relationship of MTrP and two point discrimination were experimentally checked. The subject of the research was the trigger point trapezius pars ascendens. Localized MTrP was clinically evaluated in terms of both static and dynamic factors. Using a palpometer, its sensitivity by level of pressure generated pain (pressure generated pain threshold) was rated. The quality of two-point discrimination was rated as well. Furthermore it was also rated how a made isometric relaxation changed the sensitivity as nociceptive so discriminatory. Discriminatory sensation (attention threshold (AT-TPD), stable threshold (SSV-TPD)) in the region above the trigger point was measured by a mechanical caliper with modified tips radius of 1mm. Generally 23 probands were examined, 11 of them had simultaneously diagnosed a presence of the constitutional hypermobility. The results of the work confirmed that the made isometric relaxation had a significant influence on the change of thresholds discrimination of two...
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An investigation into the effect of examiner-training on the inter-examiner reliability of the palpation of myofascial trigger pointsMoodley, Kubashnie January 2011 (has links)
Dissertation submitted in partial compliance with the requirements for the
Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. / Background: Myofascial pain is a disorder, characterized by the presence of trigger points
(MTrP). It is recognised by unique features which include a tender point in a taut band of
muscle, a local twitch response (LTR), a characteristic referred pain pattern, and the
reproduction of the patient’s usual pain upon examination. A debate exists as to the precise
diagnostic criteria used in identifying trigger points. This has hampered the standardized
assessment and treatment of Myofascial Pain Syndrome and has led to contradictory
findings being reported by various authors due to the lack of a reliable diagnostic tool.
Objectives: The first objective was to determine the inter-examiner reliability of palpation of
MTrPs in the trapezius and gluteus medius muscles. The second objective was to determine
whether training and standardization in palpation techniques would improve inter-examiner
reliability of palpation of MTrPs.
Methods: This study was designed as a quantitative pre and post intervention interexaminer
reliability study. Three examiners (one qualified Chiropractor, one senior
chiropractic intern from the CDC and the researcher) were used to examine sixty patients
(thirty symptomatic and thirty asymptomatic) for MTrPs. This study was conducted in two
phases. During the myofascial examination of patients examiners were required to
determine whether a MTrP was present or absent, differentiate whether the MTrP was active
or latent and determine the presence or absence of the five characteristics of MTrP (tender
point in a taut band of muscle, a local twitch response (LTR), a pain characteristic referred
pain pattern, the reproduction of the patient’s usual pain and a jump sign) however, in phase
one the researchers were blinded to the characteristics being investigated. Subsequent to
phase one, examiners had to attend two, one hour discussion sessions to reduce individual
variation in the application of palpation techniques.
Results: Inter-examiner reliability was assessed using Fleiss Kappa statistic, percentage
agreement and confidence intervals. The results show that three examiners are able to
attain acceptable agreement in the palpation of MTrPs, since the features (described above)
were shown to improve considerably in phase two after the training session in which
standardization of techniques was emphasized.
Conclusion: This study provides preliminary evidence that MTrP palpation is reliable and
therefore, useful diagnostic tool in the identification of MTrPs and the diagnosis of Myofascial
Pain Syndrome.
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Correlação clínica e termográfica do ponto-gatilho miofascial nos músculos da mastigação / Thermographic and clinical correlation of myofascial trigger points in the masticatory musclesHaddad, Denise Sabbagh 09 August 2011 (has links)
A síndrome dolorosa miofascial (SDM) é uma disfunção musculoesquelética não articular caracterizada por pontos-gatilho miofasciais. Estes pontos, identificados por meio da palpação, são descritos como bandas tensas na fibra muscular, podendo apresentar dor referida à compressão. Sabe-se que os pontos-gatilho miofasciais provocam hiperatividade simpática regional de temperatura local devido à atividade vasoconstritora cutânea. Para documentação objetiva por imagem desta alteração funcional, a termografia tem sido proposta como método auxiliar diagnóstico. O objetivo deste estudo foi correlacionar os exames clínico e termográfico dos pontos-gatilho nos músculos da mastigação masseter e temporal parte anterior. A amostra constituiu-se por 26 mulheres voluntárias com 41 ± 15 anos. Os resultados demonstraram correlação diretamente proporcional entre algometria e termografia na avaliação do ponto-gatilho miofascial, onde, quanto menor a força aplicada, menor a temperatura local (p<0,001). As áreas com dor referida apresentaram níveis de limiar de dor à pressão (1.28±0.45 kgf) menores quando comparados às áreas de dor local (1.73±0,59 kgf; p<0.001). Sendo assim, a imagem termográfica de um ponto-gatilho apresentou-se hiporradiante quando comparada à região de ausência de ponto-gatilho (ΔT>0,4ºC; p<0.001). Além disso, a avaliação termográfica dos pontos-gatilho nos músculos masseter e temporal pelo gradiente térmico (ΔT e Δθ) apresentou maior sensibilidade e especificidade em comparação com a temperatura absoluta (T), mesmo quando corrigidos estes valores para a temperatura ambiente e temperatura timpânica da voluntária durante o exame (θ). A termografia isoladamente identificou pontos-gatilho com sensibilidade de 62,5% e especificidade de 71,31%. Os autores concluíram que a termografia é um método de imagem não invasivo, com potencial de identificação de pontos-gatilho miofasciais na região facial. / Myofascial pain syndrome is a myalgic dysfunction characterized by myofascial trigger points (MTP). The taut band is a constant feature of a trigger point characterized by referred pain when stimulated. It is known that the myofascial trigger points cause regional sympathetic hyperactivity in local temperature due to the cutaneous vasoconstrictor activity. For detection of functional changes, thermography may be used as an auxiliary diagnostic imaging. The aim of this study was to correlate clinical and thermographic myofascial trigger points in the masticatory muscles masseter and temporalis. Twenty six women volunteers were included, having a mean age of 41 ± 15 years. The results showed directly proportional relationship by algometry and thermography in the assessment of MTP, where smaller the force applied, lower the local temperature will be (p<0.001). Moreover, when the soreness was evaluated and local vasomotor response, the temperature decreases as the worst local situation. PPT (pressure pain threshold) levels measured at the points of referred pain in MTP (1.28±0.45 kgf) were significantly lower than the areas of local pain in MTP (1.73±0,59 kgf; p<0.001). Thus, the thermographic image of a MTP presented colder than the area without trigger point (ΔT>0,4ºC; p<0.001). In the thermographic assessment of MTP in the masseter and temporalis muscles, the results suggest that the parameters of thermal asymmetry (ΔT and Δθ) show greater sensitivity and specificity in comparison to local absolute temperature values (T), even when corrected for the volunteer\'s core temperature and the temperature of the room during the exam (θ). Thermography can identify trigger points (referred pain) with sensitivity of 62,50% and specificity of 71,31%. The authors concluded that thermography is a noninvasive imaging method with potential for screening patients with MTP in the facial region.
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Correlação clínica e termográfica do ponto-gatilho miofascial nos músculos da mastigação / Thermographic and clinical correlation of myofascial trigger points in the masticatory musclesDenise Sabbagh Haddad 09 August 2011 (has links)
A síndrome dolorosa miofascial (SDM) é uma disfunção musculoesquelética não articular caracterizada por pontos-gatilho miofasciais. Estes pontos, identificados por meio da palpação, são descritos como bandas tensas na fibra muscular, podendo apresentar dor referida à compressão. Sabe-se que os pontos-gatilho miofasciais provocam hiperatividade simpática regional de temperatura local devido à atividade vasoconstritora cutânea. Para documentação objetiva por imagem desta alteração funcional, a termografia tem sido proposta como método auxiliar diagnóstico. O objetivo deste estudo foi correlacionar os exames clínico e termográfico dos pontos-gatilho nos músculos da mastigação masseter e temporal parte anterior. A amostra constituiu-se por 26 mulheres voluntárias com 41 ± 15 anos. Os resultados demonstraram correlação diretamente proporcional entre algometria e termografia na avaliação do ponto-gatilho miofascial, onde, quanto menor a força aplicada, menor a temperatura local (p<0,001). As áreas com dor referida apresentaram níveis de limiar de dor à pressão (1.28±0.45 kgf) menores quando comparados às áreas de dor local (1.73±0,59 kgf; p<0.001). Sendo assim, a imagem termográfica de um ponto-gatilho apresentou-se hiporradiante quando comparada à região de ausência de ponto-gatilho (ΔT>0,4ºC; p<0.001). Além disso, a avaliação termográfica dos pontos-gatilho nos músculos masseter e temporal pelo gradiente térmico (ΔT e Δθ) apresentou maior sensibilidade e especificidade em comparação com a temperatura absoluta (T), mesmo quando corrigidos estes valores para a temperatura ambiente e temperatura timpânica da voluntária durante o exame (θ). A termografia isoladamente identificou pontos-gatilho com sensibilidade de 62,5% e especificidade de 71,31%. Os autores concluíram que a termografia é um método de imagem não invasivo, com potencial de identificação de pontos-gatilho miofasciais na região facial. / Myofascial pain syndrome is a myalgic dysfunction characterized by myofascial trigger points (MTP). The taut band is a constant feature of a trigger point characterized by referred pain when stimulated. It is known that the myofascial trigger points cause regional sympathetic hyperactivity in local temperature due to the cutaneous vasoconstrictor activity. For detection of functional changes, thermography may be used as an auxiliary diagnostic imaging. The aim of this study was to correlate clinical and thermographic myofascial trigger points in the masticatory muscles masseter and temporalis. Twenty six women volunteers were included, having a mean age of 41 ± 15 years. The results showed directly proportional relationship by algometry and thermography in the assessment of MTP, where smaller the force applied, lower the local temperature will be (p<0.001). Moreover, when the soreness was evaluated and local vasomotor response, the temperature decreases as the worst local situation. PPT (pressure pain threshold) levels measured at the points of referred pain in MTP (1.28±0.45 kgf) were significantly lower than the areas of local pain in MTP (1.73±0,59 kgf; p<0.001). Thus, the thermographic image of a MTP presented colder than the area without trigger point (ΔT>0,4ºC; p<0.001). In the thermographic assessment of MTP in the masseter and temporalis muscles, the results suggest that the parameters of thermal asymmetry (ΔT and Δθ) show greater sensitivity and specificity in comparison to local absolute temperature values (T), even when corrected for the volunteer\'s core temperature and the temperature of the room during the exam (θ). Thermography can identify trigger points (referred pain) with sensitivity of 62,50% and specificity of 71,31%. The authors concluded that thermography is a noninvasive imaging method with potential for screening patients with MTP in the facial region.
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Změny prahu tlakově-algické citlivosti svalu v závislosti na kloubní konfiguraci - centrované vs. decentrované postavení / Joint configuration changes pressure pain threshold-centered and decentered positionJevič, Filip January 2011 (has links)
The term "joint centration" is recently perceived primarily in its biomechanical context. This paper suggests a possible neurophysiological point of view and examines the effect of centered or decentered position on pressure pain treshold (PPT) of three muscles (m. temporalis, m. tibialis anterior, m. interosseus dorsalis I) in sitting and lying position, researched on healthy volunteers. PPT was measured in four randomly ordered positions with 49 people (21 women, 28 men). Significantly higher PPT was detected in all three muscles (p=0,001; 0,0016; 0,00009). In percent the PPT change resembles some of studies working with therapeutical techniques (mobilization, joint manipulation, exercise). Influence of higher postural position (sitting compared to lying down) on PPT was not proved. Cenetered joint position increases the PPT of healthy young adults compared to decentered position. This newly proved fact opens further possibilities of conceiving the key physiotherapeutical notion of "joint centration".
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Hodnocení krátkodobého efektu aplikace rázové vlny na spoušťové body v myofasciálních tkáních / Evaluation of short-term effect of Extracorporeal shockwave therapy into muscular trriger points.Novák, Jan January 2015 (has links)
Diplomová práce Hodnocení krátkodobého efektu aplikace rázové vlny na MTrP Abstract This thesis concerns the application of radial extracorporeal shockwave therapy into muscular trigger points. It's location is derived from the descending part of trapezius muscle on the side of the dominant upper extremity. The performance analysis is based on using partially double-blind placebo-controlled, randomized clinical trial. The effects of the therapy were investigated in 28 subjects divided into experimental and control groups and objectively manifested by measuring the pressure pain threshold. Furthermore, the measuring of the active range of motion of the cervical spine, and the measuring of the maximal voluntary wrist and third finger flexion (measured before and after the therapy). After the therapy, the pressure pain threshold value of the trigger point located in trapezius muscle increased on average from 199 to 295 kPa (p = 0,025). The cervical spine lateral flexion increased on average by 3 degrees towards to the side of non-dominant upper extremity (p = 0,045). This study also investigates the pressure pain threshold value changes of 7 reference points placed remotely from the area of the application. After the shockwave therapy, the pressure pain threshold values of these reference points increased on...
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Srovnání triggerlytických účinků kombinované terapie a ultraelektrostimulace / The comparation of triggerlytic effect of combination therapy (ultrasound + TENS) and ultra electrostimulationKlesnilová, Eliška January 2021 (has links)
The thesis deals with the effect of two methods of physical therapy on myofascial trigger point, in particular combined therapy (US + TENS) and ultra- electrostimulation. Furthermore, there is investigated whether the release of MTrP is reflected in values of pressure pain threshold in chained muscles and there is discussed the use of combined therapy as an objectification tool. The theoretical part of the thesis deals with general and latest knowledge about myofascial trigger points. There are discussed some possibilities of the therapy with emphasis on physical therapy and transcutaneous electroneurostimulation, which form the basis for combined therapy (CT) and ultra-electrostimulation. The research part evaluates the effect of combined therapy and ultra-electrostimulation on a group of 12 probands randomly divided into two subgroups. Values of pressure pain threshold sensitivity, visual analogue pain scale (VAS) and the minimum intensity of electric current necessary to induce muscle contraction (measured by combined therapy) are used for objectification. Ultra-electrostimulation has proven to be a more effective method in VAS values, but in summary, the results cannot be considered statistically significant. The effect of MTrP release (of the trapezius muscle) on the chained muscles could not...
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