EFFECTIVENESS OF MANUAL COMPRESSION AND STRETCHING EXERCISE FOR SUBJECTS WITH ACTIVE VERSUS LATENT LUMBAR MYOFASCIAL TRIGGER POINTS

W.T.J. Wang¹, K.-S. Dai¹, Y.-L. Lin¹, T.-S. Huang¹

¹National Yang MIng Chiao Tung University, Physical Therapy and Assistive Technology, Taipei, Taiwan

Background: Previous studies have shown that myofascial trigger points (MTrPs) to be the culprit of Myofascial Pain Syndrome and the root cause of musculoskeletal referred pain. MTrPs are defined as highly irritable spots located within the myofascial layers of a muscle. MTrPs can generally be divided into two types, the active MTrPs and the latent MTrPs. Both types of MTrPs may present with similar symptoms including muscle spasm or tightness, increased muscle tone (MT), reduced joint’s range of motion (ROM), decrease of pressure pain threshold (PPT), and exhibition of altered muscle activation patterns. Even though latent MTrPs do not produce spontaneous symptoms, they can still cause an increase in MT and a reduction in muscle function. Regardless of its type, muscle harboring an MTrP often experiences a disruption in blood circulation and metabolism which may lead to a local energy crisis. Previous studies have revealed the effects of various management strategies and intervention, however, as the type of MTrPs varies, the intervention effects may be different.

Purpose: This study aimed to compare the immediate effect of a single session MTrP manual compression versus muscle stretching for the quadratus lumborum and erector spinae muscles in subjects with active and latent MTrPs.

Methods: The study was a randomized controlled trial. A total of 90 subjects with MTrPs located within the quadratus lumborum and erector spinae muscle (45 with active MTrPs and 45 with latent MTrPs) were randomly assigned into 3 groups with each group receiving one of the following interventions: manual compression (MC) group (n=30), stretching exercise (SE) group (n=30) and Combined (MC+SE) group (n=30). Each group received a single session of intervention and was tested immediately after the intervention. Outcomes measures included PPT, MT, lumbar ROM and perceived overall improvement.

Results: There were significant changes in all outcomes (p<0.05) in the 3 interventions groups. In terms of PPT, all 3 interventions demonstrated equal treatment effects in increasing the PPT of the quadratus lumborum and erector spinae in subjects with active MTrPs, whereas in subjects with latent MTrPs, manual compression and combined intervention were found superior to the active stretching. In subjects with either active or latent MTrPs, the MC and MC+SE group reported a greater decrease in MT than the SE group. Regarding the lumbar flexion ROM, the MC+SE group was more effective than the SE group in subjects with either active or latent MTrPs.

Conclusions: All 3 interventions showed an immediate effect in improving the PPT, MT of lumbar muscles, and the lumbar ROM for subjects with MTrPs. The intervention’s magnitude of improvement varies based on the types of MTrPs harbored in the affected muscles.

Implications: Although all 3 interventions demonstrated significant treatment effects in the affected muscles regardless of the types of MTrPs, intervention that included manual compression demonstrated significantly better effect than stretching exercise alone. In subjects with active MTrPs, changes in muscle PPT were significantly related to the changes in lumbar ROM, whereas in subjects with latent MTrPs, changes in lumbar ROM were significantly related to the changes in MT.

Funding acknowledgements: None.

Keywords:
Myofascial trigger point
Manual compression
Stretching exercise

Topics:
Musculoskeletal: spine
Orthopaedics
Pain & pain management

Did this work require ethics approval? Yes

Institution: National Yang Ming Chiao Tung University

Committee: Institutional Review Board

Ethics number: YM110164E