ABSTRACT
The goal of our study was to investigate the cumulative effect of combining medium-energy extracorporeal shock wave therapy (ESWT) and photobiomodulation therapy (PBMT), as well as to compare between their relative effectiveness in the management of plantar fasciitis (PF). One hundred twenty participants with chronic PF, more than 6 months with failure to respond to conservative treatment, were randomly assigned into four equal groups. Participants received either ESWT with PBMT, ESWT (once a week), PBMT (three times a week), or sham-PBMT (three times a week) for three consecutive weeks. A home exercise program was also included for all four groups. Outcome measures included pressure pain threshold (PPT), visual analogue scale (VAS), and functional foot index disability subscale (FFI-d) that were collected prior to the first treatment session and at the end of the 3-week treatment period, as well as at a follow-up session, 12 weeks after the final treatment session. There were statistically significant improvements in post-intervention and follow-up PPT, VAS, and FFI-d values in all treatment groups (P < 0.0001). As for the sham-PBMT, no significant difference was found between the pre-, post-intervention and follow-up values (P > 0.05). Bonferroni correction test revealed that there was a significant difference between all the four groups in PPT, VAS, and FFI-d values (P < 0.0001). All active treatment groups maintained the treatment effect at the 12-week follow-up. Both ESWT and PBMT were effective in increasing PPT values, decreasing pain and increasing functional ability. Additionally, application of PBMT after ESWT was shown to be superior over ESWT and PBMT alone, and ESWT was superior over PBMT in terms of reducing pain sensitivity and increasing function.Level of Evidence II.
Subject(s)
Extracorporeal Shockwave Therapy , Fasciitis, Plantar/radiotherapy , Low-Level Light Therapy , Disability Evaluation , Fasciitis, Plantar/physiopathology , Female , Foot/physiopathology , Humans , Male , Middle Aged , Pain Measurement , Pain Threshold , Treatment Outcome , Visual Analog ScaleABSTRACT
BACKGROUND: Electrotherapeutic modalities have proven to be one of the best therapeutic options for myofascial pain syndrome, targeting the myofascial trigger points (MTrPs). Combined therapy (CT) is described with paucity in literature as the application of ultrasound (US) and electrical stimulating current concurrently and at the same site. AIM: The aim was to compare between low-frequency, high-intensity burst transcutaneous electrical nerve stimulation CT (burst-TENS-CT) and medium-frequency, low-intensity amplitude modulated frequency CT (AMF-CT) on upper trapezius active MTrPs (A-MTrPs). PARTICIPANTS AND INTERVENTION: In this single-blinded randomized controlled trial design, 70 participants with acute mechanical neck pain and at least two A-MTrPs in the upper trapezius were simply and randomly allocated into three groups-the burst-TENS-CT, the AMF-CT, or the sham-CT control groups. All groups received three sessions per week for four consecutive weeks. OUTCOME MEASURES: Outcome measures included pressure pain threshold (PPT) using a digital electronic algometer and active cervical lateral flexion range of motion (ROM) using an iPhone Clinometer application. Data were collected prior to the first treatment and at the end of the 4-week trial. RESULTS: There were statistically significant improvements in postintervention PPT and ROM values in both treatment groups (p < 0.0001). As for the sham-US, no significant difference was found between the preintervention and postintervention values (p > 0.05). Bonferroni correction test revealed that there was a significant difference between all the three groups (p < 0.0001). Additionally, burst-TENS-CT yields a greater increase in PPT and ROM values (547% and 49.32%, respectively) than that of medium-frequency AMF-CT. CONCLUSION: Within the scope of this study, both CT modalities were effective in increasing PPT and cervical lateral flexion ROM. Nonetheless, low-frequency, high-intensity burst-TENS-CT was shown to be superior over the medium-frequency, low-intensity AMF-CT in terms of reducing pain sensitivity and increasing ROM.
Subject(s)
Myofascial Pain Syndromes/therapy , Transcutaneous Electric Nerve Stimulation/methods , Trigger Points , Adult , Female , Humans , Male , Pain Threshold , Range of Motion, Articular , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of the study was to investigate the efficacy of phonophoresis with combined therapy on active myofascial trigger points. PARTICIPANTS: One hundred participants with acute mechanical neck pain and at least one active myofascial trigger point in the upper trapezius were randomly assigned into four equal groups. INTERVENTION: Groups consisted of diclofenac phonophoresis with combined therapy, diclofenac phonophoresis, ultrasound (US) with coupling gel, and sham US and applied for 10 mins over myofascial trigger points. MEASUREMENTS: Measurements included pressure pain threshold and active cervical lateral flexion. RESULTS: There were statistically significant improvements in postintervention pressure pain threshold and range of motion values in treatment groups (P < 0.0001). As for the sham US, no significant difference was found between the preintervention and postintervention values (P > 0.05). Bonferroni correction test revealed that there was a significant difference between all the four groups in pressure pain threshold values (P < 0.0001); however, it was nonsignificant (P > 0.05) for range of motion. CONCLUSIONS: Diclofenac phonophoresis with combined therapy, phonophoresis, and US were all effective in increasing pressure pain threshold values and range of motion. In addition, phonophoresis with combined therapy was shown to be superior over phonophoresis, and phonophoresis was superior over US in terms of reducing pain sensitivity. However, none of the treatment groups were found to be superior over the other in increasing range of motion.
Subject(s)
Myofascial Pain Syndromes/therapy , Phonophoresis/methods , Transcutaneous Electric Nerve Stimulation/methods , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Combined Modality Therapy , Diclofenac/administration & dosage , Female , Humans , Male , Middle Aged , Myofascial Pain Syndromes/physiopathology , Pain Measurement , Pain Threshold , Range of Motion, Articular , Single-Blind Method , Superficial Back Muscles/physiopathology , Treatment OutcomeABSTRACT
OBJECTIVE: Currently, there is a lack of objective means to quantify myofascial trigger points (MTrPs) and their core features. Our research compares (1) MTrPs and surrounding myofascial tissue using two-dimensional grayscale ultrasound (2DGSUS) and vibration sonoelastography (VSE); (2) the accuracy of both modes in visualizing MTrPs; (3) 'active' and 'latent' MTrPs, using VSE; and (4) the accuracy of both modes in visualizing deep and superficially located MTrPs. METHODS: Fifty participants with more than two MTrPs in their quadratus lumborum, longissimus thoracis, piriformis, and gluteus medius muscles were assigned to an active MTrP (low back pain) group or a latent (currently pain free) MTrP group. MTrP identification was based on their essential criteria. An electronic algometer measured repeatedly the tenderness of MTrPs with reference to pressure pain threshold values. A handheld vibrator was applied over MTrPs, while VSE and 2DGSUS readings were taken using an EUB-7500 ultrasound scanner. RESULTS: There was a significant difference between MTrP strain and that of the immediately surrounding myofascial tissue, as measured using VSE (Pâ=â0·001). VSE visualized all superficial and deep MTrPs with an accuracy of 100% (for both groups); the blinded results obtained using 2DGSUS achieved 33% and 35% accuracy, respectively. There was no significant difference found between the tissue strain ratios of active and latent MTrPs (Pâ=â0·929). DISCUSSION: Sonoelastography can visualize superficial and deep MTrPs, and differentiate them from surrounding myofascial structure through tissue stiffness and echogenicity. VSE was more accurate than 2DGSUS in visualizing and imaging MTrPs.