Exercise Therapy Is Effective for Improvement in Range of Motion, Function, and Pain in Patients With Frozen Shoulder: A Systematic Review and Meta-analysis.

OBJECTIVE(S): To determine (1) the effect of exercise therapy alone or in combination with other interventions compared with solely exercises and programs with or without exercises and (2) what kind of exercise therapy or combination with other interventions is most effective. DATA SOURCES: PubMed, Web of Science and Cochrane Central Register of Controlled Trials. STUDY SELECTION: Studies were screened in a 2-phase approach by 2 independent reviewers (M.M. and L.M.). Reference lists of included studies and interesting systematic reviews were hand searched. DATA EXTRACTION: Two independent reviewers (M.M. and L.M.) extracted information about origin, characteristics of study participants, eligibility criteria, characteristics of interventions, outcome measures and main results in a pre-defined template. DATA SYNTHESIS: Thirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared with programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure. CONCLUSIONS: ROM, function, and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared with a program without exercises, whereas adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared with other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.

An overview of effective and potential new conservative interventions in patients with frozen shoulder.

Frozen shoulder (FS) is a pathology that is difficult to understand and difficult to manage. Over the last ten years, contradictory and new evidence is provided regarding the recovery and its natural course. This narrative review provides new information about the diagnosis and conservative treatment of patients with FS and ongoing research hypotheses that might provide new insights in the pathology and treatment options. FS has a characteristic course. People with Diabetes Mellitus and thyroid disorders have a higher risk of developing a FS. The diagnosis FS is based on pattern recognition and physical examination. Additionally, 'rule-in' and 'rule-out' criteria can be used to increase the likelihood of the frozen shoulder diagnosis. Recommended and most common physical therapy interventions are mobilization techniques and exercises, in which tissue irritability can guide its intensity. In addition, physical therapy is often complementary with patient education and pharmacotherapy. The latest evidence-based practice related to FS is proprioceptive neuromuscular facilitation and mirror therapy. In addition, interventions like pain neuroscience education, high-intensity interval training and lifestyle changes are still hypothetical. Finally, better insight in the involvement of biochemical processes, function of myofibroblasts and matrix metalloproteinases can provide better understanding in the pathophysiology and will be addressed in current review.

Factors associated with better treatment outcome of physical therapy interventions after shoulder arthroplasty: A systematic review.

OBJECTIVE: To summarize factors that are associated with a better treatment outcome after post-operative physical therapy in patients with shoulder arthroplasty. DATA SOURCES: PubMed, Cochrane, and Web of Science. REVIEW METHODS: Studies examining factors that are associated with a better outcome after post-operative physical therapy interventions in patients with shoulder arthroplasty were included. Two independent reviewers performed screening, extracted data, and assessed the risk of bias and level of evidence, using the Quality In Prognosis Studies tool and Evidence-Based Guideline Development checklist. PRISMA guidelines were followed. RESULTS: In total, 460 articles were found and 14 studies were included. Two of the included articles had a moderate risk of bias, 12 high. The overall number of patients in the included studies varied from 20 to 2053. Patients had either a reverse (N = 1863), an anatomic total shoulder arthroplasty (N = 1029) or, a hemiarthroplasty (N = 133). Anatomic total shoulder arthroplasty patients with a neutral rotation sling position showed less night pain and greater range of motion, which was awarded moderate evidence. Other modifiable and non-modifiable factors such as telemedicine, immediate range of motion exercises, and pre-operative function were only awarded preliminary or conflicting evidence. CONCLUSION: Mainly preliminary and conflicting evidence was found. The possible causes of the conflicting evidence were the different measurement methods, implant types, and follow-up times used. The methodological quality was low and physical therapy protocols differed greatly. More high-quality research with standardized protocols is needed to determine the association of various factors with treatment outcomes after post-operative physical therapy in patients with shoulder arthroplasty.

Differences in Coracohumeral Distance Between the Symptomatic and the Asymptomatic Shoulder in Patients With Unilateral Shoulder Pain and in Healthy Participants: A Cross-Sectional Study.

OBJECTIVES: The aim of this study was to analyze whether differences in the coracohumeral distance (CHD) exist between the symptomatic and the asymptomatic shoulder in patients with subacromial pain syndrome and compare with the shoulder of control participants. METHODS: This was a cross-sectional, observational study. A sample comprising 62 participants with subacromial pain syndrome was recruited from 3 different primary care centers. The CHD was determined from standardized ultrasonography measures performed on both shoulders at 0° and 60° of shoulder abduction, whereas the dominant arm was measured for the control participants. RESULTS: Statistically significant differences in CHD at 0° and 60° were found between the symptomatic and control shoulders (P = .011/P = .002) and between the contralateral asymptomatic shoulder and controls (P = .026/P = .007). CONCLUSION: We found differences in CHD at 0° and 60° of shoulder elevation between both the affected and the nonaffected shoulders when compared with healthy shoulders. These results suggest that CHD may be a contributing factor in chronic shoulder pain.

Monitoring the swimmer's training load: A narrative review of monitoring strategies applied in research.

The high incidence of injury during swim training and the increasing demands of the sports make monitoring of the swimmer's training load a key concept requiring further investigation. Research has previously introduced numerous methods for the purposes of monitoring the swimmer's training load, but a narrative review discussing the strengths and limitations of each method is lacking. Consequently, this narrative review aims to summarize the monitoring strategies that have been applied in research on competitive swimmers. This knowledge can assist professionals in the field in choosing which method is appropriate in their particular setting. The results from this study showed that external training load was predominantly obtained through real-life observation of the swimmers' training volume. However, research has investigated a number of internal load monitoring tools, including blood lactate, training heart rate, and perceived effort of training. To date, blood lactate markers are still considered most accurate and especially recommended at higher levels of competitive swimming or for those at greater risk of injury. Further, mood state profiling has been suggested as an early indicator of overtraining and may be applied at the lower competitive levels of swimming. Professionals in the field should consider the individual, the aim of the current training phase, and additional logistical issues when determining the appropriate monitoring strategy in their setting.

The predictive value of the multiple hop test for first-time noncontact lateral ankle sprains.

The predictive value of the multiple hop test for first-time noncontact lateral ankle sprains. BACKGROUND: Lateral ankle sprains (LAS) are very common sports injuries, cause high health care costs and are associated with postural control deficits. From a preventive point of view, clinicians should dispose valid field tests to identify athletes at risk for a LAS. The aim of this study is to evaluate the predictive value of the multiple hop test (MHT) for first-time noncontact LAS. METHODS: Non-elite athletes (n = 232) performed the MHT at baseline. During a 12-month follow-up period, all noncontact LAS related to health care costs were recorded. Outcomes of the MHT (completion time, balance errors and perceived difficulty) between the injured and uninjured group were compared and odds ratios (OR) and relative risks (RR) were calculated using a logistic regression analysis. RESULTS: Ten first-time noncontact LAS were recorded (4.3%). Injured athletes made significantly more change-in-support strategy (CSS) errors when compared to uninjured athletes (p = .04). The OR of the number of CSS errors was 1.14 (p = .03), the RR 4.1 (p = .04). CONCLUSIONS: Athletes scoring > 12 CSS errors, have a four times increased risk for a first-time noncontact LAS. The MHT is a valid field test to identify athletes at risk for a first-time noncontact LAS.

Association of Both Scapular Upward Rotation and Scapulothoracic Muscle Lengths With Shoulder Pain, Function, and Range of Movement.

OBJECTIVE: Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. METHODS: This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. RESULTS: The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor (r = 0.08, P = .93) and levator scapulae (r = -0.01, P = .57) muscles and (2) SUR at 45° (r = 0.17, P = .21), 90° (r = 0.08, P = .57), and 135° (r = 0.10, P = 0.45) of shoulder elevation. CONCLUSION: The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.

Kinesiophobia Is Associated With Pain Intensity and Disability in Chronic Shoulder Pain: A Cross-Sectional Study.

OBJECTIVE: Kinesiophobia is a clinically relevant factor in the management of chronic musculoskeletal pain. The aim of this study was to explore the cross-sectional association between kinesiophobia and both pain intensity and disability among individuals with chronic shoulder pain. METHODS: A total of 65 participants with chronic unilateral subacromial shoulder pain were recruited from 3 primary care centers. The Shoulder Pain and Disability Index assessed pain intensity and disability. The Tampa Scale for Kinesiophobia short form assessed the presence of kinesiophobia. A linear multivariable regression analysis evaluated the potential association between kinesiophobia and range of movement free of pain with pain intensity and disability. The analysis was adjusted for sex and age. RESULTS: In the linear multivariable regression analysis, only greater kinesiophobia (standardized ß = 0.35, P < .01) and sex (standardized ß = -0.29, P < .01) contributed to explain 19% of the variance in shoulder pain and disability scores. CONCLUSION: This cross-sectional study provides preliminary evidence about the association between kinesiophobia and pain intensity and disability among individuals with chronic shoulder pain. However, our findings only contributed to explain 19% of the variance in shoulder pain and disability scores.

Intrarater and Interrater Reliability of a Passive Shoulder Flexion Range of Motion Measurement for Latissimus Dorsi Flexibility in Young Competitive Swimmers.

CONTEXT: The latissimus dorsi plays a major role in generating the propulsive force during swimming. In addition, stiffness of this muscle may result in altered stroke biomechanics and predispose swimmers to shoulder pain. Measuring the flexibility of the latissimus dorsi can be of interest to reduce injury. However, the reliability of such measurement has not yet been investigated in competitive swimmers. OBJECTIVE: To assess the within-session intrarater and interrater reliability of a passive shoulder flexion range of motion measurement for latissimus dorsi flexibility in competitive swimmers. DESIGN: Within-session intrarater and interrater reliability. SETTING: Competitive swimming clubs in Flanders, Belgium. PARTICIPANTS: Twenty-six competitive swimmers (15.46 [2.98] y; 16 men and 10 women). INTERVENTION: Each rater performed 2 alternating (eg, left-right-left-right) measurements of passive shoulder flexion range of motion twice, with a 30-second rest period in between. MAIN OUTCOME MEASURES: The intraclass correlation coefficients were calculated to assess intrarater and interrater reliability. RESULTS: Interrater intraclass correlation coefficient ranged from .54 (95% confidence interval [CI], -.16 to .81) to .57 (95% CI, -.24 to .85). Results for the intrarater reliability ranged from .91 (95% CI, .81 to .96) to .94 (95% CI, .87 to .97). CONCLUSION: Results of this study suggest that shoulder flexion range of motion in young competitive swimmers can be measured reliably by a single rater within the same session.

The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review.

OBJECTIVE: To examine the predictive, moderating and mediating role of cognitive, emotional and behavioral factors on pain and disability following shoulder treatment. DATA SOURCES: Electronic databases (PubMed, Web of Science, Embase and PsycINFO) were searched until 14 January 2019. STUDY SELECTION: Studies including persons with musculoskeletal shoulder pain that describe the predictive, moderating or mediating role of baseline cognitive, emotional or behavioral factors on pain or disability following treatment were selected. RESULTS: A total of 23 articles, describing 21 studies and involving 3769 participants, were included. Three studies had a high risk of bias. There was no predictive role of baseline depression, anxiety, coping, somatization or distress on pain or disability across types of shoulder treatment. No predictive role of fear-avoidance beliefs was identified in patients receiving physiotherapy, which contrasted to the results found when surgical treatment was applied. Baseline catastrophizing was also not predictive for pain or disability in patients receiving physiotherapy. After conservative medical treatments, results on the predictive role of catastrophizing were inconclusive. Treatment expectations and baseline self-efficacy predicted pain and disability in patients receiving physiotherapy, which was not the case in patients receiving conservative medical treatment. Finally, there was a moderating role for optimism in the relationship between pain catastrophizing and disability in patients receiving physiotherapy. CONCLUSION: There is evidence that expectations of recovery and self-efficacy have a predictive role and optimism a moderating role on pain and/or disability following physiotherapy for musculoskeletal shoulder pain. After surgical treatment, fear-avoidance is a predictor of pain and disability.

Illness Perceptions Explain the Variance in Functional Disability, but Not Habitual Physical Activity, in Patients With Chronic Low Back Pain: A Cross-Sectional Study.

INTRODUCTION: Although the importance of psychosocial factors has been highlighted in many studies in patients with chronic low back pain (CLBP), there is a lack of research examining the role of illness perceptions in explaining functional disability and physical activity in patients with CLBP. AIM: The aim of the study was to explore the value of illness perceptions in explaining functional disability and physical activity in patients with CLBP. METHODS: Eighty-four participants with CLBP (of > 3 months' duration) completed a battery of questionnaires investigating psychosocial factors (Pain Catastrophizing Scale [PCS], Illness Perceptions Questionnaire Revised [IPQ-R], and 36-Item Short Form mental health scale [SF-36_MH]) and perceived pain intensity (visual analog scale [VAS]), as well as the Oswestry Disability Index (ODI) and Baecke questionnaire. The latter 2 were entered separately as dependent variables in a regression analysis. RESULTS: The combined variables (VAS, PCS, SF-36_MH, IPQ-R) accounted for 62% of the variance in functional disability (ODI). Adding the results of the IPQ-R to the scores of the other 3 variables (VAS, PCS, SF-36_MH) significantly increased the explained variance of ODI scores in CLBP patients, yielding 18% additional information (P < 0.01). Only 5% of the variance in the Baecke questionnaire was explained by combining the 4 variables. None of the single variables alone made a significant contribution to R². CONCLUSIONS: Illness perceptions are an important factor for explaining functional disability, but not for explaining habitual physical activity in CLBP patients.

Musculoskeletal dysfunctions associated with swimmers' shoulder.

Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers' shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers.

Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome: a systematic review.

OBJECTIVE: To systematically review the literature on the clinical outcomes of scapular-focused treatments in participants with subacromial pain syndrome (SPS). DESIGN: Systematic literature review. Studies were appraised by two reviewers using the Physiotherapy Evidence Database (PEDro) scale, and a best-evidence synthesis was performed. DATA SOURCES: The literature search was conducted in the databases PubMed, Embase and Cinahl up to February 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials evaluating the clinical outcomes of a physiotherapeutic scapular-focused treatment in participants with SPS. RESULTS: Four studies were included describing various scapular-focused interventions, including scapular-focused exercise therapy, scapular mobilisation and scapular taping. All included studies had a PEDro score of 6 or higher, indicating low risk of bias. There was moderate evidence that scapular-focused treatment compared with other physiotherapeutic treatment is effective in improving scapular muscle strength in participants with SPS. Conflicting evidence was found for improvements in pain, function and clinical measures of scapular positioning. No evidence was found for improvements in shoulder range of motion or rotator cuff muscle strength. CONCLUSIONS: There is some support for the use of scapular-focused exercise therapy in patients with SPS. Owing to the low number of studies, no firm conclusions can be drawn. Therefore, more randomised controlled trials are needed to determine the clinical outcomes of scapular-focused exercise therapy, scapular mobilisation techniques and scapular taping in patients with SPS.

Central Pain Processing in Patients with Shoulder Pain: A Review of the Literature.

BACKGROUND: Shoulder pain is a common health problem in which changes in shoulder structure cannot always explain the patient's perceived pain. Central sensitization (CS) might play a role in a subgroup of these patients. METHODS: The literature was systematically reviewed to address the role of CS in patients with shoulder pain. Electronic databases PubMed and Web of Knowledge were searched for relevant studies. RESULTS: Eighteen full-text articles were included, methodological quality was scored, and information was extracted. Studies were clustered on those studying patients with musculoskeletal (MSK) shoulder pain and those studying patients with hemiplegic shoulder pain (HSP). In particular, quantitative sensory testing revealed hyperalgesia for pressure pain in the MSK group, whereas these results were inconsistent in patients with HSP. Conditioned pain modulation was reduced in patients with MSK shoulder pain, but functioned normally in the HSP group. CONCLUSION: This review has shown that great progress has been made toward a better understanding of neurophysiologic pain mechanisms in patients with shoulder pain. The presence of generalized mechanical hyperalgesia, allodynia, and impaired conditioned pain modulation in patients with MSK shoulder pain indicates the involvement of the central nervous system. Widespread somatosensory abnormalities observed in patients with HSP could suggest a central origin for their shoulder pain and predispose patients with HSP to develop CS, although results are inconsistent. Additional research is required adopting different assessment methods (especially dynamic methods) to establish the role of CS in patients with shoulder pain.

Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review.

OBJECTIVE: To systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder. DATA SOURCES: PubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists. STUDY SELECTION: All English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included. DATA EXTRACTION: Two reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials. DATA SYNTHESIS: The efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM. CONCLUSIONS: Overall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment.

The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review.

OBJECTIVE: To establish the effects of relaxation therapy on autonomic function, pain, fatigue and daily functioning in patients with chronic fatigue syndrome or fibromyalgia. METHOD: A systematic literature study was performed. Using specific keywords related to fibromyalgia or chronic fatigue syndrome and relaxation therapy, the electronic databases PubMed and Web of Science were searched. Included articles were assessed for their risk of bias and relevant information regarding relaxation was extracted. The review was conducted and reported according to the PRISMA-statement. RESULTS: Thirteen randomized clinical trials of sufficient quality were included, resulting in a total of 650 fibromyalgia patients (11 studies) and 88 chronic fatigue syndrome patients (3 studies). None of the studies reported effects on autonomic function. Six studies reported the effect of guided imagery on pain and daily functioning in fibromyalgia. The acute effect of a single session of guided imagery was studied in two studies and seems beneficial for pain relief. For other relaxation techniques (eg. muscle relaxation, autogenic training) no conclusive evidence was found for the effect on pain and functioning in fibromyalgia patients comparison to multimodal treatment programs. For fatigue a multimodal approach seemed better than relaxation, as shown in the sole three studies on chronic fatigue syndrome patients. CONCLUSION: There is moderate evidence for the acute effect of guided imagery on pain, although the content of the visualization is a matter of debate. Other relaxation formats and the effects on functionality and autonomic function require further study.

Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders.

Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions.

Prevalence, Incidence, Localization, and Pathophysiology of Myofascial Trigger Points in Patients With Spinal Pain: A Systematic Literature Review.

OBJECTIVE: A systematic review was performed to evaluate the existing evidence related to the prevalence, incidence, localization, and pathophysiology of myofascial trigger points (MTrPs) in patients with spinal (back and neck) pain. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in 2 electronic databases (PubMed and Web of Science) using predefined keywords regarding MTrPs and spinal pain. A "PICOS" questionnaire was used to set up the search strategies and inclusion criteria. Full-text reports concerning MTrPs in patients with back or neck pain, which described their prevalence, incidence, location, or underlying physiopathology were included and screened for methodological quality by 3 independent researchers. Each study was assessed for risk of bias using a checklist derived from the Web site of the Dutch Cochrane Centre. RESULTS: Fourteen articles were retrieved for quality assessment and data extraction. Studies reporting the incidence of MTrPs in patients with spinal pain were lacking. Within spinal pain, patients with neck pain were found to have the highest prevalence rates of MTrPs. The trapezius descendens, levator scapulae, and suboccipitales muscles were the most prevalent locations for active MTrPs in patients with neck pain. Latent MTrPs were present in asymptomatic people, but no significant differences were found in the prevalence rate of latent MTrPs between patients with spinal (neck) pain and healthy controls. The only study investigating prevalence of MTrPs in different localizations of the same muscle reported no significant differences in prevalence between active and latent MTrPs within the trapezius descendens muscle. Studies examining pathophysiological mechanisms underlying MTrPs demonstrated an acidic environment, high concentration of algogenic/inflammatory substances, stiffer muscle tissue, retrograde diastolic blood flows, spontaneous muscle activity at rest, and loss of muscle contractibility in muscles with MTrPs. Altered central processing was also found to play a role in the development of MTrPs. CONCLUSIONS: Myofascial trigger points are a prevalent clinical entity, especially in patients with neck pain. Evidence was not found to support or deny the role of MTrPs in other spinal pain. Compelling evidence supports local mechanisms underlying MTrPs. Future research should unravel the relevance of central mechanisms and investigate the incidence of MTrPs in patients with spinal pain.

Endogenous pain modulation in response to exercise in patients with rheumatoid arthritis, patients with chronic fatigue syndrome and comorbid fibromyalgia, and healthy controls: a double-blind randomized controlled trial.

OBJECTIVE: Temporal summation (TS) of pain, conditioned pain modulation (CPM), and exercise-induced analgesia (EIA) are often investigated in chronic pain populations as an indicator for enhanced pain facilitation and impaired endogenous pain inhibition, respectively, but interactions are not yet clear both in healthy controls and in chronic pain patients. Therefore, the present double-blind randomized placebo-controlled study evaluates pains cores, TS, and CPM in response to exercise in healthy controls, patients with chronic fatigue syndrome and comorbid fibromyalgia (CFS/FM), and patients with rheumatoid arthritis (RA), both under placebo and paracetamol condition. METHODS: Fifty-three female volunteers - of which 19 patients with CFS/FM, 16 patients with RA, and 18 healthy controls - underwent a submaximal exercise test on a bicycle ergometer on 2 different occasions (paracetamol vs. placebo), with an interval of 7 days. Before and after exercise, participants rated pain intensity during TS and CPM. RESULTS: Patients with rheumatoid arthritis showed decreased TS after exercise, both after paracetamol and placebo (P < 0.05). In patients with CFS/FM, results were less univocal. A nonsignificant decrease in TS was only observed after taking paracetamol. CPM responses to exercise are inconclusive, but seem to worsen after exercise. No adverse effects were seen. CONCLUSION: This study evaluates pain scores, TS, and CPM in response to submaximal exercise in 2 different chronic pain populations and healthy controls. In patients with RA, exercise had positive effects on TS, suggesting normal EIA. In patients with CFS/FM, these positive effects were only observed after paracetamol and results were inconsistent.

Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review.

INTRODUCTION: It is hypothesised that the autonomic nervous system responds differently to various stressors in patients with chronic fatigue syndrome (CFS) compared with healthy controls. The goal is to systematically review the scientific literature addressing the functioning of the autonomic nervous system in patients with CFS. MATERIALS AND METHODS: All studies that were identified through electronic databases (PubMed and Web of Science) were screened for eligibility based on the selection criteria and assessed (two independent raters) for methodological quality using a methodological checklist for case-control studies. RESULTS: Twenty-seven case-control studies were included. The methodological quality varied between 50% and 71·4%. Some studies showed different responses to head-up tilt and other autonomous testing. CONCLUSION: Although comparison between the included case-control studies was difficult, we can conclude that there are differences in autonomous response between patients with CFS and healthy controls. The heart rate dynamic response during the head-up tilt test differs between patients with CFS and healthy controls, supporting the increased prevalence of postural orthostatic tachycardia syndrome. The autonomic response can be useful for the diagnosis of CFS.