The thesis is divided into theoretical and practical part. The theoretical part contains information about anatomy of the trapezius muscle and its myofascial pathology. Author further discusses trigger points, their histopathology and diagnostic and therapeutic capabilities. A significant section of the theoretical part explains the physical principle of ultrasound therapy and laser phototherapy, including clinical aspects and their use in the treatment of trigger points. The practical part is focused on comparing the efficacy and relative effectiveness of two methods of physical therapy - ultrasound therapy and laser phototherapy, where myofascial trigger points treatment effect can be expected. Research group is made up of 47 patients divided into two groups. These patients have a doctor confirmed trigger point in the upper portion of trapezius muscle. The first group of patients is treated by exactly parametrically defined ultrasound therapy. The second group of patients is treated by specifically defined laser phototherapy. The aim of this thesis is to compare the above mentioned physical procedures in terms of subjective and objective efficacy in the treatment of trigger points and also to compare their relative effectiveness.

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.

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...

Avaliou-se a eficácia do tratamento através da técnica de agulhamento a seco, com injeção de lidocaína a 0,5% e injeção de lidocaína a 1% em pacientes portadores de dor miofascial e na presença de pontos-gatilho em músculos da mastigação. Foram selecionados 26 pacientes e divididos em três grupos: Grupo I: pacientes submetidos a injeção de lidocaína a 0,5%. Grupo II: Pacientes submetidos à injeção de lidocaína a 1%. Grupo III: Pacientes submetidos ao agulhamento a seco. Avaliou-se os pacientes através do limiar de dor a palpação (LDP) e da escala de análise visual de dor (EAV) nos períodos: inicial (antes da infiltração), imediatamente após a infiltração, 24 horas depois, 7, 15, 21 e 30 dias respectivamente. Os resultados foram coletados e analisados através do teste anova a 2 critérios adotando-se nível de significância de 0,05%. Onde houve diferenças estatísticas significantes, aplicou-se o Teste de Tukey. Não houve diferenças estatísticas significantes entre os três grupos quando comparados o LDP entre os grupos, porém houve diferenças significantes quando comparado o LDP ao longo do tempo, sendo que este aumentou significativamente. Em relação à EAV, acharam-se diferenças tanto entre os grupos quanto ao longo do tempo, sendo que o grupo X teve uma diminuição mais rápida do que os outros dois. Porém, ao final, todos os grupos tiveram reduções significantes e sem diferenças entre si. Conclui-se que todos os tratamentos foram eficazes na redução dos sintomas da dor miofascial no tempo avaliado, não havendo diferenças entre os tratamentos. / The purpose of this study was to compare the effectiveness of trigger points injections using lidocaine 0,5%, lidocaine 1% and dry needling without any kind of home-based rehabilitation program. 26 patients with myofascial pain and trigger points in masticatory muscles. They were randomly assigned in three groups and received only one application session. The pressure pain threshold (PPT) was recorded before the injection, ten minutes after, 24 hours later, 7, 15, 21 end 30 days after the treatment. Visual analogue scale (VAS) was used to in all evaluation periods. There were no differences between groups for PPT. but for all groups, the PPT during the time significantly increased when compared the before treatment. VAS showed differences between groups and during the time. VAS was significant lower when compared 30 days to before treatment. Among the groups, 0,5% lidocaine ha the lowest VAS values when compared to the others, but at 30 days there were no differences among them. Despite the differences in VAS and considering there were no differences in PPT increases, we concluded that, in this study, all groups were able to disrupt the mechanisms of trigger point and relieve the myofascial pain symptoms.

Local twitch responses (LTRs) can be elicited by snapping palpation of myofascial trigger points (TrP) or TrP injections. Objective: To characterize the LTR elicited by TrP injection and snapping palpation on surface electromyography (sEMG) in subjects with myofascial pain in 14 female subjects. Methods: Surface EMG electrodes were placed around the TrP and a control site on the trapezius muscle. Then the following protocol was carried out: tension and contraction of the ipsilateral trapezius muscle, baseline resting activity (five minutes), snapping palpation of the TrP and the control sites, TrP injection, and final resting activity (five minutes). The following data were recorded: pain ratings, areas of referred pain, presence of LTR, and sEMG recordings. Results: During the TrP injection, the investigator found LTRs in only 36% of the subjects, while 64% of the subjects reported that they felt the LTR, and the sEMG recorded only one LTR in one subject. Despite the low percentage of LTRs elicited clinically (36%), a large number of subjects (71%) reported more than 50% immediate reduction in pain intensity after the TrP injection. Conclusion: The sEMG is unable to register the LTR elicited by snapping palpation and TrP injection.

Avaliou-se a eficácia do tratamento através da técnica de agulhamento a seco, com injeção de lidocaína a 0,5% e injeção de lidocaína a 1% em pacientes portadores de dor miofascial e na presença de pontos-gatilho em músculos da mastigação. Foram selecionados 26 pacientes e divididos em três grupos: Grupo I: pacientes submetidos a injeção de lidocaína a 0,5%. Grupo II: Pacientes submetidos à injeção de lidocaína a 1%. Grupo III: Pacientes submetidos ao agulhamento a seco. Avaliou-se os pacientes através do limiar de dor a palpação (LDP) e da escala de análise visual de dor (EAV) nos períodos: inicial (antes da infiltração), imediatamente após a infiltração, 24 horas depois, 7, 15, 21 e 30 dias respectivamente. Os resultados foram coletados e analisados através do teste anova a 2 critérios adotando-se nível de significância de 0,05%. Onde houve diferenças estatísticas significantes, aplicou-se o Teste de Tukey. Não houve diferenças estatísticas significantes entre os três grupos quando comparados o LDP entre os grupos, porém houve diferenças significantes quando comparado o LDP ao longo do tempo, sendo que este aumentou significativamente. Em relação à EAV, acharam-se diferenças tanto entre os grupos quanto ao longo do tempo, sendo que o grupo X teve uma diminuição mais rápida do que os outros dois. Porém, ao final, todos os grupos tiveram reduções significantes e sem diferenças entre si. Conclui-se que todos os tratamentos foram eficazes na redução dos sintomas da dor miofascial no tempo avaliado, não havendo diferenças entre os tratamentos. / The purpose of this study was to compare the effectiveness of trigger points injections using lidocaine 0,5%, lidocaine 1% and dry needling without any kind of home-based rehabilitation program. 26 patients with myofascial pain and trigger points in masticatory muscles. They were randomly assigned in three groups and received only one application session. The pressure pain threshold (PPT) was recorded before the injection, ten minutes after, 24 hours later, 7, 15, 21 end 30 days after the treatment. Visual analogue scale (VAS) was used to in all evaluation periods. There were no differences between groups for PPT. but for all groups, the PPT during the time significantly increased when compared the before treatment. VAS showed differences between groups and during the time. VAS was significant lower when compared 30 days to before treatment. Among the groups, 0,5% lidocaine ha the lowest VAS values when compared to the others, but at 30 days there were no differences among them. Despite the differences in VAS and considering there were no differences in PPT increases, we concluded that, in this study, all groups were able to disrupt the mechanisms of trigger point and relieve the myofascial pain symptoms.

The aim of this paper was to summarize the current knowledge of function and regulation of autonomic nervous system (ANS). We wanted to assess possible involvement of ANS in changes of muscle tension. Sympathetic nervous system affects the sensitivity of somatosenzory afferention, thus effecting the function of whole nervous system. Exists evidence about ANS effect on cutaneous afferents activity as well as muscle spindle afferent activity. Sympathetic modulation of proprioceptive information from muscle spindles may influence α motoneuron excitability. ANS may affect muscle tonus regulation. The selective activation of trigger point (TRP) during heightened muscle sympathetic efferent activity (MSNA) was proved. This supports the idea that the sympathetic nervous system can directly contribute on maintaining of the TRP and myofascial pain syndrome. Powered by TCPDF (www.tcpdf.org)

Background: The effect of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy are unknown. Objectives: To determine the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to exercise in a patient population with Achilles tendinopathy. Methods: This single-factor, pretest-posttest control group design included 22 subjects between the ages of 24 and 65 years with Achilles tendinopathy. Subjects were randomly assigned to either a control group (MT+Ex) or experimental group (TDN+MT+Ex). Subjects in both groups completed 8 physical therapy treatment sessions over 4 weeks. The intervention for the TDN+MT+Ex group included TDN to MTPs in the gastrocnemius, soleus or tibialis posterior each session while the same soft tissue mobilization and exercise program was conducted in both groups. Results: Within group analysis was performed for each group at 4 week and 90 day follow up. Significant improvement (p < .05) was achieved for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 90 days. The GROC was significant for MT + Ex at 90 days. The MCID for the FAAM, GROC were surpassed in both groups at 4 weeks and 90 days. NPRS surpassed the MCID for the MT + Ex group at 4 weeks. Conclusion: A large RCT to investigate the effects of TDN on MTP in Achilles tendinopathy is feasible with modifications. Recommendations: Special considerations for data collection sites should be given to the health care system, insurance payor, and financial burden to subjects.

Title of thesis: The effect of manual therapy on visual acuity. Goal: The main goal is to present theoretical facts about manual eye therapy, to examine the effect of manual therapy of oculomotor muscles on selected parameters: visual acuity, subjective evaluation using a questionnaire and eye muscle pain in patients with refractive errors and eye accommodation disorders. Methods: The research was completed by 20 patients with refractive errors and eye accommodation disorders, from aged 18 to 55 years. An initial and subsequent treatment and exit examination and of eye muscles with the help of manual techniques, in particular, reciprocal inhibition and mobilization of eyeball were performed. The initial examination was performed by an optometrist, who assessed visual acuity by using an Autorefractometr, Snellen optotype and Red-green test test. After than was performed the subjective evaluation questionnaire, then was performed palpation assessment of attachments of eye muscles. Palpation pain proband evaluated using the Numeric Pain Rating Scale.The resulting data were processed using statistical software R. A paired t-test was used to calculate p-values. Statistical significance was assessed at the critical significance level of 0.05 and 0.01. Results: Our measurement did not show a statically...

Objective: To determine the difference in effectiveness of positional release therapy (PRT) compared with therapeutic massage (TM) in treating trigger and tender points in the upper trapezius muscle. Background: Trigger points in the upper trapezius muscle are common and can be painful. Therapeutic massage is a more traditional treatment method for this condition while PRT is relatively new. Design and Setting: A randomized-group design was used to examine the differences between the 2 treatments for reducing pain and muscle tension. Subjects: Sixty healthy subjects (males = 24, females = 36; age = 27.1 ± 8.8 years; wt = 75.2 ± 17.9 kg; ht = 172.8 ± 9.7 cm) presenting with upper trapezius pain and a trigger point. Subjects were randomly assigned to the TM group or the PRT group. Measurements: Presence of upper trapezius trigger points was found via palpation by a clinician. Level of pain was measured by a visual analog scale (VAS) and pain pressure threshold (PPT) was assessed by a pressure algometer. Muscle thickness was measured by B-mode ultrasound (US) and muscle tension was measured by shear-wave elastography (SWE). Subjects were measured pretreatment and posttreatment and 48 hours later. Results: All measurements showed significant improvements for both treatments. Positional release therapy was more effective (p = 0.05) at reducing pain at day 2 and was able to maintain the pain loss. The SWE and US showed no difference between the treatment groups. There was no significant difference in PPT, but PRT PPT increased each visit while TM dropped significantly at day 2 (p = .003). Conclusion: Both treatments showed a significant ability to reduce pain and acutely decrease muscle stiffness (as measured by SWE) but there were few differences between the treatments. However, there appeared to be a slight benefit for pain reduction with PRT up to 2 days posttreatment.