Despite a paucity of experimental evidence, clinical opinion remains that though LTrPs allow pain-free movement, they are primarily associated with deleterious motor effects and occur commonly in 'healthy' muscles. The primary aim of this study was to investigate the effects of LTrPs on the muscle activation patterns (MAPs) of key shoulder girdle muscles during scapular plane elevation of the arm in the unloaded, loaded and fatigued states. In connection with the main aim, a preliminary study was carried out to examine the frequency with which LTrPs occur in the scapular positioning muscles in a group of normal subjects. After establishing intra-examiner reliability for the clinical examination process, 154 healthy subjects volunteered to be screened for normal shoulder girdle function, then undergo a physical examination for LTrPs in the trapezius, rhomboids, levator scapulae, serratus anterior and the pectoralis minor muscles bilaterally. Of these 'healthy' subjects, 89.8% had at least one LTrP in the scapular positioning muscles (mean=10.65 ± 6.8, range=1-27), with serratus anterior and upper trapezius harbouring the most LTrPs on average (2.46 ± 1.8 and 2.36 ± 1.3 respectively). Consistent with clinical opinion, this study found that LTrPs occur commonly in the scapular positioning muscles. To investigate the motor effects of LTrPs, surface electromyography (sEMG) was used to measure the timing of muscle activation of the upper and lower trapezius and serratus anterior (upward scapular rotators), the infraspinatus (rotator cuff) and middle deltoid (arm abductor). These studies found that LTrPs housed in the scapular upward rotator muscles affected the timing of activation and increased the variability of the activation times of this muscle group and were also associated with altered timing of activation in the functionally related but LTrP-free infraspinatus and middle deltoid. Compared with the control group (all muscles LTrP-free), the MAPs of the LTrP group appeared to be sub-optimal, particularly in relation to preserving the subacromial space and the loading of the rotator cuff muscles. After the initial sEMG evaluations, the LTrP subjects were randomly assigned to one of two interventions: superficial dry needling (SDN) followed by post-isometric relaxation (PIR) stretching to remove LTrP s or sham ultrasound, to act as a placebo treatment where LTrPs remained. Where LTrPs were removed, a subsequent sEMG evaluation found MAPs to be similar to the control group in most of the experimental conditions investigated. Of particular note, when LTrPs had been treated and the subjects repeated the fatiguing protocol, the resultant MAP showed no significant difference with that of the control group in the rested state, suggesting treating LTrPs was associated with an improved response to fatigue induced by repetitive overhead movements. In conclusion, the findings indicate that LTrPs commonly occur in scapular positioning muscles and have deleterious effects on MAPs employed to perform scapular plane elevation and thus affect motor control mechanisms. Treating LTrPs with SDN and PIR stretching increases pressure-pain thresholds, removes associated taut bands and at least transiently optimises the MAP during scapular plane elevation. Discussion includes possible neuromuscular pathophysiology that might explain these results.

Title: The formation of algic zones on hands while riding a spinning bike Objectives: The aim of the work is verification of changes of nociception in pre-defined points in the cyclists hands during one hour's spinning lesson. Methods: A total of 13 participants (9 female, 4 male), aged between 20-50 years old, took part in this study. First personal data was collected using a structured questionnaire. Subsequently, the pain threshold in the palms and palmar sides of the fingers of both hands was measured using algometer Algometer type II, from the company Somedic Sales AB. The acquired data was then statistically evaluated and compared by Pearson correlation quotient and analysis of variance ANOVA. A comparison of the pain treshold before and after the spinning lesson, related to gender, dominant and non-dominant hand and the age of participants, was eventually carried out. Results: After an hour of spinning had occured, in all measured points there was a reduction in pain threshold with an average of 12.83%. This change was the same in all of the measured points, which means that there was no overloading of one hand or any group of the points. The statistical evaluation has shown, that the change of the pain threshold is not dependent on the gender of the participants, and it is not statistically...

Made available in DSpace on 2016-06-02T20:19:22Z (GMT). No. of bitstreams: 1 5713.pdf: 2032376 bytes, checksum: 27f33e21a99dcce73a3151b79bdd57d7 (MD5) Previous issue date: 2014-01-10 / Financiadora de Estudos e Projetos / Myofascial pain, represented by points miofascias trigger (MTrPs), has a high prevalence in healthy adults. However, in the case of children, it is not known very well for its occurrence, and even if she is related to dominance and the sensitivity of these individuals before external stimuli, as occurs in pain assessed by pressure pain threshold (PPT). The objectives of this study were to identify the possible presence of MTrPs in typical children featuring their PPTs in the scapular region, and to verify the relationship between the two variables (MTrPs and PPTs). These results were obtained from healthy adults were also compared. Were selected 35 adults (14 men and 21 women; 23, 43 ± 3.42 years; 1.70 ± 0.10 m; 62.90 ± 10.98 kg) and 35 children (15 boys and 20 girls; 9.14 ± 1.68 years; 1.38 ± 0.10 m; 32.41 ± 7.02 kg), with no history of shoulder pathology or cervical spine. All participants underwent investigation with respect to the presence of MTrPs the shoulder musculature and evaluation of the PPT in the regions of neck, shoulder and anterior tibial, by the standards validated in the literature.The X² test was used to compare the distribution of each muscle in latent trigger points (latent TrPs) between groups. After the analysis of normality, parametric tests (test - Student's t for paired and unpaired) and nonparametric (U-Mann Whitney and Wilcoxon tests) were used to compare the amount of PPTs and latent TrPs between groups and sides. Children showed fewer latent TrPs (0.94 ± 1.34) than adults (2.02 ± 2.18). The upper trapezius muscle was more affected by MTrPs reaching 13 adults on the dominant side. The children had lower PPTs compared to healthy adults (P< 0.05). All PPTs correlated with each other in both groups moderately/high. Only adults showed correlations between the amount of latent TrPs and on both sides in total and PPTs. It is concluded that typical children have fewer and smaller latent TrPs and PPTs compared to healthy adults demonstrated to be more sensitive to pain. The pressure sensitive shoulder correlates with the presence of latent TrPs in asymptomatic adults, in other words, children PPTs are associated with increased presence of latent TrPs pattern lacking in children. / A dor miofascial, representada pelos pontos gatilho miofascias (PGMFs), apresenta elevada prevalência em adultos saudáveis. No entanto, no caso das crianças, não se conhece muito bem a sua ocorrência, e nem se ela está relacionada com a dominância e com a sensibilidade desses indivíduos diante de estímulos externos, como ocorre nas dores avaliadas pelo limiar de dor à pressão (LDP). Os objetivos do presente estudo foram: identificar a possível presença de PGMFs em crianças típicas caracterizando seus LDPs na região da cintura escapular, além de verificar a relação entre ambas as variáveis (PGMFs e LDPs). Também foram comparados estes resultados aos obtidos em adultos saudáveis. Foram selecionadas 35 crianças (15 meninos e 20 meninas; 9,14 ±1,68 anos; 1,38 ±0,10 m; 32,41 ±7,02 kg) e 35 adultos (14 homens e 21 mulheres; 23,43 ±3,42 anos; 1,70 ±0,10 m; 62,90 ±10,98 kg) sem histórico de patologias no ombro ou coluna cervical. Todos os participantes foram submetidos à investigação com relação à presença de PGMFs na musculatura do ombro e à avaliação do LDP nas regiões de pescoço, ombro e tibial anterior, segundo os padrões validados na literatura. O teste X² foi usado para comparar a distribuição dos pontos gatilho latentes (PGLs) em cada músculo entre os grupos. Após a análise de normalidade, os testes paramétricos (Teste-t de Student para dados pareados e para não pareados) e não paramétricos (U-Mann-Whitney e Wilcoxon) foram aplicados para comparar os LDPs e a quantidade de PGLs entre grupos e lados. As crianças apresentaram menor quantidade de PGLs (0,94 ±1,34) do que adultos (2,02 ±2,18). O trapézio superior foi o músculo mais afetado por PGMFs atingindo 13 adultos no lado dominante. As crianças apresentaram menor LDP comparado aos adultos saudáveis (P<0,05). Todos os LDPs correlacionaram entre si em ambos os grupos de forma moderada/alta. Somente os adultos apresentaram correlações entre a quantidade de PGLs em ambos os lados e no total e os LDPs. Conclui-se que crianças típicas apresentam menor quantidade de PGLs e menores LDPs comparado aos adultos saudáveis demonstrando serem mais sensíveis à dor e à pressão. A sensibilidade à pressão no ombro se correlaciona com a presença de PGLs em adultos assintomáticos, ou seja, menores LDPs associam-se com maior presença de PGLs, padrão inexistente nas crianças.

M.Tech. / Purpose: A study to determine the efficacy of Traumeel® gel using phonophoresis in the treatment of a latent trapezius myofascial trigger point, with regards to pain perception, cervical spine range of motion and pressure pain tolerance.Methods: A single-blinded, controlled study design was utilised. Thirty participants who all presented with a latent trapezius myofascial trigger point were randomly divided into two groups of fifteen. Each individual was subjectively and objectively assessed from baseline values prior to receiving treatment. Group A received ultrasound utilising ultrasound gel over the trapezius myofascial trigger point, as the control group. Group B received phonophoresis with Traumeel® gel over the trapezius myofascial trigger point. All participants received two treatments per week, with a total of seven consultations, over the three week study period. The subjective data was obtained utilising a Numerical Pain Rating Scale (NPRS) whilst a hand held Algometer tested pressure pain tolerance and a Cervical Range of Motion Measuring Instrument (CROM) measured cervical spine range of motion. These were utilised to form the objective data. The Data was analysed using non-parametric tests. The two independent treatment groups were assessed for capability at treatments one, four and seven using the Mann-Whitney U-test (non-parametric version of the independent sample T-test). Changes over the three week period were observed and analyzed using the Repeated Measures test or the Friedman Test (Devey, 2010). Results: In this study ultrasound utilising ultrasound gel had a statistically significant impact on the trapezius myofascial trigger point. Statistical analysis of the Traumeel® gel suggests that there was no statistical significance with regards to any of the treatment parameters or variables measured. Subjectively ultrasound gel proved to be statistically and clinically significant in decreasing the participant’s pain perception. There was no statistical improvement but there was a clinical improvement in the Traumeel® gel group.

M.Tech. / This study aimed to determine the difference between the standard dry needling technique versus the rapid dry needling technique with regards to which technique would provide quicker relief of symptoms, as measured by an increase in participant’s pressure tolerance and range of motion and a decrease in subjective pain. Subjectively it was seen that both groups had a statistical decrease in the participants perceived pain with the Oswestry Disability Index, the McGill’s Pain Questionnaire and the Numeral Pain Rating Scale. Both groups showed significant changes over the two time variables (pre-Treatment one and post-Treatment four) with regards to all the questionnaires. Group 2 showed the most significant change when comparing the two groups with regards to the Oswestry Disability Index and the Numeral Pain Rating Scale. From these results it is seen that subjectively all the participants felt relief with respect to their perceived pain. However, objectively the rapid dry needling technique proved to improve pain faster and more consistently throughout the treatment period over the standard intra-muscular dry needling technique. Therefore the rapid dry needling technique is more effective in treating active Gluteus medius muscle trigger points.

Background: Biomechanical stiffness has been linked to risk of injury and found to be a measureable characteristic in musculoskeletal disorders. Specific identification of stiffness may clarify who is most likely to benefit from the trigger point dry needling (TDN). The purpose of this study is to investigate the reliability and concurrent validity of the MyotonPRO® to the criterion of shear wave ultrasound elastography for the measurement of biomechanical stiffness in the infraspinatus, erector spinae, and gastrocnemius of healthy subjects over increasing muscle contraction. Second purpose is to investigate the biomechanical effects of TDN to latent myofascial trigger points (MTrPs) in the infraspinatus, erector spinae, or gastrocnemius. Research Design and Method: The first phase of the study investigated 30 subjects who completed three levels of muscle contraction in standardized test positions for the infraspinatus, erector spinae and gastrocnemius. Biomechanical stiffness measures were collected using shear wave elastography and MyotonPRO®. The second phase of the study investigated 60 new subjects who were categorized into infraspinatus, erector spinae, or gastrocnemius group based on an identified latent MTrP. These subjects underwent TDN while monitoring biomechanical stiffness at baseline, immediately post TDN, and 24 hours later. Analysis: Discriminate ability, reliability, and correlations were calculated for measured stiffness variable across the three conditions of contraction in the first phase of the study. Differences between stiffness at baseline and after TDN were calculated in the second phase of the study. Results: Correlation of the two measurement methods in the three muscle regions was significant and strongest in the gastrocnemius. MyotonPRO reliability was excellent, and demonstrated ability to discriminate between the three levels of muscle contraction. In the second phase, immediate decreased stiffness was observed in the MTrP following TDN treatment. Significant decreased stiffness was found in in the erector spinae and gastrocnemius group who also demonstrated a localized twitch response during TDN. Stiffness returned to near baseline values after 24 hours. Discussion: The MyotonPRO® stiffness measurement was found to be reliable and discriminate across predefined muscle contraction intensities. TDN may cause an immediate change in stiffness but this change was not observed at 24 hours. It is not known whether these effects are present in a symptomatic population or related to improvements in other clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is an indication of patient improvement in pain and function.

No description available.

Les PTM sont une source de douleur régionale et de dysfonctionnements neuromusculaires. Ils sont couramment associés à une hyperalgésie, à des troubles comportementaux et des restrictionsfonctionnelles. La douleur est bien documentée dans la littérature scientifique mais les études de ses conséquences sur le mouvement reposent exclusivement sur l’analyse de gestes simples. L’objectif dece travail est d’étudier la douleur myofasciale du membre supérieur et de vérifier si une technique de thérapie manuelle influençant cette douleur permet de rétablir la performance motrice d’un mouvement fonctionnel. Quatre études ont été réalisées afin d’analyser : 1) la performance motrice d’un mouvement elliptique dans le plan horizontal ; 2) dans le plan frontal et d’une tâche de tapement ; 3) la douleur sur le membre supérieur non atteint chez des sujets ayant subi un AVC ; 4) l’incidence de la douleur chez le personnel soignant d’un centre hospitalier. Les résultats indiquent que la présence de PTM produit la douleur myofasciale et : 1) n’influence pas significativement la performance motrice d’un mouvement elliptique horizontal ; 2) altère la performance motrice d’un mouvement elliptique frontal et d’une tâche de tapement chez les sujets présentant des PTM ; 3) modifie aussi la fonction motrice de l’extrémité supérieure ipsilatérale à la lésion ; 4) touche 8,43% du personnel soignant, étant bilatérale et pouvant conduire à des arrêts maladie dans 14,28 % des cas. L’application d’une technique de compression ischémique locale permet de retrouver la quasi-totalité de la fonction motrice. Il semblerait qu’une reprogrammation du mouvement s’avère nécessaire pour récupérer totalement la fonction motrice. / Myofascial Trigger Points (MTrPs) are source of regional pain and neuromuscular dysfunctions. They are associated to hyperalgesia, psychological disturbances and functional restrictions. Despite myofascial pain has been extensively studied, researches about its influence have only analyzed uniarticular motions. The mains goals of this research were to study the upper limb myofascial pain and to verify whether the application of manual therapy, influencing this pain, could contribute to the motor performance recovery of multiarticular motion. Four studies were carried out in order to analyze: 1) motor performance of an elliptic motion in the horizontal plane, 2) motor performance of an elliptic motion in the frontal plane including an analysis of a tapping task, 3) non-paretic upper limb pain of the stroke patients, 4) myofascial pain incidence at the medical staff in a hospital. The results showed that the presence of TrPs produces myofascial pain. This pain: 1) does not influence significantly the horizontal elliptical motions motor performance, 2) deteriorates the frontal elliptical motions motor performance and the execution of the tapping task, 3) modifies the non-paretic upper limb motor function of the stroke patients, and 4) 8,43 % of medical staff suffers from bilateral myofascial pain, leading to absence at workplace in 14,28% of the cases. The application of local ischemic compression technique allows high recovery of the upper limb motor function. Motor reprogramming therapies could contribute to recover the motor function completely.

A síndrome da dor miofascial crônica é a causa mais frequente das dores musculoesqueléticas com prevalência mundial que varia entre 13,7% e 47% da população, destes, em torno de 17% apresentam dores na região do retropé medial. O músculo abdutor do hálux que se localiza na região medial do pé representa grande importância para as síndromes dolorosas plantares, seu estudo será importante para compreender melhor a fisiopatologia da dor miofascial que ainda permanece desconhecida. Objetivos: Descrição dos pontos de penetração dos ramos do nervo plantar medial no ventre do músculo abdutor do hálux através da dissecção anatômica e a sua inter-relação com os sintomas clínicos de dor plantar nos pacientes ortopédicos. Método: O estudo foi realizado em dois grupos com a amostra calculada pelo projeto piloto realizado anteriormente. No grupo de dissecção anatômica (GDA) foram dissecados 30 pés para a avaliação do número de pontos de entrada dos ramos nervosos no músculo associado ao grupo dos pacientes ortopédicos (GPO) onde 30 pés com sintomas de dor no retropé medial foram submetidos à avaliação da sensibilidade dolorosa com o dolorímetro digital de pressão. Ambos os grupos utilizaram o referencial dos quadrantes no músculo abdutor do hálux. O GDA foi submetido a análise de equações de estimação generalizadas com distribuição Poisson e função de log logaritmo seguida de comparações múltiplas de Bonferroni assim como no GPO mas para a distribuição normal e função de ligação identidade, os dados foram expressos em média ± desvio padrão. O nível de significância foi ajustado para 5% (p < 0,05). Resultados: Neste estudo o GDA apresentou uma diferença estatisticamente significante de pontos de entrada dos ramos do nervo plantar medial no ventre muscular do abdutor do hálux no primeiro quadrante (póstero-lateral, Q1, p < 0,05) em relação aos demais quadrantes, assim como no GPO onde Q1 também apresentou uma maior sensibilidade dolorosa quando comparado aos demais quadrantes (p < 0,05). Foi registrado a partir das dissecções uma inédita fixação no osso navicular do músculo abdutor do hálux. Conclusão: Nossos resultados sugerem que existe uma possível relação entre o maior número de entrada dos ramos do nervo plantar medial no ventre do músculo abdutor do hálux e a maior sensibilidade dolorosa no retropé medial, ou seja, os problemas musculares podem desencadear sintomas clínicos dolorosos a partir da compressão nervosa na região. Os dados vão cooperar para a melhor compreensão das síndromes miofasciais dos pés que auxiliarão para o desenvolvimento de futuros tratamentos / Chronic myofascial pain syndrome is the most frequent cause of musculoskeletal pain, with a worldwide prevalence ranging from 13.7% to 47% of the population, which 17% have pain in the retromedial area. The abductor hallucis muscle is located in the medial region of the foot represent high importance for plantar painful syndromes and your study will be important to better understand the pathophysiology of myofascial pain that remains unknown. Objectives: Description through anatomical dissection of the penetration points of the medial plantar nerve branches in the abductor hallucis muscle layer and their interrelationship with the clinical symptoms of plantar pain in orthopedic patients. Methods: The study was carried out in two groups, the sample size was calculated by the previous pilot study. In the anatomical dissection group (ADG), 30 feet were dissected for the evaluation of the number of entry points of the nerve branches in the muscle belly associated with the orthopedic patients group (OPG) where 30 feet with pain symptoms were submitted to the evaluation of pain sensitivity with digital pressure gauge, both groups used the quadrants referential in the abductor hallucis muscle for the evaluation. The ADG were submitted to the analysis of generalized equation of estimation with Poisson distribuition and log logarithnm and was followed by Bonferroni multiple comparisons, for OPG the same analysis but for normal distribution and identity link function, the datas were expressed as mean ± standard deviation. The level of significance was adjusted to 5% (p < 0.05) for all tests. Results: In this study, the ADG presented a statistically significant difference of medial plantar nerve branches entry points in the first quadrant (posterolateral, Q1) in the abductor halluccis muscle (p < 0.05) in relation to the others, as well as in the OPG, where the first quadrant (Q1) also presented a greater pain sensitivity when compared to the other quadrants (p < 0.05). It was recorded an unprecedented navicular bone fixation from abductor hallucis muscle. Conclusion: Our results suggests that there are a possible relationship between the greater number of entry of the medial plantar nerve branches in the abductor hallucis muscle and the higher pain sensation in the retromedial plantar area and the muscle can trigger an nervous compression to develop painful symptoms. These datas will cooperate to better understand myofascial pain syndromes that will help to develop new treatments

Tyrimo tikslas: Įvertinti moterų griaučių raumenų sistemos viršutinės dalies funkcinę būklę prieš ir po pasyvios ir aktyvios kineziterapijos priemonių taikymo. Tyrimo uždaviniai: 1. Įvertinti moterų griaučių raumenų sistemos viršutinės dalies raumenų skausmo slenksčio pokyčius prieš ir po pasyvios ir aktyvios kineziterapijos. 2. Nustatyti moterų griaučių raumenų sistemos viršutinės dalies judesių amplitudės pokyčius prieš ir po pasyvios ir aktyvios kineziterapijos priemonių taikymo. 3. Įvertinti moterų griaučių raumenų sistemos viršutinės dalies raumenų jėgos pokyčius prieš ir po pasyvios ir aktyvios kineziterapijos. 4. Palyginti pasyvios ir aktyvios kineziterapijos priemonių efektyvumą moterų griaučių raumenų sistemos viršutinės dalies raumenų skausmo slenksčiui, judesių amplitudei bei raumenų jėgai. Tyrimo metodai: Buvo ištirtos 20 jauno ir vidutinio amžiaus sveikos moterys. Tiriamosios buvo suskirstytos į dvi grupes. Vienai grupei buvo taikomos pasyvios kineziterapijos priemonės, kitai – aktyvios. Prieš ir po kineziterapijos buvo vertinamas spaudimo sukeltas raumenų skausmo slenkstis (algometru), žasto judesių amplitudė (goniometru), rankų sukabinimo už nugaros ir kaklo judesių amplitudė (centimetrine juostele), pečių juostos raumenų jėga (rankos dinamometru ir „Stabilizer Pressure Biofeedback“ prietaisu). Išvados: 1. Po pasyvios kineziterapijos priemonių taikymo raumenų skausmo slenkstis statistiškai reikšmingai padidėjo 20- yje iš 22- jų vertintų miofascijinių... [toliau žr. visą tekstą] / The aim of the research: To evaluate women’s upper part of musculoskeletal system functional state before and after passive and active physical therapy. To achieve this aim the following tasks were set up: 1. To evaluate changes of muscle pain threshold in the upper part of the musculoskeletal system. 2. To assess changes of range of motion in the upper part of the musculoskeletal system. 3. To evaluate changes of muscle force in the upper part of the musculoskeletal system. 4. To compare the effect of passive and active physical therapy for the muscle pain threshold, range of motion and muscle force in the upper part of the musculoskeletal system. Method of the research: 20 young and middle-aged healthy women were tested. Subjects were divided in to two groups. We have applied passive physical therapy modalities for the first group, active physical exercises for the second group. We have assessed the muscle pain threshold (using algometer), the range of motion (goniometer and tape – measure) and muscle force (hand held dynamometer and „Stabilizer Pressure Bioffedback“) before and after passive and active physical therapy. Conclusions: 1. After the passive physical therapy the muscle pain threshold statistically significant increase in the 20 of 22 assessed myofascial trigger points (p<0,05). After active physical therapy - the muscle pain threshold a statistically significant increase in 12 of 22 assessed myofascial trigger points (p<0,05). 2. After passive physical... [to full text]