Exploring the Underlying Mechanisms of Action of Dry Needling: What Is the Immediate Effect on Muscle Electrophysiology? An Experimental Randomized Controlled Trial.

OBJECTIVE: Dry needling is a commonly used treatment technique for myofascial pain syndromes, such as trapezius myalgia. Despite the shown positive clinical effects on pain, the underlying mechanisms of action, such as the effect on muscle electrophysiology, remain unclear. The aim of this study was to investigate the effect of dry needling, compared with sham needling, in the upper trapezius muscle on surface electromyography activity and the relation with pain in office workers with trapezius myalgia. DESIGN: For this experimental randomized controlled trial, 43 office workers with work-related trapezius myalgia were included. Surface electromyography activity was measured before and after a pain-provoking computer task and immediately after, 15, and 30 mins after treatment with dry or sham needling. Pain scores were evaluated at the same time points as well as 1, 2, and 7 days after treatment. RESULTS: No significant differences in surface electromyography activity between dry needling and sham needling were found. Significant positive low to moderate Spearman correlations were found between surface electromyography activity and pain levels after dry needling treatment. CONCLUSIONS: This study shows no immediate effects of dry needling on the electrophysiology of the upper trapezius muscle, compared with sham needling.

Myofascial Pain Syndrome Focused on the Upper Trapezius Muscle: A Comparative Randomized Controlled Trial of the Court-Type Traditional Thai Massage versus the Thai Hermit.

Myofascial pain syndrome is a common problem that can develop at any age. This study compares the efficacy of the court-type traditional Thai massage (CTTM) to the Thai hermit exercise (THE) in improving the cervical range of motion (CROM) and reducing pain in the upper trapezius muscle. In this study, 46 patient subjects were randomized into 2 groups, with 1 group administered CTTM and the other administered THE. Prior to and following the experiment, their demographic characteristics, pain levels and CROM were measured using a visual analog scale (VAS) and a goniometer, respectively. Data was then analyzed using descriptive statistics, percentage, mean, and standard deviation, as well as inferential statistics. The findings indicate that subjects in both groups demonstrated significantly lower pain and significantly better CROM (P < 0.05). In terms of comparative treatment between the CTTM and THE groups, the results were not found to differ in the range of motion, but a clear difference in pain level measured by VAS was found, in which CTTM provides a better way of reducing pain at the trigger point than THE (P < 0.05). From the findings, it can be concluded that both CTTM and THE are comparably efficacious therapies for myofascial pain in the upper trapezius muscle.

Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome.

PURPOSE: This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance. METHODS: Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system. RESULTS: During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups. CONCLUSION: This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.

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.

Shoulder pain and scapular dyskinesis associated with lower trapezius dysplasia - A case report.

BACKGROUND: Scapular dyskinesis (SD) has been associated with shoulder soft-tissue tightness as well scapular muscle strength and/or activation deficits. Inadequate development of the trapezius muscle (trapezius dysplasia) is a relatively rare condition inconsistently associated with shoulder dysfunction. CASE DESCRIPTION: a 24-year old male complaining of left scapular area pain associated with SD and scapular muscle weakness was noted to present with a smaller ipsilateral lower trapezius (LT). Further inquiry including electromyography, rehabilitative ultrasound imaging (RUSI) and magnetic resonance imaging ruled out nerve palsy and demonstrated a hypoplastic left LT. This led to a greater emphasis on serratus anterior (SA) training along with the addition of neuromuscular electrical stimulation of the LT. OUTCOMES: Following 12 sessions over a 5-month period the patient reported no pain or functional deficits, and was able to resume all recreational activities. The patient's subjective shoulder value increased from 55% to 80%, and LT strength was markedly improved. DISCUSSION: Scapular muscle dysplasia may represent a less recognized cause of SD. A more thorough inspection of scapular muscle shape and orientation, possibly augmented by RUSI may be indicated in patients presenting with SD. Neuromuscular electrical stimulation is a potentially useful modality for addressing scapular muscle activation and strength deficits and future research into its efficacy under these circumstances may be warranted.

Interrater and Intrarater Reliability and Minimum Detectable Change of Ultrasound for Active Myofascial Trigger Points in Upper Trapezius Muscle in Individuals With Shoulder Pain.

OBJECTIVE: We sought to investigate the interrater and intrarater reliability of ultrasound and the minimum detectable change (MDC) for the trigger points (TrPs) active in the upper trapezius (UT) muscle in individuals with shoulder pain. METHODS: Forty individuals with shoulder pain were investigated for the presence of active TrPs in the UT muscle by means of ultrasound for the parameters of gray scale, muscle thickness of UT muscle at rest, and contraction and area of TrPs. The intrarater reliability was performed on 2 days, and interrater reliability on the same day. For the gray scale, the reliability was evaluated using the kappa coefficient (κ), while the other parameters were measured by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and MDC. RESULTS: For the gray scale, the intrarater agreement was almost perfect (κ = 1.00) and the interrater agreement was substantial (κ = 0.75). The intrarater and interrater reliability were excellent for most of the parameters, except for the area of TrPs (intrarater: ICC = 0.71, substantial; interrater: ICC = 0.52, substantial). The MDC for intrarater reliability varied between 0.04 and 0.05 (SEM% between 2.4% and 38.87%), and that for interrater reliability ranged from 0.05 to 0.07 (SEM% between 3.18% and 55.10%), with a higher value for area. CONCLUSION: Parameters such as gray scale, resting muscle thickness, and muscle contraction of the UT muscle, obtained through ultrasound, showed excellent intrarater and interrater reliability with low SEM%. The intrarater and interrater reliability for the area deserves a caveat regarding their use.

Single-Session Video and Electromyography Feedback in Overhead Athletes With Scapular Dyskinesis and Impingement Syndrome.

CONTEXT: Subacromial impingement syndrome (SIS) is associated with scapular dyskinesis, or imbalanced scapular muscle activity. Evidence has shown that feedback can improve scapular control in patients with SIS. However, it is unknown whether real-time video feedback or electromyography (EMG) biofeedback is optimal for improving scapular kinematics and muscle activity during a functional task. OBJECTIVE: To compare the effects of video and EMG feedback sessions on absolute muscle activity (upper trapezius [UT], lower trapezius [LT], serratus anterior), muscle balance ratios (UT/LT, UT/serratus anterior), and scapular kinematics (anterior-posterior tilt, external-internal rotation, upward rotation) in SIS participants during arm elevation and lowering. DESIGN: Randomized controlled clinical trial. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Overhead athletes who were diagnosed with SIS and who also exhibited scapular dyskinesis (N = 41). MAIN OUTCOME MEASURE(S): Three-dimensional kinematics and EMG were recorded before and after feedback training. RESULTS: Lower trapezius muscle activity increased (4.2%-18%, P < .011) and UT/LT decreased (0.56-1.17, P < .013) in the EMG biofeedback training group as compared with those in the video feedback training group. Scapular upward rotation during arm elevation was higher in the video group than in the EMG group after feedback training (2.3°, P = .024). CONCLUSIONS: The EMG biofeedback improved muscle control and video feedback improved the correction of scapular upward rotation in patients with SIS. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT03252444.

Chronic neck pain and muscle activation characteristics of the shoulder complex.

INTRODUCTION: Neck pain is a very common musculoskeletal complaint in industrialized countries. Theoretically, chronic neck pain is thought to possibly change biomechanics and muscle activation patterns of the shoulder complex, causing its pain and dysfunction in the long term. PURPOSE: The present cross-sectional study was conducted to compare shoulder complex muscle activation characteristics in patients with chronic non-specific neck pain, compared to healthy participants. METHOD: Twenty patients with chronic neck pain and twenty healthy participants were recruited for the present study. Surface Electromyographic (sEMG) activity was recorded from four selected muscles (anterior and middle deltoid, upper and lower trapezius) during shoulder elevation with a predetermined load (25-30% of an individual's maximum voluntary exertion). RESULT: Results revealed only two significant increased onset delays in the anterior and middle deltoid,and a peak delay in the upper trapezius in chronic neck pain patients. Furthermore, increased onset delay for other muscles and decreased peak normalized amplitude (MVE%) for all muscles were found in chronic neck pain patients; however, these findings were not statistically significant. CONCLUSION: There were relationships between chronic non-specific neck pain and the shoulder muscle activation characteristic; hence, the alteration may be considered a predisposing factor for the shoulder dysfunction in future studies.

A soft massage tool is advantageous for compressing deep soft tissue with low muscle tension: Therapeutic evidence for self-myofascial release.

OBJECTIVES: This study aimed to compare the amount of deep tissue pressure and muscle relaxation between a soft inflatable rubber ball (SIRB) and a hard massage ball (HMB). DESIGN: Crossover experimental design study. INTERVENTIONS: Thirty participants with neck pain (age: 65.9 ± 3.4, Neck Disability Index score: 34.0% ± 15.2) pillowed a SIRB or an HMB beneath the suboccipital region in the supine position. For the baseline condition, participants pillowed a foam block without a ball. MAIN OUTCOME MEASURES: To quantify the amount of deep-tissue pressure by a ball, compressed soft tissue thickness was measured with lateral cervical radiographs. To assess muscle relaxation, the amount of muscle tension was determined using electromyography of the sternocleidomastoid and upper trapezius muscles. To monitor the cervical lordosis in each condition, the extension angles of the cervical vertebrae were quantified using the relative rotation angles. RESULTS: The compressed soft tissue thickness in the SIRB condition was significantly lower than that in the HMB condition. The normalised muscle activities exhibited that right sternocleidomastoid muscle activity in the HMB condition was significantly higher than that in the baseline and SIRB conditions. In the SIRB and HMB conditions, Numeric Rating Scale for pain was 0.2 ± 0.5 and 5.2 ± 1.4, respectively. CONCLUSIONS: Our findings demonstrate that a SIRB is more advantageous than an HMB for pressing the soft tissue deeply. This finding would be related to reduced muscle tension and discomfort in the SIRB condition when compared with the HMB condition.

Kinesio taping versus dry needling in the treatment of myofascial pain of the upper trapezius muscle: A randomized, single blind (evaluator), prospective study.

BACKGROUND: Although a number of therapeutic interventions for trigger-point inactivation have been studied, it remains controversial which intervention is better. OBJECTIVE: To compare the effectiveness of the kinesio taping and dry needling methods in patients with trigger-point related myofascial pain syndrome of the upper trapezius muscle. METHODS: A total of 42 patients were randomly allocated to the kinesio taping group (n= 23) and dry needling group (n= 19). The patients were assessed for pain, pressure pain threshold (PPT), cervical range of motion (CROM), and function at baseline, at short- and medium-term stages after treatment. To investigate the effects of the interventions over time, two-way repeated measures analysis of variance (ANOVA) was used. RESULTS: There was a significant improvement in pain intensity at rest and cervical motion, in the PPT readings (p< 0.05), in CROM (p< 0.05), and in function (p< 0.05) in both groups, with no superiority either (p> 0.05). CONCLUSIONS: Kinesio taping may be a choice of trigger point inactivation in patients who do not want to be needled or who show contraindication(s) to treatments other than kinesio taping.

The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial.

BACKGROUND: Chronic neck pain is associated with various myofascial trigger points (MTrPs). OBJECTIVE: A single-blind randomized clinical trial was designed to compare the effects of extracorporeal shock wave therapy (ESWT) with dry needling (DN) techniques on the upper trapezius muscle trigger point in patients with non-specific neck pain (NSNP). METHODS: Seventy patients with NSNP and active MTrPs of the upper trapezius muscle were randomly divided into two groups: an ESWT group (n= 35) and a DN group (n= 35). Treatment sessions were performed for three weeks and all participants received related intervention once a week. The outcome measures were pain intensity, measured by a numeric pain rating scale (NPRS), pain pressure threshold (PPT), measured with a digital algometer, and functional disability, evaluated by using the neck disability index (NDI). RESULTS: NPRS and NDI were significantly decreased in the DN group and ESWT group (P< 0.05). Also, the PPT was significantly increased in the DN group and ESWT. However, there was no significant difference in pain intensity, NDI, and the PPT between the two groups (P⩾ 0.05). CONCLUSION: Both ESWT and DN can be employed to treat MTrPs of the upper trapezius muscle in patients with NSNP.

The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes.

BACKGROUND: Pain from myofascial trigger points is often treated by dry needling (DN). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. Muscle damage after eliciting LTR can increase the risk of tissue fibrosis in some cases. OBJECTIVE: This study aimed to compare two methods of DN including with and without LTR on clinical parameters. METHODS: Twenty-six participants suffering from chronic non-specific neck pain with an active trigger point (TrP) in their upper trapezius muscles were recruited via the convenience sampling method. Participants were randomly assigned in DN with LTR (control group) and without eliciting LTR or "de qi" (experimental group). Then, they received 3 sessions of dry needling, 3 days apart. We evaluated pain, pain pressure threshold, active cervical lateral flexion range of motion, and Neck Disability Index before the intervention and 4 weeks after the treatment. RESULTS: After the treatment, significant higher changes were seen in the experimental group compared to the control group (p< 0.05) regarding pain, pain pressure threshold, and active cervical lateral flexion. However, there was no significant difference between groups according to the disability (p> 0.05). CONCLUSION: DN without eliciting LTR has superiority over the DN along with eliciting LTR while the treatment aimed to receive long-term effects.

Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome.

CONTEXT: Chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points (MTrPs), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe postneedle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard. OBJECTIVE: To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. The authors hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP. DESIGN: Single-blind randomized clinical trial. SETTING: Sports medicine physical therapy clinic. PARTICIPANTS: A total of 40 overhead athletes (age = 36 [16] y; 20 females and 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n = 21) and ISP DN (n = 19) groups. INTERVENTION: An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in 3 sessions (2-day interval between each sessions) for each group. MAIN OUTCOME MEASURES: Pain intensity (visual analog scale), pain pressure threshold, and disability in the arm, shoulder, and hand were assessed before and after the interventions. RESULTS: Pain and disability decreased significantly in both groups (P < .001) and pain pressure threshold increased significantly only in the ISP group (P = .02). However, none of the outcome measures showed a significant intergroup difference after treatments (P > .05). CONCLUSIONS: Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.

Effects of Integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points.

INTRODUCTION: Upper trapezius trigger points are among the most common causes of neck pain. This study aimed to investigate the effects of integrated Neuromuscular Inhibition Technique (INIT) on pain intensity and threshold. MATERIALS & METHODS: Thirty two female participants with upper trapezius trigger points were recruited in this study. The participants were assigned to control (n = 16) or intervention (n = 16). The intervention group received INIT in one session, consisted of muscle energy technique, ischemic compression and strain-counter strain. Pain threshold and intensity were measured using Pressure Pain Threshold (PPT) and Numerical Pain Scale (NPS). These measurements were performed at baseline, immediately after treatment and 24 h after treatment. FINDINGS: The results showed that pain intensity significantly decreased in the intervention group immediately after treatment (P = .01) and 24 h after treatment (P = .009) in comparison with the control group. There were no significant differences in pressure pain threshold between both groups. CONCLUSION: It seems that Integrated Neuromuscular Inhibition Technique can reduce pain intensity in patients with upper trapezius trigger points.

Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius.

The objective of the study was to compare the effects of shockwave therapy and laser therapy on pain, neck functionality, and quality of life in patients with myofascial pain syndrome of the trapezius. 61 patients (> 18 years) were randomly allocated to two treatment groups: (1) 31 patients received soft laser therapy once daily in a 3-week period for a total of 15 sessions, (2) 30 patients received shockwave therapy once in a week for 3 weeks, totalling 3 treatments. Resting pain and pain tolerance were assessed by a 100 mm visual analogue scale; functional status and quality of life were measured by specific questionnaires (Neck Disability Index, SF-36) before and after the 3-week therapy and at the 15th week follow-up visit. All measured parameters improved significantly in both groups at week 3 and week 15. Comparing the two groups, patients receiving shockwave therapy demonstrated significantly better changes in pain tolerance (mean between-group differences at visit 1-0 = 14.911, 95% CI = 2.641-27.182, mean between-group differences at visit 2-0 = 17.190, 95% CI = 4.326-30.055 in the left trapezius), neck functionality (mean between-group differences at visit 1- 0 = 0.660, 95% CI = - 1.933 to 3.253, mean between-group differences at visit 2-0 = 1.072, 95% CI = - 2.110 to 4.254), and in all domains using SF-36 QoL questionnaire. The only parameter in which the laser group showed significantly higher benefits was at week 15 for resting pain (mean between-group differences at visit 2-0 = - 1.345, 95% CI = - 14.600 to 11.910). The results of our study point to a conclusion that both laser and shockwave therapy are effective in myofascial pain syndrome, though we found shockwave therapy to be somewhat more beneficial. Clinical trial registration number NCT03436459 ( https://clinicaltrials.gov/ct2/show/NCT03436459 ).

Increase in Lactate Without Change in Nutritive Blood Flow or Glucose at Active Trigger Points Following Massage: A Randomized Clinical Trial.

OBJECTIVE: To investigate changes in nutritive blood flow as well as interstitial glucose and lactate within an active myofascial trigger point (MTrP) following massage. DESIGN: Randomized, placebo-controlled trial. SETTING: Subjects were recruited from the general population; procedures were conducted at a research center affiliated with a university hospital. PARTICIPANTS: Adults (N=25) (18-49y old) with episodic or chronic tension-type headache and an active MTrP in the upper trapezius muscle. INTERVENTIONS: Subjects were randomized to receive a single trigger point (TrP) release massage or sham ultrasound (US) treatment at an active MTrP in the upper trapezius muscle. Microdialysis was used to continuously sample interstitial fluid from the MTrP before, during, and for 60 minutes following intervention. MAIN OUTCOME MEASURES: The primary outcome measure was nutritive blood flow within the MTrP as measured by microdialysis ethanol clearance; secondary measures included dialysate glucose, dialysate lactate, and subject discomfort with the procedures. Pressure-pain threshold (PPT) was determined to assess treatment effectiveness. RESULTS: There was no treatment effect of TrP release massage on nutritive blood flow (P=.663) or dialysate glucose (P=.766). The interaction for lactate was significant indicating that dialysate lactate increased for TrP release massage vs sham US (P=.04); maximum lactate increase over baseline was observed at 60 minutes after TrP release massage (P=.007, 0.128 µM, 95% confidence interval 0.045-0.212). Pain evoked by probe placement into an active MTrP was low. An interaction effect on PPT was significant (P=.005). CONCLUSION: TrP release massage of an active MTrP affected anaerobic metabolism as represented by an increase in dialysate lactate without change in nutritive blood flow or dialysate glucose. The lack of a treatment effect on blood flow is discussed.

Association Between Trapezius Muscle Tenderness and Tension-Type Headache in Female Office Workers: A Cross-sectional Study.

OBJECTIVE: The purpose of the study was to determine the association between trapezius muscle tenderness and tension-type headache among female office workers. METHODS: Through a questionnaire survey, 256 female office workers with tension-type headaches reported the level of palpable tenderness ("no," "some," or "severe tenderness") in the trapezius muscle. The number of days with headache ("0-7," "8-14," or ">14"), intensity ("low," "moderate," or "high"), duration of headache ("<8 hours per day," ">8 hours per day," and "all day"), and use of analgesic medications were reported. Odds ratio (OR) for tenderness in the trapezius muscle ("no/some" vs "severe tenderness") as a function of days with headache, intensity of headache, duration of headache, and use of analgesic medications were calculated using a binary logistic regression controlling for age and body mass index. RESULTS: After adjustments for confounders, a strong association was found between the level of trapezius muscle tenderness and intensity of headache (moderate intensity, OR 2.45; 95% confidence interval [CI] 1.08-5.54; high intensity, OR 7.51 [95% CI 2.65-21.29]) and days with headache (>14 days, OR 4.75 [95% CI 1.41-15.89]). No association was observed for duration of headache or use of analgesic medications. CONCLUSIONS: For the participants studied, there was a strong association between trapezius muscle tenderness and the level of intensity and the number of days with a headache among female office workers. No association was seen for duration of headaches or use of analgesic medications.

Analysis of chronic myofascial pain in the upper trapezius muscle of breast cancer survivors and women with neck pain.

Myofascial trigger points are present in dysfunctioning muscles and are associated with several diseases. However, the scientific literature has not established whether myofascial trigger points of differing etiologies have the same clinical characteristics. Thus, the objective of the present study was to compare the intensity of myofascial pain, catastrophizing, and the pressure pain threshold at myofascial trigger points among breast cancer survivors and women with neck pain. This was a cross-sectional study that included women over 18 years old complaining of myofascial pain in the upper trapezius muscle region for more than 90 days, equally divided into breast cancer survivors (n = 30) and those with neck pain (n = 30). For inclusion, the presence of a bilateral, active, and centrally located trigger point with mean distance from C7 to acromion in the upper trapezius was mandatory. The measures of assessment were: pain intensity, catastrophizing, and the pressure pain threshold at the myofascial trigger points. A significant difference was observed only when comparing pain intensity (p < 0.001) between the breast cancer survivors (median score: 8.00 points, first quartile: 7.00 points, third quartile: 8.75 points) and women with neck pain (median score: 2.50 points, first quartile: 2.00 points, third quartile: 4.00 points). No significant difference was found between groups in catastrophizing and pressure pain threshold. The conclusion of this study was that breast cancer survivors have a higher intensity of myofascial pain in the upper trapezius muscle when compared to patients with neck pain, which indicates the need for evaluation and a specific intervention for the myofascial dysfunction of these women.

Immediate Effect of Acupuncture on Electromyographic Activity of the Upper Trapezius Muscle and Pain in Patients With Nonspecific Neck Pain: A Randomized, Single-Blinded, Sham-Controlled, Crossover Study.

OBJECTIVE: The objective of this study was to assess changes in upper trapezius myoelectric activity and pain in patients with nonspecific neck pain after a single session of acupuncture (ACP). METHODS: A blinded randomized clinical trial was conducted. Fifteen patients with nonspecific neck pain and 15 healthy participants were enrolled in a randomized, single-blinded, crossover study. Each participant was subjected to a single session of ACP and sham acupuncture (SACP). The electromyography (EMG) signal of the upper trapezius muscle was recorded during different step contractions of shoulder elevation force (15%-30% maximal voluntary contraction) before and after ACP treatment. RESULTS: Significant effects were confirmed after the treatment (ACP and SACP) for Numeric Rating Scale scores (F1,28 = 51.61; P < .0001) and pain area (F1,2 = 32.03; P < .0001). Significant decreases in the EMG amplitude were identified for the nonspecific neck pain group (NPG) (F1,112 = 26.82; P < .0001) and the healthy participant group (HPG) (F1,112 = 21.69; P < .0001) after ACP treatment. No differences were identified between the ACP and SACP treatment protocols for Numeric Rating Scale score (NPG: F1,28 = 0.95; P = .33), pain area (NPG: F1,28 = 1.97; P = .17), or EMG amplitude (NPG: F1,112 = 0.47; P = .49; HPG: F1,112 = 0.75; P = .38). CONCLUSION: The effect of ACP at acupoints triple energizer 5 and large intestine 11 triple energizer 5, or in close proximity, contributes to pain relief among patients with nonspecific neck pain. The electromyographic analysis indicated a greater resistance to muscle fatigue and decrease of activity of the upper trapezius muscle among healthy participants and patients with nonspecific neck pain.

Ischemic compression and kinesiotherapy on chronic myofascial pain in breast cancer survivors.

OBJECTIVE: assess the effects of ischemic compression and kinesiotherapy on the rehabilitation of breast cancer survivors with chronic myofascial pain. METHODS: A randomized, controlled, blinded clinical trial was performed with 20 breast cancer survivors with myofascial trigger point in the upper trapezius muscle. Patients were randomly allocated to ischemic compression + kinesiotherapy (G1, n = 10) and kinesiotherapy (G2, n = 10). Both groups were submitted to 10 sessions of treatment. The variables evaluated were: Numeric Rating Scale, Pain Related Self-Statement Scale, pressure pain threshold, Functional Assessment of Cancer Therapy-Breast and Infrared thermography. RESULTS: A significant reduction (p < 0.05) was observed in pain intensity after 10 sessions in Groups 1 and 2, a significant increase (p < 0.05) in pressure pain threshold in both the operated and non-operated side after 10 sessions for Group 1. CONCLUSION: Ischemic compression associated with kinesiotherapy increases the pressure pain threshold on the myofascial trigger point in the upper trapezius muscle and reduces the intensity of pain in breast cancer survivors with myofascial pain.