To evaluate the effectiveness of trigger point manual therapy (TPMT) in treating rotator cuff related shoulder pain (RCRSP).

Randomized controlled trials that compared the effects of TPMT with no or other conservative treatments in patients with RCRSP were included. Primary outcomes were shoulder pain intensity and function. Secondary outcomes were pressure pain threshold (PPT) and number of myofascial trigger points (MTrPs). The Cochrane Risk of Bias 2.0 tool, PEDro scale and GRADE approach were employed.

Ten studies were included in this systematic review and seven in the meta-analysis. Very low to low quality of evidence showed no statistically significant difference between TPMT and other conservative treatments in rest and activity pain reduction in the short term (3 days to 12 weeks), and the difference in shoulder function was statistically significant in favor of TPMT. Furthermore, TPMT was found to be effective in the improvement of PPT and the inactivation of active MTrPs in the short term.

TPMT may be equally effective as other passive treatments for the pain reduction in patients with RCRSP in the short term, and slightly more effective for functional improvement. TPMT seems to be effective to treat the active MTrPs in RCRSP.

CRD42023409101.

Myofascial pain syndrome (MPS) is a chronic regional pain condition characterized by trigger points-hyperirritable spots within taut bands of muscle fibers that cause both localized and referred pain. The pathogenesis, diagnostic criteria, and classification of MPS are still under investigation, which complicates the development of standardized treatment protocols. Although diagnostic tools have improved, MPS often remains underrecognized due to symptom overlap with other pain disorders, such as fibromyalgia, neuropathic pain, and joint disorders. Factors contributing to its onset and persistence include muscle overuse, postural imbalance, systemic conditions, and psychological and behavioral influences. This narrative review explores the primary risk factors, current hypotheses on pathogenesis, diagnosis and differential diagnosis, and both conventional and emerging treatments. Sufficient evidence supports the use of local anesthetic injections for MPS. Some evidence suggests that dry needling, acupuncture, magnetic stimulation, ultrasound therapy, laser therapy, extracorporeal shock wave therapy, and manual therapy may be effective, particularly compared to sham or placebo. However, non-steroidal anti-inflammatory drugs, diclofenac, botulinum toxin, and transcutaneous electrical nerve stimulation show insufficient evidence, while the effectiveness of muscle relaxants, antidepressants, gabapentin, opioids, topical lidocaine, capsaicin, EMLA cream, and kinesio taping remains inconclusive. Effective management of MPS requires a patient-centered approach that integrates empirically supported and evidence-based treatments tailored to individual needs. This review synthesizes the current understanding of MPS and highlights the need for high-quality research to improve clinical decision-making in managing this complex condition.

The most common cause of muscle pain is myofascial pain syndrome. Myofascial pain syndrome caused by sensitive areas called trigger points (TrP). Some physiotherapy modalities have acceptable effects for this disorder, but it is necessary to check the effects of placebo, appropriate dose, and long-term effects for each intervention. The aim of this study is to investigate the effect of intramuscular electrical stimulation (IMES) compared to dry needling (DN) on sonographic and clinical parameters in upper trapezius muscle TrP.

This is a randomized, single-blind control trial. The study period was from December 2, 2020, to April 10, 2021. Thirty volunteer patients with active upper trapezius TrP were randomly allocated into two groups: (1) IMES, (2) DN. Participants received interventions in three sessions. Primary outcome measurements were neck range of motion (ROM) and TrP circumference. Secondary outcome measurements were pain by visual analog scale (VAS), pain pressure threshold (PPT), disability, TrP longitudinal and transverse diameter, TrP stiffness, and muscle blood flow by vascular resistance index (RI). All outcome measurements were evaluated before, after, and one month after the intervention. If the data were normal, the repeated measure ANOVA test was used; if data were not normal, the Friedman test and the Kruskal-Wallis test was used. A significance level of 0.05 has considered.

ROM increment was significantly more in the IMES group. TrP circumference decrement was significantly more in the IMES group. VAS changes did not show significant difference between two groups. The PPT improvement was significantly more in the IMES group. Disability changes were not significant. Longitudinal diameter changes were significantly more in the IMES group. TrP stiffness changes were not significant. The vascular RI decreased significantly in IMES group.

It seems that both IMES and DN have promising effects for improving upper trapezius TrPs. However, IMES is more effective in some clinical and ultrasound parameters. In order to investigate the effects of this intervention more precisely more studies are necessary.

This study was prospectively registered at Iranian registry of clinical trials (IRCT: IRCT20170616034567N2).

Dry needling (DN) has recently been investigated as an alternative strategy to reduce muscle spasticity and improve mobility in people with multiple sclerosis (pwMS). The aim of the present review was to identify any available literature on the potential benefits of DN in pwMS.

A systematic literature search was conducted in the PubMed, Scopus, ScienceDirect, Embase/Ovid, CINAHL, CENTRAL, Web of Science and PEDro databases and at ClinicalTrials.gov. The search results were limited to studies published between 2000 and 2023 without language restrictions. All articles reporting on the application of DN (defined as the use of a needle to target myofascial trigger point(s) without injection) in pwMS were included. Studies related to traditional medicine were excluded. Two reviewers independently investigated the quality of reporting based on Joanna Briggs Institute critical appraisal tools. Data on the effects of DN on muscle spasticity, pain intensity, mobility and other reported outcomes in pwMS were extracted and analyzed.

Four original articles (two case reports and two case series) and one conference paper reporting the findings of a randomized controlled trial randomized controlled trial (RCT) were included. The RCT was small (n = 16 participants) and sham-controlled with no significant differences between groups. In all four case reports/series, reduced spasticity was observed following DN treatment in pwMS. Findings with respect to other outcomes (including pain intensity, mobility, quality of life, manual dexterity and disability reduction) were mixed.

Although no firm conclusions can be drawn from these uncontrolled case reports/series, DN for pwMS appears feasible and (based on limited clinical observation) may have potential as an adjunct therapeutic method to address spasticity in pwMS. However, the quantity and quality of available data are extremely limited. There is a need for high-quality studies of DN (ideally adequately sized RCTs with a low risk of bias) to further explore its effectiveness in the MS population.

To explore the intra- and interexaminer reliability of shear wave elastograhy (SWE), (an objective alternative to highly subjective procedures with poor inter-rater reliability such as manual palpation) in measuring the stiffness of latent myofascial trigger points (MTrPs) and healthy surrounding areas in the infraspinatus muscle, pressure pain threshold (PPT), interexaminer reliability, and mean differences in SWE and PPTs between MTrPs and control points.

Longitudinal observational study: Intra- and interexaminer reliability study.

A university laboratory.

Forty participants (N=40) with latent MTrPs within the infraspinatus muscle.

Not applicable.

One experienced examiner identified and classified latent MTrPs and selected an asymptomatic control point within the infraspinatus muscle. Later, 2 blinded examiners assessed once the PPTs (blinded to the scores) and acquired 2 SWE images of each location. Reliability estimates were calculated for assessing PPT interexaminer reliability and SWE intra- and interexaminer reliability. PPT and SWE scores were compared by location (MTrP and control) and gender (male/female).

PPTs were significantly lower in MTrPs than control points in males (P=.003) and females (P=.006), and lower in females than males (MTrP P<.001; control point P=.001). Good interexaminer reliability was found for PPTs (intraclass correlation coefficient [ICC]>0.84) and SWE (ICC>0.82). Intraexaminer reliability for SWE was excellent (ICC>0.95) in both the novice and experienced examiners.

This study demonstrated excellent SWE intraexaminer reliability (ICCs>0.9) and good interexaminer reliability (ICCs>0.82). Although PPT scores indicated significant differences in hyperirritability between latent MTrPs and control points, SWE measurements revealed no significant differences in muscle stiffness.

Background: Dry needling is increasingly utilized by clinicians in the treatment of patients with headaches. Although current evidence supports the use of dry needling for reducing headache pain, needling approaches are inconsistent among published studies, and no guidelines on dry needling for headaches have been established. Methods: A study will be conducted using the Delphi method, consisting of three rounds of questionnaires sent to an expert panel of clinicians and researchers. Results: To guide the development of the initial survey, we completed a literature review of articles related to dry needling for headaches. A steering committee will assess the initial survey items synthesized from the literature search and provide recommendations for the first and subsequent rounds of the study. Percentage agreement will be the primary measure throughout all rounds of this study. We define consensus to have been reached when 75% agreement is achieved. Conclusions: We seek to develop clinical recommendations that will guide research and treatment practices regarding dry needling for headaches. Having consensus-driven recommendations on dry needling for headaches will assist researchers in the design of future studies on this condition. In addition, having guidelines that clinicians can reference prior to the delivery of dry needling for headaches would benefit patient care.

Individuals with low back pain (LBP) often exhibit weakness and the presence of trigger points in their Gluteus Medius (GMe) muscle.

To examine the effectiveness of adding dry needling (DN) for the GMe to standard care of active physical therapy in patients with chronic nonspecific LBP.

A randomized, prospective, sham-controlled trial was conducted. Participants with chronic nonspecific LBP (N = 22, age range: 31-55 years) were randomly divided into intervention and control groups. Both groups received active physical therapy including exercises for 6 treatments. In addition, at each session, the intervention group received deep DN to their GMe muscle, and the control group received sham needling. Outcome measures included level of pain (using VAS scale), function (Oswestry disability index ODI), low back range of motion (ROM) (forward flexion and schober tests), and global rating of change. The research group was further divided into moderate and minimal disability according to the ODI.

The research group showed greater improvement in pain level compared with control (p = 0.01). The change in ODI was higher in the moderate LBP group compared with the control group (B = 5.25, p < 0.05). The change in forward flexion distance test was higher in the moderate disability LBP group compared with the control group (B = 6.31, p < 0.01). Simple mean analysis also revealed a significant difference between the moderate and minimal disability groups (B = 6.16, p = 0.01).

Incorporating DN into physical therapy treatments for chronic nonspecific low back pain, can improve pain level and function.

NCT04498572 (clinicaltrial.gov).

This study was designed to determine the prevalence of myofascial pain and the location of myofascial trigger points (MTPs) in dogs with osteoarthritis.

Thirty-five dogs were selected and examined for the presence of MTPs using palpation. Assessments were performed independently by two examiners. Correlations between age, MTP number and location, and the site of osteoarthritis were also investigated.

Thirty out of 35 dogs (86%) had at least one MTP and only 5 (14%) had none. A total of 177 MTPs were identified in dogs in this sample. The prevalence of MTPs was higher in the longissimus thoracicae (40% and 43%; left and right side respectively), followed by the quadriceps femoris (40% and 31%), longissimus lumborum (20% and 23%), gluteus medius and deltoid muscles (14%; left side only), and the pectineus muscle (11%; right side only). The number of osteoarthritic joints was not correlated with the number of MTPs or age. However, age was positively correlated with the number of muscles affected by MTPs. Correlations between the presence of MTPs in muscles surrounding and the affected joints were also lacking.

The prevalence of MTPs in dogs with osteoarthritis is high. Myofascial TPs are positively correlated with age in these patients. The subjective nature of palpation is a major limitation in myofascial pain assessment. Appropriate training and use of standardized diagnostic criteria are recommended.

Myofascial trigger points (MTrPs) are potential contributors to shoulder pain and can lead to local ischemia and hypoxia, thus causing pain. Color Doppler ultrasound (US) has been used to examine the vascular environment around MTrPs, but has not been used to examine blood flow impairments in patients with shoulder pain and MTrPs. The reliability of color Doppler US for measuring infraspinatus muscle blood flow also has not been established. This study aimed to investigate differences in blood flow between individuals with and without shoulder pain and the reliability of Doppler US for measuring infraspinatus muscle blood flow.

Forty participants were enrolled, 20 with shoulder pain and MTrPs and 20 without. Color Doppler US examination was performed twice on each participant to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatile index (PI) of the infraspinatus muscle.

The symptomatic participants had significantly higher PSV (ie, impaired blood flow) than the asymptomatic participants. There were no significant between-group differences in EDV, RI, and PI. The results also demonstrated good-to-excellent intra-rater reliability for color Doppler US measurements of PSV, EDV, RI, and PI for both groups.

This study demonstrated differences in blood flow near MTrPs in the infraspinatus muscle between individuals with and without shoulder pain. It also established good-to-excellent reliability of color Doppler US in measuring infraspinatus muscle blood flow. These findings suggest color Doppler US is a useful tool to identify vascular impairments for shoulder pain associated with MTrPs.

Background/Objectives: Low back pain (LBP) is a widespread public health issue, with myofascial pain syndrome (MPS) being a common cause, affecting 67-100% of patients. However, there are significant challenges in the diagnostic process due to the subjective and unreliable nature of manual palpation. Focused Extracorporeal Shockwave Therapy (F-ESWT), traditionally used for MPS treatment, offers a reproducible and non-invasive mechanical stimulus, making it a potential diagnostic tool. This study evaluated F-ESWT's diagnostic efficiency in chronic LBP patients by focusing on "recognition" and "referral" of pain. Methods: twenty-eight participants were screened for myofascial trigger points (MTrPs) in the lumbar, gluteal, and thigh regions. Identified MTrPs were stimulated using F-ESWT, and patient feedback was recorded. Results: data showed high diagnostic accuracy for muscles such as the quadratus lumborum, gluteus medius, and gluteus minimus muscles, achieving "referral" rates of 96%, 95%, and 92% and "recognition" rates of 84%, 86%, and 85%, respectively. Other structures like adductors, iliopsoas, erector spinae, and biceps femoris muscle showed consistent but lower diagnostic rates. Conclusions: the study's findings indicate that F-ESWT effectively reproduces pain patterns, offering a precise, reproducible, and non-invasive diagnostic approach for MPS in chronic LBP. However, they also highlight the necessity for detailed diagnostic criteria in managing myofascial pain.

Increased muscle stiffness in the upper trapezius has been suggested to be associated with cervical myofascial pain and myofascial trigger points (MTrP). Recently, efforts have been made to objectively detect MTrP using ultrasound shear wave elastography (SWE). However, there is no consensus on the relationship between muscle stiffness assessed by SWE and MTrP. This may be due to the possibility that muscle stiffness is not uniform even in the asymptomatic trapezius. The present study aimed to characterize passive muscle stiffness at the proximal, central, and distal sites of the anterior and posterior parts of the upper trapezius.

Seventeen healthy young males without neck pain participated in the study. The upper trapezius was divided into anterior and posterior parts based on anatomical landmarks: the line between C6 and the lateral end of the clavicle was defined as the anterior part, while the line between C7 and the acromion angle was defined as the posterior part. Shear wave speed (SWS; an index of stiffness) was measured using ultrasound SWE at six sites in the anterior and posterior parts of the upper trapezius, at 25% (proximal), 50% (central), and 75% (distal) of the muscle belly length.

SWS in the anterior part was significantly higher at the proximal (p < 0.001) and distal (p < 0.001) sites than at the central site. In the posterior part, there was no significant difference in SWS between the proximal, central, and distal sites. Comparisons between the anterior and posterior parts showed no significant differences in SWS at the proximal (p = 0.147), central (p = 0.339), and distal sites (p = 0.051).

The characteristics of passive stiffness distribution in the anterior and posterior parts of the upper trapezius have important implications with respect to the optimal location of the control point during MTrP detection. In particular, it may be preferable to set the control point for detecting MTrP in the transverse direction rather than in the fascicle direction, that is, to compare passive muscle stiffness at the same levels between the anterior and posterior parts.

Physiotherapists encounter challenges in diagnosing myofascial trigger points (MTrPs), which are crucial for managing myofascial pain but difficult due to their complex referred pain patterns. We aimed to assess if an interactive software (MyofAPPcial) can enhance the ability of physical therapists specialized in musculoskeletal disorders (as clinicians and as researchers and educators) to identify referred pain patterns associated with specific MTrPs and to explore their opinion about incorporating this technology regularly into their professional setting.

After developing the app, a descriptive cross-sectional survey study was conducted. Participants were asked about their demographic characteristics, professional experience, two knowledge tests (first without and later with MyofAPPcial support) and the 18-item mHealth app usability questionnaire.

Fifty-nine participants completed the survey (47.5% clinicians and 62.5% researchers/educators). Groups were comparable in terms of age, gender and professional experience (p > .05). However, clinicians coursed shorter specific MPS trainings (p = .007) and handle more cases a week (p < .001). In the first knowledge test, participants in both the groups were more accurate in identifying pain maps of highly prevalent MTrPs than those with a moderate or low prevalence (p < .001), with no differences between the groups for individual items (all, p > .05) nor the total score (p > .05). In the second knowledge test, perfect scores were obtained for all items in both the groups. Finally, MyofAPPcial scored high satisfaction and app usefulness, with no difference between clinicians and researchers/educators (except greater convenience of use for researchers/educators p = .02).

MyofAPPcial enhances physiotherapists' ability to accurately identify MTrPs, with a good acceptation among clinicians and researchers/educators.

Trigger point-related myofascial pain commonly accompanies cervical disc herniation. The aim of the study is to investigate the effect of dry needling for accompanying trigger points on cervical interlaminar epidural steroid injection treatment outcomes.

Among the patients scheduled for interlaminar epidural steroid injection for cervical disc herniation, those with active trigger points were randomly divided into three groups: interlaminar epidural steroid injection + dry needling, interlaminar epidural steroid injection + sham dry needling, and only interlaminar epidural steroid injection group. Outcome measures were determined as the change in Numeric Rating Scale, number of active trigger points, and the pressure-pain threshold measurement.

A total of 66 patients, 22 per group, were included in the final evaluation. While significant decrease in Numeric Rating Scale scores was observed in all three groups at 3rd week and 3rd month, this decrease was significantly more pronounced in the interlaminar epidural steroid injection + dry needling group (P < 0.001). There was a significant decrease in the number of active trigger points in all three groups (P < 0.001). While a significant increase was observed in the pressure-pain threshold value only in the interlaminar epidural steroid injection + dry needling group at the 3rd week, this increase was found to be significant in all three groups at the 3rd month (P < 0.001).

Combination therapy with dry needling has superiority to interlaminar epidural steroid injection + sham dry needling and only interlaminar epidural steroid injection groups in reducing pain and increasing pressure-pain threshold values.

This study aimed to compare the effects of manual therapy combined with dry needling (MTDN) to a control group, focusing on the impact on pressure pain threshold (PPT), muscle tone (MT), muscle stiffness (MS), muscle strength, and range of motion in the neck muscles of adult combat sports athletes. A randomized controlled study design was employed, with one group of athletes (n = 15) receiving MTDN intervention, while the other group (n = 15) underwent a control treatment (CG) involving a quasi-needle technique combined with manual therapy. Both groups participated in three sessions, either in the MTDN intervention or the control condition. All athletes, who were experiencing neck pain, were evaluated at rest, after one session, after three sessions, and again 72 hours after the third session. Muscle tone (MT) and muscle stiffness (MS) were measured using myotonometry, pressure pain threshold (PPT) was assessed with an algesiometer, muscle strength was evaluated using a handheld dynamometer, and range of motion was measured with an electronic goniometer. Group comparisons revealed significantly higher MT in CG compared to MTDN after the 3rd session (p < 0.001; d = 1.50). Additionally, CG showed significantly greater MS than MTDN after the 3rd session (p < 0.001; d = 1.75) and at 72 hours post-session (p < 0.001; d = 2.45). Conversely, MTDN exhibited significantly greater PPT than CG at 72 hours post-session (p < 0.001; d = 1.80). Our results suggest that MTDN is significantly more effective in improving muscle tone, stiffness, and acute pain compared to manual therapy alone. However, no significant impact was observed on maximal strength or neck range of motion. A combined approach may offer benefits by more rapidly reducing neck pain and better preparing muscle properties for future activities.

Neck pain can be associated with specific conditions, such as neurological disorders, vascular or inflammatory diseases, fractures, herniated discs, etc. However, the majority of neck pain cases cannot be attributed to a specific cause. The objective of this review is to describe the muscle dysfunctions associated with neck pain, as measured by electromyography, and to determine the effectiveness of dry needling in improving these muscular dysfunctions. The research was conducted using the following databases: PubMed, Alcorze, and Google Scholar. The next conclusions have been extracted after the revision of the 65 selected manuscripts. The current scientific evidence supports electromyographic pathological findings in individuals with chronic neck pain, especially during general upper limb movement, repetitive work, violin playing, cervical force, and cervical movement tasks. Dry needling applied to an active myofascial trigger point in the upper trapezius can be suggested as an intervention to enhance the performance in the cranio-cervical flexion. Dry needling applied to latent myofascial trigger points in the upper trapezius after typing tasks in healthy subjects resulted in decreased upper trapezius activity and fatigue in the short term. In women with trapezius myalgia, dry needling applied to the upper trapezius led to a lower increase in electromyography activity compared to no intervention.

Objectives: The dry needling of the piriformis muscle (especially in the medial region) is a challenging procedure since there is a high risk of accidentally puncturing the sciatic nerve. This study aimed to explain the variance of the deep limit of the piriformis based on anthropometric and demographic predictors potentially associated with it by exploring if clinicians can select the optimal needle length needed accurately to avoid accidental punctures of the sciatic nerve during palpation-guided dry needling interventions. Methods: An observational study was conducted that included fifty-six patients with piriformis muscle syndrome. We recorded the skin-to-sciatic nerve distance at the location with greatest risk of accidental sciatic puncture (assessed with ultrasound imaging) and demographic (e.g., age, gender, height, weight and body mass index-BMI) and anthropometric (hip circumference) variables. Results: Thirty-four males (n = 34) and twenty-two females (n = 22) were analyzed. Although men presented a significantly greater hip circumference than women (p = 0.007), no skin-to-sciatic nerve distance differences were observed (p > 0.05). Correlation analyses revealed that the sciatic nerve's depth is associated with weight, BMI and hip perimeter (all, p < 0.01) but not with age or height (p > 0.05). Due to shared variance and multicollinearity, the hip circumference was the only predictor included in the regression model, explaining 37.9% of the piriformis muscle's deeper fascia depth variance (R2 Adjusted = 0.379). Conclusions: Although the use of landmarks and measuring the hip perimeter may result in greater dry needling accuracy and a lower risk of adverse events derived from accidental sciatic nerve puncture, ultrasound guidance is encouraged as is the safest method for avoiding serious adverse events.

Endometriosis is one of the gynecological diseases where women suffer from pain, quality of life decreased. The aim of this review was to describe the most common non-medical methods used in the treatment of symptoms associated with endometriosis and to determine their effectiveness. The review was performed in PubMed, Embase and Web of Science databases. Randomized controlled trials, case studies, observational studies, retrospective studies, prospective studies, pilot studies, trails, publications in English or Polish were searched based on the Participant-Intervention-Comparator-Outcomes-Study design (PICOS) format. The criteria used to select studies were: women with endometriosis, no cancer, included any physiotherapeutic or non-medical intervention. 3706 articles were found, however only 26 met the inclusion criteria and were included in the review. Quality of the studies was assessed by Risk of Bias 2 tool and ROBINS-1 tool. The most holistic approach used in the treatment of symptoms of endometriosis include physical therapy, manual therapy, electrophysical agents acupuncture, diet and psychological interventions. Most research has focused on relieving pain and increasing quality of life. Non-medical methods showed reduction of symptoms of endometriosis. Physical activity, manual therapy, electrophysical agents, acupuncture, diet and cognitive behavioral therapy showed no negative side effects and reduced pain, what improved the quality of life and reduced the perceived stress.

Myofascial pain syndrome (MPS) caused by trigger points in muscles is a common cause of local or generalized pain, which is clinically common, has a high incidence, and has no specific cure. The most popular and widely used clinical method mainly targets the trigger point for treatment, i.e. trigger point injection (TPI) therapy. The injectable drugs mainly include glucose, saline, local anesthetics, botulinum toxin type A, platelet-rich plasma, platelet-poor plasma, steroid preparations, etc. This method is low cost and less invasive, and early clinical applications have shown good efficacy. In this paper, we have reviewed clinical research progress in treating MPS with TPI therapy.

The purpose of this study was to compare the effect of frequency specific intramuscular electrical stimulation on post trigger point dry needling soreness.

Dry needling (DN) with intramuscular electrical stimulation (DN/IMES) has been shown to be effective in reducing post needling soreness. The effect of frequency specific intramuscular electrical stimulation on post needling soreness has not been studied abundantly, but initial results are favorable. This study investigated the effect of frequency specific intramuscular electrical stimulation on post needling soreness.

A convenience sample of 45 (α = 0.05, power = 95%) subjects was recruited for this study and randomly assigned to DN (n = 15), DN/IMES [f-2Hz] (n = 15) and DN/IMES [f-100Hz] (n = 15) groups. Pain Pressure Threshold (PPT) and Numeric Pain Rating Scale (NPRS) were measured before and 24 hours after the intervention.

Both DN/IMES [f-2Hz and 100 Hz] groups showed statistically significant improvement in NPRS (p = 0.001 and 0.00005, respectively) and PPT (p = 0.004 and 0.0002, respectively). No statistically significant changes were observed in DN group in NPRS (p = 0.726) and PPT (p = 0.238).

Both dry needling with Intramuscular electrical stimulation (DN/IMES [f-2Hz and 100Hz]) groups demonstrated statistically significant improvement in soreness as compared to DN group, but DN/IMES [f-100 Hz] group showed more significant improvement as compared to DN/IMES [f-2 Hz] group in reducing post needling soreness.

Chronic nonspecific low back pain (cNLBP) can be effectively treated by electroacupuncture (EA) at traditional acupoints (TAPs) and myofascial trigger points (MTrPs). However, the optimal type and frequency of stimulation (alternated frequency [AF] and high frequency [HF]) remain unclear. This study aimed to explore this.

A double-blinded randomized controlled trial was conducted with four treatment groups: EA using AF at MTrPs (MTP-AF group), HF at MTrPs (MTP-HF group), AF at TAPs (TAP-AF group), and HF at TAPs (TAP-HF), each with 40 middle-aged cNLBP patients. The AF was 2/100 Hz and HF was 100 Hz. Pain-visual analog scale (pain-VAS), paracetamol requirement, Oswestry disability index (ODI) score, global improvement, and adverse effects (AEs) were monitored.

After 4 weeks, groups of EA targeting MTrPs and TAPs with the same frequency showed no significant differences. Groups using AF demonstrated significantly superior pain-VAS and ODI percentage score reductions compared with HF groups, extending at least 4 weeks post-EA. All groups showed consistent results in paracetamol use, global improvement, and safety. Subgroup analysis indicated that EA with AF at MTrPs provided better results in patients aged ≥60-65 years.

EA at MTrPs and TAPs demonstrated similar effects on cNLBP. However, an AF proves more effective than an HF, potentially maintaining this trend in the short term. Older patients may respond better to EA at MTrPs with AF. Future studies may explore combined MTrPs and TAPs for cNBLP treatment with a broader age range and more diverse demographic groups.

myofascial pain syndrome (MPS) is associated with reductions in range of movement (ROM), decrease in physical function and performance and increase in pain in different populations. Elucidating the best prevention and treatment strategies for MPS has been one of the main goals in the last decade. The objective of the present study was to compare the acute effects of self-myofascial foam rolling release (SFR) and dry-needling (DN) techniques on ankle dorsiflexion ROM, soreness post-needling and performance through countermovement jump (CMJ) height.

a prospective crossover design composed by 12 active adults, aged 23.41 ± 1.68 years (weight: 78.33 ± 9.02 Kg; height: 1.79 ± 0.088 m) with active ankle dorsiflexion restriction was performed. Participants were randomized into the SFR and DN techniques to analyze its effects on ankle dorsiflexion ROM, muscle soreness and jump height at pre, post and 24 h post-intervention.

significant improvements were found by DN on ankle dorsiflexion at 24 h post intervention and muscle soreness by SFR at the same time point. No significant differences were found between conditions.

Both SFR and DN are effective in improving ankle dorsiflexion and performance in young adults without producing an acute effect in muscle soreness.

The goals of this study were to i. describe the prevalence of latent myofascial trigger points (MTrPs) in the medialis gastrocnemius in runners versus non-runners, and ii. examine their level of pain and stiffness.

Healthy runners and non-runners were recruited. Each participant's medialis gastrocnemius MTrPs count was recorded in both legs. The mean pain and the most painful MTrPs pain levels were recorded using an algometer, and the stiffness was evaluated using myotonometry (MyotonPro device) on the most painful MTrP.

With a medium effect size (p = 0.001), runners (n = 20) showed significantly more latent MTrPs than non-runners (n = 26). Runners also reported higher overall pain on the latent MTrPs site than non-runners (p = 0.003) and a significant difference (p = 0.001) for the most painful latent MTrP. Runners were substantially stiffer than non-runners in the most painful latent MTrP, with a mean stiffness difference of +9.98 N/m (p = 0.018, medium effect size).

Runners have a higher number of latent MTrPs than non-runners. The MTrPs found in runners' legs were more painful and stiff than those found in non-runners' legs.

Migraine affects one in ten individuals worldwide and is the second leading cause of disability. Studies have shown an association between migraine and the musculoskeletal system, and myofascial trigger points (MTrPs) play an essential role. Additionally, those with myofascial pain have been proven to experience higher levels of depression and anxiety. Understanding the association between MTrPs and migraine is crucial for developing targeted treatment strategies. Additionally, recognizing the link between MTrPs and migraine-related depression and anxiety underscores the importance of a holistic approach to migraine management. By addressing both musculoskeletal and neurological factors, healthcare providers can provide more effective and personalized care for migraine patients. This study aims to determine the association between MTrPs with migraine-related disability, anxiety, depression, and migraine characteristics.

This cross-sectional study included 68 migraine patients from an outpatient neurology clinic. The number of MTrPs was determined through examination by an experienced neurologist during a migraine-free period using the recommended international criteria. We evaluated anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and disability with the Migraine Disability Assessment Scale (MIDAS).

We enrolled 68 patients (22 males) with a mean age of 36.23 ± 9.63 years. The mean number of MTrPs was 2.75 ± 2.934. MTrPs were positively correlated with severity (CC: 0.576, P-value < 0.001). There was no association between MTrPs and HADS-D or MIDAS, but migraine patients with abnormal HADS-A scores had more MTrPs than patients with normal HADS-A scores (0.6 ± 0.84 vs 3.56 ± 3.11, P-value:0.013).

The number of MTrPs is associated with higher anxiety levels and headache intensity. Further research could investigate the impact of MTrP-based therapies on anxiety among individuals suffering from migraines.

Injury prevention and performance enhancement are paramount goals in sports. Myofascial Pain Syndrome, primarily caused by myofascial trigger points, can result in referred pain, stiffness, muscle shortening, and weakness. This study aimed to assess the impact of dry needling (DN) on latent myofascial trigger points on vertical jump performance in female volleyball players.

A single-blind, randomized controlled clinical trial was conducted with twenty-six healthy female volleyball players who had no lower limb injuries in the last six months, exhibited latent trigger points in the triceps surae muscles, and were familiar with the countermovement jump test. Participants were randomly assigned to either a control group or an experimental group (which received a single DN session). Vertical jump performance variables, including jump height as the primary outcome, were assessed using a force platform at five time points: before the intervention, immediately post-treatment, 24 h post-treatment, 72 h post-treatment, and one-week post-intervention.

The experimental group showed significantly lower values for vertical jump height, flight time, velocity, strength, and power immediately after the needling intervention (p < 0.05). However, these values were significantly higher one-week post-intervention across all variables (p < 0.01). These findings indicate that DN initially decreases jumping performance, but improvements are observed one week after the intervention. In the comparison between groups, the experimental group exhibited higher values at the one-week follow-up for vertical jump height, flight time, speed, and power compared to the control group (p < 0.05).

DN appears to be an effective technique for improving vertical jump performance in female volleyball players one week after its application.

ClinicalTrials.gov, identifier (NCT06184672).

Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated.

To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain.

Thirty-one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).

The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale.

Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia.

Short-track speed skating (short track) is an Olympic sport characterized by a specific body position and counterclockwise movement on the track. Based on previous studies, we hypothesized that athlete body positions employed in this sport could lead to asymmetric overuse disorders of the left lower limb muscles. An increased number of latent trigger points (LTrPs) was confirmed in individual muscles of the overloaded left limb of short-track athletes. This study aimed to compare the number of LTrPs and the level of resting muscle tone between elite junior short-track athletes and healthy non-athletes.

The experimental (EXP) group comprised 15 elite short-track junior athletes from the Polish national team and the control (CON) group comprised 15 healthy young volunteers. In both groups, the left leg was tested for (i) the presence of LTrPs and (ii) resting muscle tone (RMT), assessed using surface electromyography in six muscles.

The EXP group showed a higher number of LTrPs in the left lower limb, compared with the CON group. The muscle that was most significantly affected in the athletes was the vastus lateralis obliquus [χ 2 (1, N = 30), p < 0.001, V Cramer = 0.71]. This muscle also differed significantly between the groups in terms of the RMT (p = 0.033, Cohen's d = 0.87).

Elite short-track junior athletes presented with increased RMT and an increased number of LTrPs in the vastus lateralis oblique muscle, compared with healthy non-athletes.

Myofascial pain syndrome (MPS) is a chronic musculoskeletal pain syndrome. The purpose of this review is to describe the epidemiological and treatment evidence and to address the future research agenda in patients with cancer.

A narrative review of previous reports investigating the prevalence and treatment of MPS in the oncology field is presented. The target population is patients with cancer and cancer survivors.

There have been three prospective and two retrospective studies investigating the prevalence of MPS. MPS is as high as 38%-45% in patients with advanced or incurable cancer and 11.9%-44.8% in cancer survivors. A total of nine reports investigated the efficacy of the following interventions: trigger point injection (TPI), myofascial techniques and ischaemic compression. TPI has been reported to be effective in four observational studies. One randomised study reported the efficacy of myofascial techniques, but two randomised studies reported no added beneficial effects of it in breast cancer survivors. Two randomised studies investigated the efficacy of ischaemic compression, but the obtained results were contradictory.

MPS is highly prevalent. We should know that non-cancer pain is also common in both patients with cancer and survivors. In treating such pain, careful physical examination is essential. Then, non-pharmacological treatment should be considered as well as pharmacotherapy. As evidence regarding MPS in the oncology field is scarce, further research is warranted.

This study aimed to elucidate the intramuscular distribution pattern of the medial plantar nerve and determine its motor nerve ending territories within the abductor hallucis muscle using modified Sihler's staining and external anatomical landmarks. The study included 40 specimens of the abductor hallucis muscle (13 men and seven women) from formalin-fixed (ten cadavers) and fresh cadavers (ten cadavers), with a mean age of 77.6 years. The entry point of the medial plantar nerve into the muscle was examined, followed by Sihler's staining to analyze the intramuscular distribution pattern and motor nerve ending location within the abductor hallucis muscle. Ultrasound- and palpation-guided injections were performed to verify the applicability of motor nerve ending location-based injections. The areas with the highest concentrations of nerve entry points and nerve endings were identified in the central portion of the muscle. Ultrasound- and palpation-guided injections were safely positioned near the densest nerve ending region of the muscle. These detailed anatomical data and injection methods would be beneficial for proceeding with safe and effective injection treatments using various analgesic agents to alleviate abductor hallucis muscle-associated pain disorders.

Skeletal muscle is the largest organ system in the human body and plays critical roles in athletic performance, mobility, and disease pathogenesis. Despite growing recognition of its importance by major health organizations, significant knowledge gaps remain regarding skeletal muscle health and its crosstalk with nearly every physiological system. Relevant public health challenges like pain, injury, obesity, and sarcopenia underscore the need to accurately assess skeletal muscle health and function. Feasible, non-invasive techniques that reliably evaluate metrics including muscle pain, dynamic structure, contractility, circulatory function, body composition, and emerging biomarkers are imperative to unraveling the complexities of skeletal muscle. Our concise review highlights innovative or overlooked approaches for comprehensively assessing skeletal muscle in vivo. We summarize recent advances in leveraging dynamic ultrasound imaging, muscle echogenicity, tensiomyography, blood flow restriction protocols, molecular techniques, body composition, and pain assessments to gain novel insight into muscle physiology from cellular to whole-body perspectives. Continued development of precise, non-invasive tools to investigate skeletal muscle are critical in informing impactful discoveries in exercise and rehabilitation science.

Musculoskeletal disorders, especially chronic muscle pain, have a significant impact on public health, affecting millions worldwide. This review examines recent advancements in the diagnosis and management of myofascial pain, with a focus on the refined application of trigger point theory. This theory now incorporates an intricate model that blends biomechanical and neurophysiological mechanisms, essential for understanding the initiation and persistence of pain, and necessitating targeted therapeutic interventions. Utilizing a methodical approach, this paper categorizes muscle pain into three types: Muscle Belly Pain, Origin-Insertion Pain, and Referred Pain, as delineated in the most recent edition of "Myofascial Pain and Dysfunction-The Trigger Point Manual." Such classification enhances diagnostic precision and therapeutic effectiveness by establishing a specific treatment protocol for each type of pain. The paper discusses the implications of various treatments, such as dry needling and manual therapy, which are informed by empirically derived trigger point charts. These charts are instrumental in pinpointing the exact locations of pain sources and customizing treatment plans. Moreover, this review critically assesses the evolving nature of trigger point charts and champions a holistic approach to pain management. It underscores the necessity of integrating biomechanics, kinesiology, and compensatory mechanisms to provide a comprehensive understanding that allows practitioners to address not only symptomatic pain but also the root causes of musculoskeletal disorders, thereby enhancing long-term patient care outcomes in clinical environments.

Myofascial pain syndrome is a chronic pain condition prevalent in the general population. Muscular symptoms at the level of the trapezius and rhomboid muscles are frequent and the response to therapeutic interventions established so far is variable.

We present a case series of six patients who underwent a new technique of interfacial trapezius-rhomboid block (TRB) performed under ultrasonographic guidance by applying 10 cubic centimeters (cc) of analgesic solution (bupivacaine 0.25 % and methylprednisolone 40 mg) in the interfacial plane between the trapezius and rhomboid muscles at the level of the fifth and sixth ribs.

At a follow-up of one and eight weeks, measurements of numerical rating scale (NRS) pain intensity were carried out, finding an average decrease of NRS pain intensity by 70 %.

This new technique may be considered for the treatment of myofascial pain syndrome of the trapezius and rhomboid muscles. Larger future studies are needed to better establish its safety and efficacy.

The objective of this study is to determine characteristics of patients with myofascial pain syndrome (MPS) of the low back and the degree to which the low back pain in the patients examined can be attributed to MPS. Twenty-five subjects with myofascial trigger point(s) [MTrP(s)] on the low back participated in this cross-sectional study. The location, number, and type of selected MTrPs were identified by palpation and verified by ultrasound. Pain pressure threshold, physical function, and other self-reported outcomes were measured. Significant differences were found in Group 1 (Active), 2 (Latent), 3 (Atypical, no twitching but with spontaneous pain), and 4 (Atypical, no twitching and no spontaneous pain) of participants in the number of MTrPs, current pain, and worst pain in the past 24 h (p = .001-.01). There were interaction effects between spontaneous pain and twitching response on reports of physical function, current pain, and worst pain (p = .002-.04). Participants in Group 3 reported lower levels of physical function, and higher levels of current pain and worst pain compared to those in Group 4. Participants in Group 1 and 2 had similar levels of physical function, current pain, and worst pain. The number of MTrPs is most closely associated with the level of pain. Spontaneous pain report seems to be a decisive factor associated with poor physical function; however, twitching response is not.

Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case-control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) - Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.

Shear-wave elastography (SWE) provides quantitative and absolute metrics for analyzing the elasticity of soft tissues. Despite the anterior scalene muscle (AS) is a key structure in patients with neck pain and nerve compressive syndromes, the majority of SWE studies only included asymptomatic subjects. This study aimed to analyze the Young's modulus and shear wave speed test-retest reliability in a sample of patients with neck pain symptoms to characterize the AS stiffness.

A diagnostic accuracy study acquiring a set of ultrasound images at C7 level in 42 patients with mechanical neck pain by one experienced examiner. After blinding the participants' identity, trial and side, the Young's modulus and shear wave velocity were measured by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC) and coefficient of variation (CV%) were calculated.

The sample reported moderate pain intensity (5.9/10 points) and disability (17.38/100 points). AS stiffness metrics assessed showed no significant differences between males and females, left and right side nor painful and non-painful side. (all, p > 0.05). Intra-examiner reliability was excellent for calculating the Young's modulus for shear wave speed (ICC > 0.90).

The results support the use of this procedure for assessing the AS stiffness in populations with mechanical neck pain as excellent reliability estimates were obtained. However, future research should analyze case-control differences and the association between SWE metrics with clinical severity indicators.

Myofascial trigger point therapy (MTrP) is a widely used therapeutic approach, although the underlying mechanisms remain unclear. Mechanisms discussed include peripheral involvement of muscles as well as central pain modulating processes such as the conditioned pain modulation (CPM). The aim of this study was to investigate whether the analgesic response of MTrP and the analgesic response of CPM correlate in asymptomatic participants in order to identify shared underlying mechanisms of MTrP and CPM.

Both, CPM and MTrP protocols consisted of heat-based test stimuli (heat pain thresholds before and after the intervention) and pressure-based (conditioning) stimuli. Asymptomatic participants (n = 94) were randomly assigned to receive either mild, intense or no pressure stimuli (between-group design) to both the fingernail and the MTrP of the infraspinatus muscle (within-group design). Pressure stimuli at both locations (fingernail, MTrP) were applied with a pressure algometer for 120 s and continuously adjusted to maintain a constant pain intensity of mild or intense pain. All thermal stimuli were applied on the lower leg with a thermal stimulator.

A significant correlation was shown between the analgesic effect of CPM and MTrP therapy for mild (r = 0.53, p = 0.002) and intensive stimuli (r = 0.73, p < 0.001). 17.3% of the variance of the MTrP effect were explained by CPM after mild stimulation, and 47.1% after intense stimulation. Pain-related characteristics did not explain the variance within the analgesic response using a regression analysis.

Between the analgesic responses following MTrP and CPM paradigms, a moderate to strong correlation was observed, suggesting shared underlying mechanisms.

Myofascial trigger points (MTrPs) are localized contraction knots that develop after muscle overuse or an acute trauma. Significant work has been done to understand, diagnose, and treat MTrPs in order to improve patients suffering from their effects. However, effective non-invasive diagnostic tools are still a missing gap in both understanding and treating MTrPs. Effective treatments for patients suffering from MTrP mediated pain require a means to measure MTrP properties quantitatively and diagnostically both prior to and during intervention. Further, quantitative measurements of MTrPs are often limited by the availability of equipment and training. Here we develop ultrasound (US) based diagnostic metrics that can be used to distinguish the biophysical properties of MTrPs, and show how those metrics can be used by clinicians during patient diagnosis and treatment. We highlight the advantages and limitations of previous US-based approaches that utilize elasticity theory. To overcome these previous limitations, we use a hierarchical approach to distinguish MTrP properties by patients' reported pain and clinician measured palpation. We show how US-based measurements can characterize MTrPs with this approach. We demonstrate that MTrPs tend to be smaller, stiffer, and deeper in the muscle tissue for patients with pain compared to patients without pain. We provide evidence that more than one MTrP within a single US-image field increases the stiffness of neighboring MTrPs. Finally, we highlight a combination of metrics (depth, thickness, and stiffness) that can be used by clinicians to evaluate individual MTrPs in combination with standard clinical assessments.

The study aimed to evaluate the immediate effects of a dry needling (DN) therapy session on biomechanical properties, muscle power, perfusion, and pressure pain threshold of the gastrocnemius muscle with latent trigger points. Twenty mixed martial arts athletes (MMA) were randomly divided into two groups: experimental (eDN, n = 10) and sham (qDN, n = 10) to undergo one session of DN either with a real or a qazi needle. The measurements were taken at rest, 1-5 minutes after the DN (Post1-5min) and 24h after the DN (Post24h). DN significantly increased the muscle perfusion (Post1-5min and Post24h, p < 0.001), reduced its tone (Post1-5min and Post24h, p < 0.001) and stiffness (Post1-5min, p < 0.05; Post24 h, p < 0.001), and improved its elasticity (Post1-5min and Post24h, p < 0.001). DN also caused a significant increase in pressure pain threshold (Post1-5min, p < 0.001; Post24h, p < 0.05) and in muscle power (Post24h, p < 0.01). The DN session increased the blood perfusion and improved the biomechanical properties of the gastrocnemius muscle, which led to improved muscle power. The DN also had an analgesic effect. These effects were maintained at 24 h, which suggests that DN could facilitate muscle recovery in a post-exercise period of MMA athletes.

Myofascial pain is a soft tissue pain syndrome with local and referred musculoskeletal pain arising from trigger points. Myofascial pain and myofascial pain syndromes are among some of the most common acute and chronic pain conditions. Myofascial pain can exist independently of other pain generators or can coexist with or is secondary to other acute and chronic painful musculoskeletal conditions. Myofascial pain is most effectively treated with a multimodal treatment plan including injection therapy (known as trigger point injections, physical therapy, postural or ergonomic correction, and treatment of underlying musculoskeletal pain generators. The objectives of this review are to outline the prevalence of myofascial pain, describe the known pathophysiology of myofascial pain and trigger points, discuss the clinical presentation of myofascial pain, and present evidence-based best practices for pharmacologic, non-pharmacologic, and interventional treatments for myofascial pain.

 Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling.

 The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain.

 A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023.

 A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability.

 Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

Thoracic myofascial pain syndrome is a clinical problem arising from the muscles and soft tissues of thoracic region, which include the mid and upper back area. Risk factors associated with myofascial pain syndrome are muscle overuse and repetitive strain, poor posture, trauma or injury, emotional and psychological stresses. The management of myofascial pain syndrome (MPS) typically involves a multidimensional approach that focuses on relieving pain, reducing muscle tension, and improving muscle function. Bowen therapy and tennis ball technique are also recommended for treating myofascial pain syndrome.

The objective of this study was to compare the effects of Bowen therapy and tennis ball technique on pain and functional disability in patients with thoracic myofascial pain syndrome.

It was a randomized clinical trial conducted on thirty patients. It was carried out in physiotherapy outpatient department of D.H.Q Hospital, Kasur. Non-probability convenience sampling technique was used. Data collection was done from the patients of thoracic myofascial pain syndrome by using Numeric Pain Rating Scale (NPRS) for pain and Pain Disability Questionnaire (PDQ) for functional disability. Participants were randomly allocated into two groups using computer generated random number method. Group A received Bowen therapy, and group B received tennis ball technique. Outcome measures were measured at baseline, after second week treatment session and after fourth week with three sessions in a week on alternate days. Data analysis was done by using Statistical Package for the Social Sciences (SPSS) version 26.

There was significant difference between the mean values of NPRS and PDQ in both groups at baseline, second week and fourth week with p value < 0.05. The results indicated that both treatments were significant but Bowen therapy is more effective treatment than tennis ball technique. Within-group difference calculated with repeated-measure ANOVA indicated that there was significant difference from pre- to post-values of both groups.

This study concluded that Bowen therapy produced statistically significant and clinically relavant results for all the outcome measures.

(IRCT20190717044238N7).

Myofascial pain syndrome (MPS) is a common muscle condition characterized by painful trigger points. Vitamin D deficiency has been recognized as a precipitating factor of MPS. The present study aimed to determine the prevalence and risk factors of vitamin D deficiency in patients with chronic MPS.

A cross-sectional study was conducted, using a structured face-to-face interview to collect demographic information, clinical characteristics, pain duration and location, as well as the bodily pain subscale of SF36 and EQ-5D-5 L. The Elecsys vitamin D total II assay was used to measure serum total 25-hydroxyvitamin D level.

Of 120 participants, vitamin D insufficiency (20 to 29.9 ng/ml) and deficiency (< 20 ng/ml) were 47.5% (95% CI: 38.3-56.8%) and 34.2% (95% CI: 25.8-43.4%), respectively. The adjusted odds ratios for vitamin D deficiency of participants aged < 45 years and who reported having ≤ 15 min sunlight exposure per day were 3.5 (95% CI: 1.54 to 7.98) and 2.38 (95% CI: 1.05 to 5.26), respectively. The bodily pain score (r = - 0.02, P = 0.86) and EQ-5D-5 L utility (r = 0.04, P = 0.66) did not significantly correlate with vitamin D levels.

Approximately one third of patients with chronic MPS had vitamin D deficiency. Age < 45 years and sunlight exposure ≤ 15 min/day were identified as potential risk factors for vitamin D deficiency in MPS patients.

The public is increasingly questioning equestrianism's social license to operate. While the focus historically centered on horseracing, increased scrutiny is now being placed on how dressage, showjumping, and eventing are addressing equine management and welfare concerns. Nominated equestrian federation and equestrian organization experts (n = 104) directly involved in international and/or national-level horse sports took part in a four-stage, iterative Delphi to obtain consensus on what factors should be considered essential to manage sporthorse health and welfare. Five core domains were agreed as essential: training management, competition management, young horse management, health status and veterinary management, and the horse-human relationship. Two further domains: stable and environmental management, and welfare assessment were rated as important but not essential, as most respondents felt that these areas were already managed well. Participants felt increased education and guidance combined with further policy development and regulation are needed to support stakeholders to optimize sporthorse management. An appetite to engage with research to generate evidence that promotes sporthorse welfare was evident. The development of a sporthorse welfare charter and evidence-based guidelines to inform the management and monitoring of sporthorses' health and welfare are recommended to provide horses with a good life and to safeguard the future of equestrian sports.

The aim of the study was to assess short-term changes in shoulder muscle activity elicited by dry needling in chronic unilateral shoulder pain (USP) patients.

A randomized, double-blind, placebo-controlled clinical trial was conducted, in which 30 volunteers with USP were recruited and randomly assigned to either real or sham dry needling conditions. Pain intensity scores, pressure pain threshold, glenohumeral internal rotation angles, and electromyographic activity during isotonic shoulder tasks (shoulder flexion and extension) were assessed before, immediately, and 72 hours after the intervention in the infraspinatus and deltoid muscles.

A single application of real dry needling resulted in lower pain intensity scores and a larger range in glenohumeral internal rotation 72 hours after the intervention in comparison with sham dry needling. No differences in pressure pain threshold or muscle activity were observed due to the intervention.

A single application of real dry needling resulted in clinically significant changes in the short term. No differences were detected in muscle activation in the infraspinatus or deltoid muscles. Complementary interventions and longer follow-up times may be required to observe changes in muscle activity.

Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.