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Ogbeivor C, AlMubarak H, Akomolafe T, Alkahtani H, AlMugizel H, Marin I, Aldosari H, Aldhwayan N, Mohamed G, Alobthani K. The effectiveness of radial shockwave therapy on myofascial pain syndrome: a two-armed, randomized double-blind placebo-controlled trial. BMC Musculoskelet Disord 2025; 26:413. [PMID: 40275291 PMCID: PMC12023603 DOI: 10.1186/s12891-025-08659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 04/14/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is a common, costly, and often persistent musculoskeletal condition. Radial shockwave therapy (RSWT) is one of the most frequently used treatments for MPS. However, there is limited evidence to support its short-term effectiveness, primarily due to the poor methodological quality of the studies. This study aimed to determine the effectiveness of radial shockwave therapy, compared with placebo treatment, in patients with MPS in the neck and upper back. METHOD A two-armed, randomized, double-blind, placebo-controlled trial was carried out in an outpatient physical rehabilitation department in a tertiary hospital. The sample comprised 70 adults aged 18 years or above with MPS. The intervention group received six treatment sessions. These consisted of RSWT: 1.5 bars (0.068 mJ/mm2), 2000 pulses, and a frequency of 15 Hz; and standard physical therapy stretches and exercises, including therapeutic home exercises. The control group received an identical treatment regime, except that they received a no-energy shock (nontherapeutic dose) of 0.3 bar (0.01 mJ/mm2). The outcome measures were the numeric pain score (NPS), neck disability index (NDI), pressure pain threshold (PPT) and SF-12 score at the 4-, 8- and 12-week follow-ups. RESULTS The study revealed a significant improvement (p < 0.05) in the NPS and PPT at the follow-up assessments (0-4, 0-8, and 0-12 weeks). The placebo group showed a significant difference in NDI scores at all intervals, whereas the shockwave group only showed significant improvement at 0-4 weeks. The shockwave group did not have significant changes in SF-12 scores, whereas the placebo group showed significant improvement in the SF physical score between 0-8 weeks (p = 0.01) and 0-12 weeks (p = 0.02). No statistically or clinically significant differences were observed between the placebo and shockwave groups across all outcomes at 4, 8, and 12 weeks. CONCLUSION No significant differences were found between the placebo and shockwave groups at 4, 8, and 12 weeks. However, both groups showed statistically and clinically significant improvements in the NPS and PPT. Both groups showed improvements in the NPS and PPT scores; therefore, we recommend using radial RSWT as an adjunct to standard care, which includes therapeutic home exercises for individuals with MPS. TRIAL REGISTRATION The trial was prospectively registered on 19 April 2022 with https://clinicaltrials.gov/study/NCT05381987 and conducted according to Consolidated Standards of Reporting Trials (CONSORT) guidelines.
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Affiliation(s)
- Collins Ogbeivor
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia.
| | - Huda AlMubarak
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | | | - Hamad Alkahtani
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Hussain AlMugizel
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Inga Marin
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Hala Aldosari
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Nouf Aldhwayan
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Gamal Mohamed
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
| | - Khaled Alobthani
- Physical Rehabilitation Department, King Faisal Specialist Hospital and Research Centre, 11211, Riyadh, Saudi Arabia
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Xia C, Zhao Y, Lin L, Yu Y, Wang J, Fan J, Yuan X, Zhang S. Comparison of extracorporeal shock wave therapy and manual therapy on active trigger points of the sternocleidomastoid muscle in cervicogenic headache: A randomized controlled trial. Turk J Phys Med Rehabil 2025; 71:56-65. [PMID: 40270630 PMCID: PMC12012926 DOI: 10.5606/tftrd.2024.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/19/2024] [Indexed: 04/25/2025] Open
Abstract
Objectives This study aims to investigate the effect of extracorporeal shock wave therapy (ESWT) and manual therapy (MT) on active trigger points of the sternocleidomastoid muscle (SCM) in patients with cervicogenic headache (CEH). Patients and methods A total of 42 patients were included (27 females, 15 males; mean age: 33.2±7.7 years; range, 18 to 45 years) in the randomized controlled trial between March 2022 and December 2022. The patients were randomly divided into the ESWT group (n=21) and the MT group (n=21). Each group received therapy once a week for four weeks. The primary outcome measure was the Visual Analog Scale (VAS), and secondary outcome measures were pressure pain threshold (PPT), Neck Disability Index (NDI), and stiffness (shear elastic modulus) of the SCM measured at baseline, postintervention, and four weeks after treatment. Results One patient from the ESWT group was lost to follow-up. The missing data were imputed for intention-to-treat analysis. Significant decreases of VAS, NDI, and shear elastic modulus of SCM were found at postintervention and four weeks after treatment in both groups (p<0.01). The PPT scores markedly increased over time compared to baseline in both groups (p<0.01). The repeated measures of analysis of variance revealed a significant time effect (p<0.001) in each outcome variable for both groups. There were no significant differences between the two groups in VAS, PPT, NDI, and the stiffness of SCM at each time point. Conclusion Extracorporeal shock wave therapy and MT were equally effective in pain relief, functional recovery, and reduction of muscle stiffness. Extracorporeal shock wave therapy may be used as an alternative treatment method for CEH patients with active myofascial trigger points of the SCM.
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Affiliation(s)
- Chunfeng Xia
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Yanjun Zhao
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Lizhen Lin
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Yanni Yu
- Department of Ultrasound, Weifang People's Hospital, Weifang, Shandong, China
| | - Jialiang Wang
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Jiecheng Fan
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Xiangzhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Shuyun Zhang
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
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Müller-Ehrenberg H, Giordani F, Müller-Ehrenberg A, Stange R. The Use and Benefits of Focused Shockwaves for the Diagnosis of Myofascial Pain Syndrome by Examining Myofascial Trigger Points in Low Back Pain. Biomedicines 2024; 12:2909. [PMID: 39767813 PMCID: PMC11673203 DOI: 10.3390/biomedicines12122909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 12/16/2024] [Accepted: 12/18/2024] [Indexed: 01/06/2025] Open
Abstract
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.
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Affiliation(s)
| | - Federico Giordani
- Villa Rosa Rehabilitation Hospital, APSS Trento, 38122 Trento, Italy
| | | | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute of Musculoskeletal Medicine, University Münster, 48149 Münster, Germany;
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Santilli G, Ioppolo F, Mangone M, Agostini F, Bernetti A, Forleo S, Cazzolla S, Mannino AC, Fricano A, Franchitto A, Taurone S, Ciccarelli A, Paoloni M. High Versus Low-Energy Extracorporeal Shockwave Therapy for Chronic Lateral Epicondylitis: A Retrospective Study. J Funct Morphol Kinesiol 2024; 9:173. [PMID: 39330257 PMCID: PMC11432994 DOI: 10.3390/jfmk9030173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 09/18/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
Background: Chronic lateral epicondylitis (LE), also known as tennis elbow, affects 1-3% of the population, primarily those over 40 years old. Most cases resolve with conservative treatments, but some require more advanced interventions. Extracorporeal shockwave therapy (ESWT) has emerged as a non-surgical treatment option, utilizing either low- or high-energy levels to alleviate pain and improve function. Objective: This study aimed to compare the efficacy of low-energy versus high-energy ESWT in the treatment of chronic LE, focusing on pain relief and functional improvement. Methods: A retrospective observational study was conducted including patients treated for chronic LE between 2021 and 2024. Participants were divided into two groups: low-energy ESWT (0.10 mJ/mm2) and high-energy ESWT (0.20 mJ/mm2). Both groups received 2400 pulses at a frequency of 6 Hz once a week for three weeks. Pain and functional outcomes were measured using a visual analog scale (VAS) and the Patient-Rated Tennis Elbow Evaluation Questionnaire (PRTEE) at the baseline, three months (T1), and six months (T2) post-treatment. Results: Forty-six patients participated, with 24 in the low-energy group and 22 in the high-energy group. Baseline demographics and clinical characteristics were similar across groups. At T1 and T2, the low-energy group showed significantly greater reductions in the VAS scores (T1: 4.45 ± 0.8 vs. 3.6 ± 1.7, p = 0.04; T2: 3.2 ± 1.2 vs. 2.1 ± 1.1, p = 0.004) and PRTEE scores (T1: 34.3 ± 6.9 vs. 26.8 ± 11.9, p = 0.03; T2: 25.3 ± 6 vs. 17.6 ± 9, p = 0.005). Significant treatment-time interactions were observed for both the VAS and PRTEE scores, indicating sustained improvements in the low-energy group. Conclusions: Low-energy ESWT was more effective than high-energy ESWT in treating chronic LE, providing greater and longer-lasting pain relief and functional improvement. These findings suggest that low-energy ESWT should be preferred in clinical practice for managing this condition. Future research should focus on larger sample sizes and randomized controlled trials to confirm these results and explore the underlying mechanisms of differential efficacy between energy levels.
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Affiliation(s)
- Gabriele Santilli
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Francesco Ioppolo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Science and Technologies, University of Salento, 73100 Lecce, Italy
| | - Sara Forleo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Sara Cazzolla
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Anna Camilla Mannino
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Alessio Fricano
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Antonio Franchitto
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Samanta Taurone
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Antonello Ciccarelli
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
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Avendaño-López C, Megía-García Á, Beltran-Alacreu H, Serrano-Muñoz D, Arroyo-Fernández R, Comino-Suárez N, Avendaño-Coy J. Efficacy of Extracorporeal Shockwave Therapy on Pain and Function in Myofascial Pain Syndrome: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Am J Phys Med Rehabil 2024; 103:89-98. [PMID: 37205742 DOI: 10.1097/phm.0000000000002286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The aim of the study is to examine the effectiveness of extracorporeal shockwave therapy in reducing pain, improving functionality, joint range of motion, quality of life, fatigue, and health status self-perception in people with myofascial pain syndrome. METHODS PubMed, the Cochrane Library, CINAHL, the Physiotherapy Evidence Database, and SPORTDiscus were systematically searched for only randomized clinical trials published up to June 2, 2022. The main outcome variables were pain, as reported on the visual analog scale and pressure pain threshold, and functionality. A quantitative analysis was conducted using the inverse variance method and the random effects model. RESULTS Twenty-seven studies were included ( N = 595 participants in the extracorporeal shockwave therapy group). The effectiveness of extracorporeal shockwave therapy for relieving pain was superior for the extracorporeal shockwave therapy group compared with the control group on the visual analog scale (MD = -1.7 cm; 95% confidence interval = -2.2 to -1.1) and pressure pain threshold (mean difference = 1.1 kg/cm 2 ; 95% confidence interval = 0.4 to 1.7) and functionality (standardized mean difference = -0.8; 95% confidence interval = -1.6 to -0.04) with high heterogeneity. However, no differences were found between extracorporeal shockwave therapy and other interventions as dry needling, exercises, infiltrations, and lasers interventions. CONCLUSIONS Extracorporeal shockwave therapy is effective in relieving pain and improving functionality in patients with myofascial pain syndrome compared with control and ultrasound therapy. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Determine the effectiveness of radial and focal extracorporeal shockwaves on pain perception, the pressure pain threshold, and functionality in people with myofascial pain syndrome; (2) Describe the intervention protocol of extracorporeal shockwave therapy to improve pain perception in people with myofascial pain syndrome; and (3) Describe the advantages and disadvantages of extracorporeal shockwave therapy versus other intervention such as dry needling. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Carlos Avendaño-López
- From the Centre Hospitalier de Niort, Niort, France (CA-L); Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain (ÁM-G, HB-A, DS-M, NC-S, JA-C); Biomechanical and Technical Aids Unit, National Hospital for Paraplegia, Finca La Peraleda, Spain (ÁM-G); and Water & Health Research Group (GIAS), Spain (RA-F)
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Shamseldeen NE, Hegazy MMA, Fayaz NA, Mahmoud NF. Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome. World J Orthop 2023; 14:572-581. [PMID: 37485429 PMCID: PMC10359744 DOI: 10.5312/wjo.v14.i7.572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Active myofascial trigger points (TrPs) often occur in the upper region of the upper trapezius (UT) muscle. These TrPs can be a significant source of neck, shoulder, and upper back pain and headaches. These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning, work-related productivity, and general quality of life.
AIM To investigate the effects of instrument assisted soft tissue mobilization (IASTM) vs extracorporeal shock wave therapy (ESWT) on the TrPs of the UT muscle.
METHODS A randomized, single-blind, comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo. Forty patients (28 females and 12 males), aged between 20-years-old and 40-years-old, with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups (A and B). Group A received IASTM, while group B received ESWT. Each group was treated twice weekly for 2 weeks. Both groups received muscle energy technique for the UT muscle. Patients were evaluated twice (pre- and post-treatment) for pain intensity using the visual analogue scale and for pain pressure threshold (PPT) using a pressure algometer.
RESULTS Comparing the pre- and post-treatment mean values for all variables for group A, there were significant differences in pain intensity for TrP1 and TrP2 (P = 0.0001) and PPT for TrP1 (P = 0.0002) and TrP2 (P = 0.0001). Also, for group B, there were significant differences between the pre- and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2 (P = 0.0001). There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1 (P = 0.9) and TrP2 (P = 0.76) and PPT for TrP1 (P = 0.09) and for TrP2 (P = 0.91).
CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs. There is no significant difference between either treatment method.
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Affiliation(s)
- Nourhan Elsayed Shamseldeen
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
| | - Mohammed Moustafa Aldosouki Hegazy
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
| | - Nadia Abdalazeem Fayaz
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
| | - Nesreen Fawzy Mahmoud
- Department of Physical Therapy for Musculoskeletal Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 14531, Egypt
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Yankai A, Leelarungrayub J, Laskin JJ. Preliminary Study: Short-term Beneficial Effects of Thai Tok Sen Massage on Pain, Pressure Pain Threshold, and Upper Trapezius Muscle Thickness Among People with Shoulder Pain. Int J Ther Massage Bodywork 2023; 16:3-12. [PMID: 36866181 PMCID: PMC9949614 DOI: 10.3822/ijtmb.v16i1.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Shoulder muscle pain and spasm is the most common problem in people after prolonged working, similar to that resulting from office syndrome. Various medicinal treatments with analgesic drugs, hot packs, therapeutic ultrasound, or deep friction techniques can be clinically applied. Alternatively, traditional Thai massage (TM) with deep compression gentle technique also can help to release that problem. In addition, an traditional Thai treatment with Tok Sen (TS) massage has been generally performed in the Northern part of Thailand without any scientific evidence support. Thus, the aim of this preliminary study was to reveal the scientific value of Tok Sen massage on shoulder muscle pain and upper trapezius muscle thickness among people with shoulder pain. Materials & Methods Twenty participants (6 males and 14 females) who suffered from shoulder pain were randomized into TS (n =10, aged 34.2 ± 7.34 yrs) or TM (n=10, aged 32.8 ± 7.24 yrs). Each group received two times 5-10 minutes of treatment, one week apart. At the baseline and after completing two times of each intervention, pain score, pain pressure threshold (PPT), and specific trapezius muscle thickness were evaluated. Results Before both TM and TS interventions, pain score, PPT, and muscle thickness were not statistically different between groups. After two times of intervention, pain scores significantly reduced in TM (3.1 ± 0.56; p = .02, 2.3 ± 0.48; p < .001), as same as in TS (2.3 ± 0.67; p = .01, 1.3 ± 0.45; p < .001) when compared to baseline. This was the same as the results of PPT in TM (4.02 ± 0.34; p = .012, 4.55 ± 0.42; p = .001) and TS (5.67 ± 0.56; p = .001, 6.8 ± 0.72; p < .001). However, the trapezius muscle thickness reduced significantly after two interventions by TS (10.42 ± 1.04; p = 0.002 & 9.73 ± 0.94 mm, p < .001), but did not change in TM (p > .05). Moreover, when compared between intereventions at the first and second periods, TS showed a significant difference in pain score (p = .01 & p <.001), muscle thickness (p = .008 & p = .001) as well as PPT (p < .001 & p < .001) when compared to TM. Conclusion Tok Sen massage improves upper trapezius thickness from muscle spasms and reduces pain perception and increases the pressure threshold pain among participants who suffer from shoulder pain similar to that of office syndrome.
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Affiliation(s)
- Araya Yankai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Jirakrit Leelarungrayub
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand,Corresponding author: Jirakrit Leelarungrayub, PhD, Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand,
| | - James J. Laskin
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana, USA
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Ahadi T, Yousefi A, Sajadi S, Yousefi N, Babaei-Ghazani A. Comparing radial extracorporeal shockwave therapy and corticosteroid injection in the treatment of piriformis syndrome: A randomized clinical trial. J Bodyw Mov Ther 2023; 33:182-188. [PMID: 36775517 DOI: 10.1016/j.jbmt.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 04/17/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study was designed to compare the effects of shockwave therapy and corticosteroid injection in the treatment of piriformis syndrome. METHODS AND MATERIALS In this randomized clinical trial, thirty-five patients with piriformis syndrome were randomly divided into two groups of 18 in the shockwave group and 17 in the corticosteroid group. The Shockwave group underwent three sessions of shockwave therapy per week (2000 pulses per session with 5Hz frequency and pressure equal to 4 Bar) and the corticosteroid group underwent an injection of 40 mg methylprednisolone with 1 mL of 1% lidocaine under ultrasound guidance. All patients were assessed by SF-36 questionnaire and visual analogue scale (VAS). The SF-36 questionnaire was used to evaluate the quality of life before and 4 weeks after the intervention. VAS scale was used to evaluate pain before the intervention, and 1, 4, 8, and 12 weeks after the intervention. RESULTS The baseline characteristics of the two groups were not significantly different. At the end of the study, both groups had a significant improvement in pain and quality of life compared to before the intervention. However, according to the VAS, in the shockwave group improvement was seen in the first follow-up while not seen in the corticosteroid group (P-value <0.001 and P-value 1.00, respectively). According to the SF-36 questionnaire, the overall score in both groups had a significant improvement (P-value <0.05). CONCLUSIONS It seems that shockwave therapy and corticosteroid injection are both effective in the treatment of piriformis syndrome. There was no significant difference between the two groups in the quarterly follow-up. Because shockwave therapy is a relatively non-invasive treatment with fewer side effects, it can be useful to improve pain and the quality of life of patients with piriformis syndrome.
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Affiliation(s)
- Tannaz Ahadi
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arastoo Yousefi
- Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Simin Sajadi
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Naseh Yousefi
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Babaei-Ghazani
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Department of Physical Medicine & Rehabilitation, University of Montreal Health Center, Montreal, Canada.
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Story MR. Integrative Approach to Neck Pain and Dysfunction. Vet Clin North Am Equine Pract 2022; 38:485-492. [DOI: 10.1016/j.cveq.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pellegrino R, Di Iorio A, Brindisino F, Paolucci T, Moretti A, Iolascon G. Effectiveness of combined extracorporeal shock-wave therapy and hyaluronic acid injections for patients with shoulder pain due to rotator cuff tendinopathy: a person-centered approach with a focus on gender differences to treatment response. BMC Musculoskelet Disord 2022; 23:863. [PMID: 36109717 PMCID: PMC9479346 DOI: 10.1186/s12891-022-05819-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rotator cuff (RC) tendinopathy is a common shoulder pain condition. Extracorporeal shockwave therapy (ESWT) and hyaluronic acid peritendinous injection are viable treatment options for RC tendinopathy. The aim of this study is to evaluate the response in two different therapeutic rehabilitative approaches, the combined treatment ESWT plus hyaluronic acid injections (E + Hy) compared to ESWT alone (ESWT-al), in a cohort of patients with RC tendinopathy according to gender differences. METHODS This is a retrospective longitudinal cohort study of patients with painful RC tendinopathy. Patients that had received a clinical evaluation, a shoulder ultra sound examination, as well as the Shoulder Pain and Disability Index (SPADI) questionnaire, and the Numerical Rating Scale (NRS) for pain at baseline, 1-month (T1) and 2-month follow-ups (T2) were included. RESULTS Medical records of 53 patients were analyzed. In the comparison between baseline to T1 and similarly from baseline to T2, a statistically significant reduction has been reported in the NRS (p < 0.001) and in the SPADI (p < 0.001) in the entire study group. At T1, patients in the E + Hy compared to ESWT-al group, showed a slight but statistically significant reductions in both NRS and SPADI score, while these changes were more evident at T2 (p < 0.001). Interestingly, a gender dimorphism in NRS and in SPADI was found, with female patients that apparently responded better to the combined E + Hy compared to ESWT-al approach. CONCLUSION This retrospective cohort study suggests that the combination of ESWT plus HyA injections seems to be more effective than ESWT alone in RC tendinopathy in both genders. Moreover, in ESWT alone treatment, male patients reported better outcomes compared to females. However, further randomized controlled trials should be structured to confirm and enforce these conclusions.
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Affiliation(s)
- Raffaello Pellegrino
- Antalgic Mini-invasive and Rehab-Outpatients Unit, Department of Innovative Technologies in Medicine & Dentistry, University “G. d’Annunzio”, 66100 Chieti-Pescara, Italy
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Pazzallo Switzerland
| | - Angelo Di Iorio
- Antalgic Mini-invasive and Rehab-Outpatients Unit, Department of Innovative Technologies in Medicine & Dentistry, University “G. d’Annunzio”, 66100 Chieti-Pescara, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy
| | - Teresa Paolucci
- Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology, University G D’Annunzio, 66100 Chieti-Pescara, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania, “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania, “Luigi Vanvitelli”, 80138 Naples, Italy
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11
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Paoletta M, Moretti A, Liguori S, Toro G, Gimigliano F, Iolascon G. Efficacy and Effectiveness of Extracorporeal Shockwave Therapy in Patients with Myofascial Pain or Fibromyalgia: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1014. [PMID: 36013480 PMCID: PMC9416523 DOI: 10.3390/medicina58081014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
Myofascial pain syndrome (MPS) and fibromyalgia (FM) are underestimated painful musculoskeletal conditions that could impact function and quality of life. A consensus about the most appropriate therapeutic approach is still not reached. Considering the long course of the diseases, prolonged assumption of drugs, such as NSAIDs and pain killers, could increase the risk of adverse events, often leading affected patients and physicians to prefer non-pharmacological approaches. Among these, radial and focused extracorporeal shock waves therapies (ESWT) are widely used in the management of painful musculoskeletal conditions, despite the fact that the mechanisms of action in the context of pain modulation should be further clarified. We performed a scoping review on PubMed using Mesh terms for analyzing the current evidence about the efficacy and effectiveness of ESWT for patients with MPS or FM. We included 19 clinical studies (randomized controlled trials and observational studies); 12 used radial ESWT, and 7 used focused ESWT for MPS. Qualitative analysis suggests a beneficial role of ESWT for improving clinical and functional outcomes in people with MPS, whereas no evidence was found for FM. Considering this research gap, we finally suggested a therapeutic protocol for this latter condition according to the most recent diagnostic criteria.
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Affiliation(s)
- Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (S.L.); (G.T.); (G.I.)
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (S.L.); (G.T.); (G.I.)
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (S.L.); (G.T.); (G.I.)
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (S.L.); (G.T.); (G.I.)
| | - Francesca Gimigliano
- Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.P.); (S.L.); (G.T.); (G.I.)
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12
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Ryskalin L, Morucci G, Natale G, Soldani P, Gesi M. Molecular Mechanisms Underlying the Pain-Relieving Effects of Extracorporeal Shock Wave Therapy: A Focus on Fascia Nociceptors. Life (Basel) 2022; 12:life12050743. [PMID: 35629410 PMCID: PMC9146519 DOI: 10.3390/life12050743] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 12/11/2022] Open
Abstract
In recent years, extracorporeal shock wave therapy (ESWT) has received increasing attention for its potential beneficial effects on various bone and soft-tissue pathologies, yielding promising outcomes for pain relief and functional recovery. In fact, ESWT has emerged as an alternative, non-invasive, and safe treatment for the management of numerous musculoskeletal disorders, including myofascial pain syndrome (MPS). In particular, MPS is a common chronic painful condition, accounting for the largest proportion of patients affected by musculoskeletal problems. Remarkably, sensory innervation and nociceptors of the fascial system are emerging to play a pivotal role as pain generators in MPS. At the same time, increasing evidence demonstrates that application of ESWT results in selective loss of sensory unmyelinated nerve fibers, thereby inducing long-lasting analgesia. The findings discussed in the present review are supposed to add novel viewpoints that may further enrich our knowledge on the complex interactions occurring between disorders of the deep fascia including changes in innervation, sensitization of fascial nociceptors, the pathophysiology of chronic musculoskeletal pain of MPS, and EWST-induced analgesia. Moreover, gaining mechanistic insights into the molecular mechanisms of pain-alleviating effects of ESWT may broaden the fields of shock waves clinical practice far beyond the musculoskeletal system or its original application for lithotripsy.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Gianfranco Natale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
- Museum of Human Anatomy "Filippo Civinini", University of Pisa, 56126 Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, 56126 Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, 56121 Pisa, Italy
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Effects of Repeated Injection of 1% Lidocaine vs. Radial Extracorporeal Shock Wave Therapy for Treating Myofascial Trigger Points: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040479. [PMID: 35454318 PMCID: PMC9027125 DOI: 10.3390/medicina58040479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: This study tested the hypothesis that treatment of myofascial trigger points (MTrPs) in the upper trapezius muscle (UTM) with repeated injection of 1% lidocaine results in better alleviation of muscular stiffness and soreness as well as improved metabolism in the hypercontracted MTrP area than treatment with radial extracorporeal shock wave therapy (rESWT). Materials and Methods: A single-blinded, prospective, randomized controlled trial was conducted on patients suffering from MTrPs in the UTM. Thirty patients were treated with repeated injection of 2 mL of 1% lidocaine (three injections; one injection per week). Another 30 patients were treated with rESWT (three treatment sessions; one treatment session per week; 2000 radial extracorporeal shock waves per treatment session; positive energy flux density = 0.10 mJ/mm2). The primary outcome measure was pain severity using the VAS score. The secondary outcome measures included muscle elasticity index, pressure pain threshold and neck disability index. Evaluation was performed at baseline (T1), 15−30 min after the first treatment in order to register immediate treatment effects (T2), before the second treatment (i.e., one week after baseline) (T3) and one week after the third treatment (i.e., four weeks after baseline) (T4). Results: There were no statistically significant differences in the primary and secondary outcome measures between the patients in the lidocaine arm and the patients in the rESWT arm at T1 and T4. Within the arms, the mean differences of all outcomes were statistically significant (p < 0.001) when comparing the data obtained at T1 with the data obtained at T3 and the data obtained at T4. Conclusions: The results of this pilot study suggest that the use of rESWT in patients with MTrPs in the UTM is safe and leads to reduced pain and improved muscle elasticity, pressure pain threshold and neck disability index, without adverse effects. Larger trials are necessary to verify this. Clinicians should consider rESWT instead of injections of lidocaine in the treatment of MTrPs in the UTM.
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14
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Effectiveness of extracorporeal shockwave therapy for frozen shoulder in perimenopausal diabetic women. BIOMEDICAL HUMAN KINETICS 2022. [DOI: 10.2478/bhk-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: To evaluate the effectiveness of extracorporeal shockwave therapy (ESWT) for frozen shoulder in perimenopausal diabetic women.
Materials and methods: A single blind randomized controlled trial was conducted on sixty-two perimenopausal women diagnosed with diabetic frozen shoulder. They were divided randomly into two groups. Group (A) received physiotherapy program in the form of maitland joint mobilization for shoulder joint, self-stretching exercises, range of motion exercises (ROM) and strengthening exercises. Sessions were held 3 times per week, for 4 weeks. Group (B) study group: received the same physiotherapy program in addition to ESWT, once per week, for 4 weeks. Visual analogue scale was used to measure pain intensity, shoulder pain and disability index (SPADI) was used to evaluate disability level, while an electrogoniometer was used to measure shoulder flexion, abduction and external rotation range of motion. All measurements were recorded pretreatment and posttreatment program.
Results: For intragroup comparison, significant improvement in all treatment outcomes was noted in both groups (P < 0.05). However, no significant differences were found between both groups regarding all outcome measures in case of intergroup comparison in the study (P > 0.05).
Conclusion: The use of ESWT have a positive effect in reducing pain and improving shoulder range of motion in perimenopausal women suffering from frozen.
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Anwar N, Li S, Long L, Zhou L, Fan M, Zhou Y, Wang S, Yu L. Combined effectiveness of extracorporeal radial shockwave therapy and ultrasound-guided trigger point injection of lidocaine in upper trapezius myofascial pain syndrome. Am J Transl Res 2022; 14:182-196. [PMID: 35173837 PMCID: PMC8829647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Myofascial pain syndrome (MPS) is a major musculoskeletal problem and a leading cause of disability worldwide. Extracorporeal shockwave therapy (ESWT) and trigger point injection (TPI) have shown positive results for MPS but no previous study has investigated the combined effects of radial shockwave and trigger point injection of lidocaine for upper trapezius myofascial pain syndrome. METHOD For this purpose, forty-five participants were randomly divided into shockwave (n = 15), shockwave with ultrasound-guided trigger point injection (combined; n = 15), and control (standard care; n = 15) groups. Participants were assessed at baseline, one week and four weeks by using the visual analog scale, neck disability index, electromyography, infrared thermography, and sonoelastography. RESULTS Compared with control group, both shockwave and combined groups showed a statistically significant reduction in pain (P<0.01), functional disability (P<0.01), skin temperature (P<0.01), and elastic stiffness, with greater reduction in the combined group (P<0.01) than shockwave group (P<0.05) at four weeks. However, no significant difference was found in electrical activity between the groups (P>0.05). The combined group also showed significant differences in pain (P<0.05) and elastic stiffness (P<0.01) compared with shockwave group at four weeks. CONCLUSION Our study revealed that extracorporeal radial shockwave therapy combined with trigger point injection of lidocaine was more effective for decreasing pain and elastic stiffness in upper trapezius myofascial pain syndrome at four weeks.
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Affiliation(s)
- Nadia Anwar
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
| | - Shuangyu Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
| | - Lu Long
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
| | - Li Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
| | - Meng Fan
- Department of Traditional Chinese Medicine, Weinan Central HospitalWeinan 714000, Shaanxi Province, China
| | - Yi Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
| | - Sanrong Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010, China
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16
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Lee CH, Lee SU. Usefulness of Extracorporeal Shockwave Therapy on Myofascial Pain Syndrome. Ann Rehabil Med 2021; 45:261-263. [PMID: 34496468 PMCID: PMC8435462 DOI: 10.5535/arm.21128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
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17
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Yalçın Ü. Comparison of the effects of extracorporeal shockwave treatment with kinesiological taping treatments added to exercise treatment in myofascial pain syndrome. J Back Musculoskelet Rehabil 2021; 34:623-630. [PMID: 33682694 DOI: 10.3233/bmr-200234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although studies examined kinesiological taping (KT) and extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome (MPS), no study has yet compared these two treatments. OBJECTIVE This study aimed to compare the efficacy of KT and ESWT on pain, pain threshold, functional level and neck movements in the treatment of MPS, which is an important cause of disability and constitutes 50-80% of chronic painful diseases. METHODS Two hundred and sixty-two patients diagnosed with MPS in the upper part of the unilateral trapeze muscle were included in the study. The patients were divided into three groups according to the treatment they received: Group 1 (n= 75): ESWT + exercise, Group 2 (n= 82): KT + exercise, Group 3 (n= 105) and the latter receiving only exercise therapy (control group). Visual analog scale (VAS), pain threshold with algometer, Neck Disability Index (NDI), and neck contralateral lateral flexion angle were assessed before and three months after treatment. RESULTS VAS, pain threshold, NDI and contralateral flexion angle values after treatment improved significantly in the ESWT and KT groups (p< 0.05) compared to the control group. The level of improvement in the ESWT group was higher (p< 0.05) than in the KT group in terms of VAS, pain threshold and NDI scores. CONCLUSION Exercise, KT and ESWT applications in MPS were effective in all of the parameters examined. However, the ESWT + exercise therapy was more effective in terms of pain, pain threshold and disability.
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18
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Sugawara AT, Lima MDC, Dias CB. Predictive factors of response in radial Extracorporeal Shock-waves Therapy for Myofascial and Articular Pain: A retrospective cohort study. J Back Musculoskelet Rehabil 2021; 34:485-490. [PMID: 33492278 DOI: 10.3233/bmr-200152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Myofascial Pain Syndrome causes disability in daily life activities and despite all efforts, it continues to be a challenge, perpetuating suffering, overloading services and costs. New treatment options need to be tested. OBJECTIVE We aimed to quantify the rESWT short-term analgesic effect and identify the predictors of success through comparing results achieved in MPS and Articular Pain (AP). METHOD Retrospective cohort study of 1,580 patients with Myofascial Pain Syndrome or Articular Pain underwent two weekly radial Extracorporeal Shock-wave Therapy sessions. The pain intensity was measured by Visual Analog Scale before and one week after the end of the treatment (3 weeks). RESULTS The therapy decreases pain by 62.50% (p< 0.0001), with a high success rate (91.59%) and a low worsening of baseline conditions rate (2.1%). The best recommendation is for patients with intense myofascial pain (Visual Analog Scale ⩾ 70 mm), using high shock-wave frequency (⩾ 15 Hz). CONCLUSIONS Two rESWT sessions promote pain relief, with a high success rate and low rates of treatment abandonment and worsening. The best results are obtained in myofascial pain patients with high pain intensity, treated with high-frequency dosage.
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Affiliation(s)
- André Tadeu Sugawara
- Department of Physical and Rehabilitation Medicine, Hospital do Servidor Publico Estadual, Sao Paulo, Brazil
| | - Moises da Cunha Lima
- Department of Physical and Rehabilitation Medicine, Hospital do Servidor Publico Estadual, Sao Paulo, Brazil
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Taheri P, Naderi M, Khosravi S. Extracorporeal Shock Wave Therapy Versus Phonophoresis Therapy for Neck Myofascial Pain Syndrome: A Randomized Clinical Trial. Anesth Pain Med 2021; 11:e112592. [PMID: 34336620 PMCID: PMC8314093 DOI: 10.5812/aapm.112592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to assess the effects of using Extracorporeal Shock Wave Therapy (ECSWT) and phonophoresis therapy on pain and neck disability in patients with neck myofascial pain syndrome (MPS). METHODS Forty eligible patients were randomly divided into two groups of ECSWT (received three sessions of ECSWT, once a week for three weeks) and phonophoresis (received ultrasound using hydrocortisone gel 1% over the trigger point on trapezius muscle, three times a week for three weeks). Patients in both groups received the same stretching exercise program and drug regimen during the intervention. RESULTS Pain and NDI scores in both groups were significantly improved at the end of the treatment and four weeks later. At the end of the treatment, the pain score was similar between the groups. Four weeks after the treatment, the pain score in the ECSWT group was significantly lower than in the phonophoresis group (P-value = 0.030). The NDI score was not significantly different between the groups at the end of the treatment. However, four weeks after the treatment, the NDI score was significantly lower in the ECSWT group than in the phonophoresis group (P-value=0.032). The trend of changes in the pain and NDI scores was not significantly different between the groups. CONCLUSIONS Both phonophoresis and ECSWT groups effectively decreased pain and neck disability in patients with MPS, with the superiority of ECSWT with a more lasting effect for a month after the end of the treatment.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzie Naderi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Khosravi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Fleischmann M, McLaughlin P, Hayes A, Vaughan B. The clinical management of neck pain of novice and experienced Australian osteopaths: A secondary analysis of a nationally representative sample. J Bodyw Mov Ther 2021; 25:87-93. [PMID: 33714517 DOI: 10.1016/j.jbmt.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Neck pain is one of the most common musculoskeletal disorders worldwide. Osteopaths are primary contact health professionals who predominantly manage musculoskeletal complaints. How Australian osteopaths manage neck pain is beginning to emerge in the literature and there may be differences based on clinical experience. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and aims to examine the clinical management characteristics of experienced and novice osteopaths who often treat neck pain. METHODOLOGY Secondary analysis of a cross-sectional survey of osteopaths registered with the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Demographic, practice and treatment characteristics of osteopaths who 'often' treat neck pain. Data was split into two groups: novice practitioners (up to nine years in clinical practice), and experienced practitioners (10 years or more in clinical practice), and clinical management was compared. RESULTS Most (98%) of the 971 osteopaths reported that they treat neck pain often. Of those that treat neck pain often, 58% reported being male. The mean number of patient care hours per week was 28.1 ± 12.1 and the mean number of patient visits per week was 36.7 ± 18.7. There was a statistically significant difference between novice and experienced groups for discussing occupation (p < 0.01; d = 0.26) and stress (p = 0.045; d = 0.13) during their consultations, with a low to medium and low effect size, respectively. CONCLUSION This work demonstrates differences in the management strategies of experienced and novice Australian osteopaths that includes utilisation of a multidisciplinary approach to patient management. The results support the conclusion that there are differences in the clinical management strategies employed by experienced versus novice Australian osteopaths.
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Affiliation(s)
- Michael Fleischmann
- Institute for Health & Sport (IHeS), Victoria University, Melbourne, Australia.
| | - Patrick McLaughlin
- Institute for Health & Sport (IHeS), Victoria University, Melbourne, Australia
| | - Alan Hayes
- Institute for Health & Sport (IHeS), Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Brett Vaughan
- Department of Medical Education, The University of Melbourne, Melbourne, Australia; School of Health & Human Sciences, Southern Cross University, Lismore, Australia
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Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. Animals (Basel) 2021; 11:ani11020422. [PMID: 33562089 PMCID: PMC7915466 DOI: 10.3390/ani11020422] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 01/14/2023] Open
Abstract
Simple Summary Neck pain and dysfunction in the horse is becoming an increasingly important topic among riders, trainers and veterinarians. Some horses may present for a subtle performance decline, while others may show dramatic, dangerous behavior. It is important to recognize how to carefully evaluate the horse in an effort to understand the different types of pain that may be contributing to the different behaviors. The musculoskeletal and nervous systems may both play a role in the development of clinical signs. Recognizing that there are many diagnostic options as well as several treatments choices is important. This synopsis covers the disease processes that may contribute to the development of neck pain and dysfunction in the horse, as well as several possible diagnostic and treatment options. Abstract Interest in the cervical spine as a cause of pain or dysfunction is increasingly becoming the focus of many equine practitioners. Many affected horses are presented for poor performance, while others will present with dramatic, sometimes dangerous behavior. Understanding and distinguishing the different types of neck pain is a starting point to comprehending how the clinical presentations can vary so greatly. There are many steps needed to systematically evaluate the various tissues of the cervical spine to determine which components are contributing to cervical pain and dysfunction. Osseous structures, soft tissues and the central and the peripheral nervous system may all play a role in these various clinical presentations. After completing the clinical evaluation, several imaging modalities may be implemented to help determine the underlying pathologic processes. There are multiple treatment options available and each must be carefully chosen for an individual horse. Provided is a synopsis of the current knowledge as to different disease processes that can result in cervical pain and dysfunction, diagnostic approaches and treatment strategies. Improving the knowledge in these areas will ideally help to return horses to a state of well-being that can be maintained over time and through the rigors of their job or athletic endeavors.
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Jun JH, Park GY, Chae CS, Suh DC. The Effect of Extracorporeal Shock Wave Therapy on Pain Intensity and Neck Disability for Patients With Myofascial Pain Syndrome in the Neck and Shoulder: A Meta-Analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2021; 100:120-129. [PMID: 32520797 DOI: 10.1097/phm.0000000000001493] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the efficacy of extracorporeal shock wave therapy on myofascial pain syndrome in the neck and shoulder compared with that of other treatments. DATA SOURCES PubMed, Embase, and Web of Science were systematically searched until May 30, 2019, to select randomized controlled trials. REVIEW METHODS The randomized controlled trials comparing extracorporeal shock wave therapy with sham extracorporeal shock wave therapy or other treatments for patients with myofascial pain syndrome in the neck and shoulder patients were included. Two reviewers independently identified eligible studies. The Cochrane Handbook was used to evaluate the methodological quality of the included randomized controlled trials. Main outcomes associated with pain intensity, pressure pain threshold, and neck disability were selected. The study was registered with PROSPERO (Registration Number CRD 42019137459). RESULTS A total of 11 randomized controlled trials were finally included. The results indicated that extracorporeal shock wave therapy had a large effect size on improving pain intensity (standardized mean difference [SMD] = 0.67, 95% confidence interval = 0.11 to 1.23, P = 0.02) and pressure pain threshold (SMD = 1.19, 95% confidence interval = 0.27 to l2.12, P = 0.01) at postintervention. However, there was no significant effect on neck disability at postintervention (SMD = 0.03, 95% confidence interval = -0.76 to 0.83, P = 0.93). After the subgroup analyses on the type of extracorporeal shock wave therapy, focused extracorporeal shock wave therapy had a significant effect on improving pain intensity (SMD = 0.75, 95% confidence interval = 0.13 to 1.36, P = 0.02) and pressure pain threshold (SMD = 1.70, 95% confidence interval = 0.21 to 3.18, P = 0.03) at postintervention in comparison with that of other treatments. CONCLUSIONS Extracorporeal shock wave therapy is superior to other treatments in terms of alleviating the pain intensity and pressure pain threshold of patients with myofascial pain syndrome in the neck and shoulder at postintervention. In particular, focused extracorporeal shock wave therapy shows significant improvement in pain relief. However, radical extracorporeal shock wave therapy for myofascial pain syndrome treatment still remains unclear.
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Affiliation(s)
- Ji Hyun Jun
- From the Health Insurance Review and Assessment Service, Wonju, Gangwondo, Republic of Korea (JHJ); Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (G-YP); Department of Rehabilitation Medicine, Cheonan Medical Center, Cheonan, Chungcheongnamdo, Republic of Korea (CSC); and College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea (JHJ, D-CS)
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Kamel FH, Basha M, Alsharidah A, Hewidy IM, Ezzat M, Aboelnour NH. Efficacy of Extracorporeal Shockwave Therapy on Cervical Myofascial Pain Following Neck Dissection Surgery: A Randomized Controlled Trial. Ann Rehabil Med 2020; 44:393-401. [PMID: 32986940 PMCID: PMC7655229 DOI: 10.5535/arm.20055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate the efficacy of extracorporeal shockwave therapy (ESWT) on cervical myofascial pain following neck dissection in reducing pain and improving cervical range of motion (ROM). Methods Forty-six patients with cervical myofascial pain following neck dissection surgery were recruited and subdivided at random into two equal groups. The ESWT group received ESWT once a week for 4 weeks (0.25 mL/mm2, 1,000 shocks) and a topical non-steroidal anti-inflammatory drug (3 times/day for 4 weeks). The control group received only topical NSAID. The pain assessment was done by using the visual analog scale (VAS) and pressure algometry. A cervical ROM device was used for the assessment of the lateral flexion and rotation of the neck ROM on both sides. All measurements were collected at baseline, 2 weeks, and 4 weeks. Results The ESWT group revealed a significant improvement in all parameters at post I and post II than did the control group (p>0.001), that revealed a statistical decrease only in the VAS score at post I without any statistical difference in the pain threshold and neck ROM. However, there were statistical differences in all parameters at post II compared to those at pre-treatment and post I (p<0.001). Conclusion As a confirmation of the efficacy of ESWT in cervical myofascial pain control following neck dissection, we observed better results with no side effects in the ESWT group (Clinical Trial Registry No. PACTR202002648274347).
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Affiliation(s)
- FatmaAlzahraa Hassan Kamel
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Saudi Arabia.,Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Maged Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah, Saudi Arabia
| | - Ashwag Alsharidah
- Department of Physiology, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | | | - Mohamed Ezzat
- Department of Physical Therapy for Orthopedics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Nancy Hassan Aboelnour
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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Zhang Q, Fu C, Huang L, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of Extracorporeal Shockwave Therapy on Pain and Function in Myofascial Pain Syndrome of the Trapezius: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2020; 101:1437-1446. [DOI: 10.1016/j.apmr.2020.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 01/30/2023]
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Rahbar M, Samandarian M, Salekzamani Y, Khamnian Z, Dolatkhah N. Effectiveness of extracorporeal shock wave therapy versus standard care in the treatment of neck and upper back myofascial pain: a single blinded randomised clinical trial. Clin Rehabil 2020; 35:102-113. [PMID: 32731757 DOI: 10.1177/0269215520947074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the efficacy of extracorporeal shock wave therapy versus standard care (ultrasound + hot pack + self-stretch-exercises) in treatment of neck and upper back myofascial pain syndrome. DESIGN Single-blind randomised clinical trial. SETTING Outpatients setting. SUBJECTS Patients with neck and upper back myofascial pain. INTERVENTION Participants were randomly allocated into shock wave group (n = 24), standard care (ultrasound + hot pack + self-stretch-exercises) group (n = 24) and control (self-stretch-exercises) group (n = 24) for four weeks. MAIN MEASURES The primary outcomes were pain intensity (visual analogue scale), pain pressure threshold (algometer) and disability (neck disability index). Measures were performed at baseline (week 0), week 1 and post-intervention (week 4). RESULTS Shock wave and ultrasound improved visual analogue scale (7.50 ± 1.71 to 5.72 ± 2.20 and 6.22 ± 2.54 to 4.95 ± 2.86, respectively, P = 0.083) and disability index (54.24 ± 15.53 to 39.04 ± 19.58 50.23 ± 19.57 to 32.10 ± 18.34, respectively, P = 0.495) similarly at first week examinations that were significantly higher than control (P < 0.05). In week 4 measurements, additional improvements were achieved concerning visual analogue scale and disability index in the shock wave (-4.00 ± 2.22 and -20.24 ± 16.56, respectively) and ultrasound (-2.18 ± 2.71 and -21.79 ± 10.56, respectively) groups. However, visual analogue scale improved more significantly in shock wave group than ultrasound group in fourth week measurements (P = 0.012). CONCLUSION Extracorporeal shock wave therapy was more effective in controlling of the pain intensity compared to ultrasound one month after treatment. However it had no superiority over ultrasound in improving neck disability index at this time point.Trial registrationwww.irct.ir, IRCT201608154104N5, registered 2016-09-25.
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Affiliation(s)
- Mohammad Rahbar
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Samandarian
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yaghoub Salekzamani
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zhila Khamnian
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Yoo JI, Oh MK, Chun SW, Lee SU, Lee CH. The effect of focused extracorporeal shock wave therapy on myofascial pain syndrome of trapezius: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19085. [PMID: 32049811 PMCID: PMC7035035 DOI: 10.1097/md.0000000000019085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is commonly seen in clinical settings and negatively influences a patient's daily life. Recently, the application of extracorporeal shock wave therapy (ESWT) has been utilized as one of the treatment methods for MPS. The aim of this systematic review and meta-analysis was to summarize the current evidence for the short-term effect of ESWT on MPS of trapezius. METHODS PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched from the database inception to March 2019. Two reviewers independently screened articles, evaluated methodological quality, and extracted data. The primary outcome was post-interventional pain intensity. RESULTS Randomized controlled trials (RCTs) were conducted to determine whether ESWT was used as the main treatment on MPS. The 5 studies reviewed in this meta-analysis were evaluated for changes in pain intensity. Compared with other treatments, focused ESWT in MPS was more effective in reducing the scores of visual analog scale (VAS) (standardized mean difference [SMD] = -0.48, 95% CI -0.74 to -0.22). CONCLUSIONS There is very low level evidence that focused ESWT is effective for short-term relief of neck pain in MPS. The limited sample size and poor quality of these studies highlight and support the need for large scale, good quality placebo controlled trials in this area.
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Affiliation(s)
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongjaro, Seongsan-gu, Changwon, Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chang Han Lee
- Department of Rehabilitation Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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Manafnezhad J, Salahzadeh Z, Salimi M, Ghaderi F, Ghojazadeh M. 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. J Back Musculoskelet Rehabil 2020; 32:811-818. [PMID: 30883334 DOI: 10.3233/bmr-181289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Javad Manafnezhad
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Zahra Salahzadeh
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Mehdi Salimi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Fariba Ghaderi
- Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran
| | - Morteza Ghojazadeh
- Physiology Department, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Sukareechai C, Sukareechai S. Comparison of radial shockwave and dry needling therapies in the treatment of myofascial pain syndrome. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2016.0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Myofascial pain syndrome is a frequent problem in the musculoskeletal system. As a method of treatment for myofascial pain syndrome, dry needling therapy is an effective and convenient treatment for patients because they do not need to be treated every day. However, as patients often have post-needle soreness or some patients are afraid of needles, there are limitations to this treatment. The purpose of this study is to compare the effectiveness of radial shockwave therapy with dry needling therapy to treat myofascial pain. Methods A total of 42 patients attending the rehabilitation department with at least one myofascial pain trigger point in their upper back muscles, were randomly assigned to receive radial shockwave therapy or dry needling therapy. Treatment was performed once a week for 3 weeks in both groups. Participants' pain pressure threshold, measured using an algometer, and pain levels, measured using a numeric pain scale, were assessed before the designated treatment was applied each week. Each patient also performed upper trapezius, rhomboid and infraspinatus muscle stretches twice a day throughout the study period. Results There was no difference in pain pressure threshold at the three trigger points before treatment with the different modalities commenced. At the end of the study, the radial shockwave therapy group had a significant improvement in trapezius pain pressure threshold, increasing from 11.7 at baseline to 14.8 at the end of study. There was no significant between-group difference in pain level (P=3.4 vs P=2.6) at the end of the study. Both treatments significantly reduced pain levels: from 7.2 to 3.4 in the radial shockwave group (P<0.001) and from 6.8 to 2.6 in the dry needling therapy group (P<0.001). Conclusions Dry needling and radial shock wave therapies are effective in reducing myofascial pain syndrome originating in the upper back muscles. Participants' pain pressure threshold increased after 3 weeks of treatment with both therapies. Radial shock therapy can be used as an alternative to dry needling in the treatment of myofascial pain syndrome in patients who have trouble attending daily physical therapy or in whom dry needling therapy is contraindicated.
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Affiliation(s)
- Chomkajee Sukareechai
- Lecturer, Department of Rehabilitation, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Somchai Sukareechai
- Lecturer, Department of Rehabilitation, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
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Luan S, Zhu ZM, Ruan JL, Lin CN, Ke SJ, Xin WJ, Liu CC, Wu SL, Ma C. Randomized Trial on Comparison of the Efficacy of Extracorporeal Shock Wave Therapy and Dry Needling in Myofascial Trigger Points. Am J Phys Med Rehabil 2019; 98:677-684. [PMID: 31318748 DOI: 10.1097/phm.0000000000001173] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to compare the efficacy of radial extracorporeal shock wave therapy and dry needling in the treatment of myofascial trigger points in the upper trapezius muscle. DESIGN A total of 65 patients with myofascial trigger points were randomly divided into extracorporeal shock wave therapy group (n = 32) and dry needling group (n = 33). Patients received 3 wks of treatment at 1-wk intervals (in both groups). Visual analog scale, pressure pain threshold, Neck Disability Index, and shear modulus were evaluated before treatment, immediately after the first therapy, 1 mo, and 3 mos after the completion of the third therapy. RESULTS Significant improvements of visual analog scale, pressure pain threshold, and Neck Disability Index scores were observed at all time points after treatment (P < 0.01) in both treatment groups. The shear modulus of myofascial trigger points was reduced in both dry needling group (P < 0.05) and extracorporeal shock wave therapy group (P < 0.01) immediately after the first treatment. Significant reductions in shear modulus were maintained up to 3-mo posttreatment in both groups (P < 0.01). There were no significant differences between the radial extracorporeal shock wave therapy group and dry needling group. CONCLUSIONS The extracorporeal shock wave therapy is as effective as dry needling for relieving pain, improving function, and reducing shear modulus for patients with myofascial trigger points after a series of three treatments.
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Affiliation(s)
- Shuo Luan
- From the Department of Rehabilitation Medicine, Guangdong Second Provincial General Hospital, Southern Medical University, Guangzhou, People's Republic of China (SL); Department of Rehabilitation Medicine, Lianjiang People's Hospital, Guangdong, People's Republic of China (ZZ); Department of Rehabilitation, Sun Yat-Sen Memorial Hospital, Guangzhou, People's Republic of China (SL, C. Lin, SK, C. Liu, SW, CM); Department of Ultrasonic, Sun Yat-Sen Memorial Hospital, Guangzhou, People's Republic of China (JR); and Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China (WX)
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High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial. Arch Rheumatol 2019; 35:78-89. [PMID: 32637923 DOI: 10.5606/archrheumatol.2020.7496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/21/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effects of extracorporeal shock wave therapy (ESWT) on pain, sleep, fatigue, disability, depression, and quality of life (QoL) in patients with myofascial pain syndrome (MPS). Patients and methods Between March 2018 and September 2018, a total of 94 patients (16 males, 78 females; mean age 44.2±11.94 years; range, 19 to 74 years) with the diagnosis of MPS were included in the study. The patients were divided into two groups. The treatment group consisted of 49 patients and a total of seven sessions of high-energy flux density ESWT (H-ESWT) (0.26 mJ/mm2) were given with three days interval. The control group consisted of 45 patients and the treatment of hot pack, transcutaneous electrical nerve stimulation, and ultrasound was given for five days for two weeks. At baseline and one month after treatment, the visual analog scale (VAS), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale, Neck Disability Index (NDI), and Beck Depression Inventory (BDI) scores were compared between the groups. Results There were no statistically significant differences in the age, sex, demographic characteristics, and baseline VAS, SF-36, NDI, BDI, FACIT, and PSQI scores between the groups (p>0.05). In the ESWT group, there was a statistically significant decrease in the VAS, SF-36, NDI, BDI, FACIT, and PSQI scores after treatment compared to the baseline scores, while only the SF-36 subscale scores were statistically significantly higher (p<0.05). There was a statistically significant correlation between the VAS and SF-36 scores and the BDI, NDI, FACIT and PSQI scores after the treatment. Conclusion Our study results suggest that H-ESWT is more effective than traditional physical therapy methods on pain, QoL, sleep, fatigue, depression, and disability in patients with MPS.
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Rampazo ÉP, Bellew JW, Pinfildi CE, Guerra RLS, Liebano RE. Low-Level Laser Therapy and Electrotherapy for Neck Pain: "Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients with Nonspecific Neck Pain," Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162-171. Phys Ther 2019; 99:118-119. [PMID: 30476228 DOI: 10.1093/ptj/pzy120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/21/2018] [Indexed: 11/14/2022]
Affiliation(s)
| | - James W Bellew
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana
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García-Muntión A, Godefroy L, Robert H, Muñoz-García D, Calvo-Lobo C, López-de-Uralde-Villanueva I. Study of the mechanisms of action of the hypoalgesic effect of pressure under shock waves application: A randomised controlled trial. Complement Ther Med 2018; 42:332-339. [PMID: 30670263 DOI: 10.1016/j.ctim.2018.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/29/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine if the perceived pain intensity during the application of shock waves (SWs) is a determinant mechanism in producing hypoalgesic changes in pressure pain thresholds (PPTs) in asymptomatic individuals. DESIGN A randomised, single-blind controlled trial [NCT03455933]. SETTING University. PARTICIPANTS Sixty-three asymptomatic individuals. INTERVENTIONS Participants were randomised into three groups: 1-SWs causing mild pain (SW-DP); 2-SWs generating moderate pain (SW-MP); and 3-cold pressor test (CPT). MAIN OUTCOME MEASUREMENTS Before and after the intervention, the PPT was evaluated bilaterally at the following points: lateral epicondyle, median nerve in the flexure of the elbow, and tibia. RESULTS The results showed differences between various groups over time for all PPTs assessments, due to the existence of statistically significant differences in the interaction group x times (dominant arm lateral epicondyle [P < 0.001; η2p = 0.255]; dominant arm median nerve [P = 0.001; η2p = 0.212]; nondominant arm lateral epicondyle [P < 0.001; η2p = 0.275]; nondominant arm median nerve [P < 0.001; η2p = 0.268]; tibia [P = 0.012, η2p = 0.138]). The SW-MP group obtained a significant increase in all the PPT evaluations compared with the SW-DP group (d > 0.80). The CPT group only showed significantly higher results, and of high magnitude (d > 0.80), regarding the SW-DP group for the PPT evaluation in the dominant member. The SW-MP group showed differences compared with the CPT only for the PPT obtained in the nondominant arm. CONCLUSIONS The findings show that SW treatment generates a hypoalgesic effect on the application point, with moderate pain. Further studies are necessary in order to link these hypoalgesic changes to the activation of the descending inhibitory systems.
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Affiliation(s)
- Alberto García-Muntión
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Loris Godefroy
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Hugo Robert
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Muñoz-García
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Universidad de León, Av. Astorga, s/n, Ponferrada, 24401, León, Spain.
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain
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Comparative study of shockwave therapy and low-level laser therapy effects in patients with myofascial pain syndrome of the trapezius. Rheumatol Int 2018; 38:2045-2052. [DOI: 10.1007/s00296-018-4134-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
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Park KD, Lee WY, Park MH, Ahn JK, Park Y. High- versus low-energy extracorporeal shock-wave therapy for myofascial pain syndrome of upper trapezius: A prospective randomized single blinded pilot study. Medicine (Baltimore) 2018; 97:e11432. [PMID: 29995794 PMCID: PMC6076058 DOI: 10.1097/md.0000000000011432] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the efficacy of high- and low-energy extracorporeal shock wave therapy (ESWT) for patients with myofascial pain syndrome (MPS) of the upper trapezius. METHODS Thirty patients (3 men, 27 women) were randomly assigned to receive either high-energy ESWT (0.210 mJ/mm) or low-energy ESWT (0.068 mJ/mm). Both groups received 1500 pulses of ESWT once a week, for 2 weeks. Outcome measurement was assessed by verbal numeric pain scale (VNS), neck disability index (NDI), neck range of motion (ROM) (flexion, extension, rotation, lateral bending), and pressure threshold (PT). Statistical analysis was performed with significance level of P < .05. RESULTS No statistically significant differences of demographic and clinical characteristics existed between the 2 groups. VNS, NDI, neck ROM (rotation to sound side, lateral bending to affected side, lateral bending to sound side), and PT were improved in both groups. In contrast, statistically significant improvements in neck flexion and neck extension were observed only in the high-energy group. We also found significant differences in post-treatment NDI (4.20 ± 1.78 vs 6.47 ± 2.48) and post-treatment neck flexion ROM (65.47 ± 10.09 vs 55.93 ± 11.07) between high-energy and low-energy group. CONCLUSION ESWT effectively improves VNS, NDI, neck ROM, and PT to patients with MPS of the upper trapezius. High-energy ESWT was more effective in improving NDI and neck flexion ROM compared to the low-energy ESWT, suggesting superiority in functional improvement. Further studies are required to specify the effect of ESWT by energy intensity.
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Affiliation(s)
- Ki Deok Park
- Department of Rehabilitation Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon
| | | | - Min-ho Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jae Ki Ahn
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Yongbum Park
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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Aktürk S, Kaya A, Çetintaş D, Akgöl G, Gülkesen A, Kal GA, Güçer T. Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled study. J Phys Ther Sci 2018; 30:448-453. [PMID: 29581669 PMCID: PMC5857456 DOI: 10.1589/jpts.30.448] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to compare effectiveness of extracorporeal shock wave therapy (ESWT), ultrasound (US) and sham ESWT in the treatment of myofascial pain syndrome (MPS). [Subjects and Methods] Sixty MPS patients aged 18-60 years were included in the study. The patients were randomized equally into 3 groups. Group 1 received ESWT for 4 session with 3 day-intervals. Group 2 received 4 sessions of sham ESWT. US was applied to Group 3 for 10 sessions. All patients were recommended an exercise program. The patients were evaluated before-post and 6 weeks after treatment. Measurements were made using pressure pain threshold (PPT), pain score (PS) and visual analogue scale (VAS). Patients were evaluated by using SF-36 and HADS (hospital anxiety and depression scale). [Results] A significant posttreatment difference was found in VAS, PPT and SF-36 subparameters in group 1. In group 2, a significant difference was not found in any parameter. In group 3, a significant difference was detected in parameters of VAS and PPT. A significant difference was found between groups 1 and 2 as for subtitles of PPT, VAS, SF-36. [Conclusion] These results suggest that ESWT is as effective as US. ESWT and US are significantly more effective than sham ESWT.
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Affiliation(s)
- Semra Aktürk
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Inönü Univesity: Malatya, Turkey
| | - Arzu Kaya
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Faculty of Medicine, Turkey
| | - Derya Çetintaş
- Department of Physical Medicine and Rehabilitation, Elazığ Education and Research Hospital, Turkey
| | - Gürkan Akgöl
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Faculty of Medicine, Turkey
| | - Arif Gülkesen
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Faculty of Medicine, Turkey
| | - Gül Ayden Kal
- Department of Physical Medicine and Rehabilitation, Elazığ Education and Research Hospital, Turkey
| | - Tülin Güçer
- Department of Physical Medicine and Rehabilitation, Anadolu Hospital, Turkey
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Bier JD, Scholten-Peeters WGM, Staal JB, Pool J, van Tulder MW, Beekman E, Knoop J, Meerhoff G, Verhagen AP. Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain. Phys Ther 2018; 98:162-171. [PMID: 29228289 DOI: 10.1093/ptj/pzx118] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/30/2017] [Indexed: 02/07/2023]
Abstract
The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews.During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions.In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual."In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar.In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary.In case of neck pain grade III (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks.
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Affiliation(s)
- Jasper D Bier
- Department of General Practice, Erasmus University of Rotterdam, Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands
| | - Wendy G M Scholten-Peeters
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - J Bart Staal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands, and Research Group for Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Jan Pool
- Institute of Human Movement Studies, Department of Lifestyle and Health, HU University of Applied Sciences, Utrecht, the Netherlands
| | - Maurits W van Tulder
- Faculty of Earth and Life Sciences, Institute of Health Sciences, VU University Amsterdam, the Netherlands
| | - Emmylou Beekman
- The Research Centre for Autonomy and Participation for Persons With a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jesper Knoop
- The Research Centre for Autonomy and Participation for Persons With a Chronic Illness, Zuyd University of Applied Sciences
| | - Guus Meerhoff
- The Research Centre for Autonomy and Participation for Persons With a Chronic Illness, Zuyd University of Applied Sciences
| | - Arianne P Verhagen
- Department of General Practice, Erasmus University of Rotterdam, Rotterdam, the Netherlands
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Walsh R, Kinsella S, McEvoy J. The effects of dry needling and radial extracorporeal shockwave therapy on latent trigger point sensitivity in the quadriceps: A randomised control pilot study. J Bodyw Mov Ther 2018; 23:82-88. [PMID: 30691767 DOI: 10.1016/j.jbmt.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/15/2018] [Accepted: 02/02/2018] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Latent myofascial trigger points (TrP) can alter joint kinematics, reduce strength and alter activation patterns, affecting athletic performance. TrP sensitivity can be measured with the pressure pain threshold (PPT). Dry needling (DN) has been used to treat latent TrPs, but may cause post-needling soreness. Radial extracorporeal shockwave therapy (rESWT) could be used as an alternative to DN during heavy training or competition. METHODS After baseline measures, 21 recreational athletes were split into three groups: DN, rESWT or control group, and were treated for three sessions in one week. Follow-up outcome sessions were conducted two to four and seven days after the last treatment. TrP sensitivity was measured using the PPT. RESULTS There was a groupXtime interaction for the PPT (p < 0.05). After a decrease in PPT during treating, there was a significant increase (p < 0.05) in PPT for the DN group (12.92%). The rESWT group also significantly (p < 0.05) increased (13.26%), but did not show any post-treatment soreness during the treatment phase. There was no difference in the PPT in the control group during any session. CONCLUSION DN is effective for increasing PPT of latent TrPs, but can be associated with post-treatment soreness. rESWT is as effective, but without the post-treatment soreness. Future studies should include treating multiple TrPs in the lower kinetic chain as well as measuring muscle activation and joint function. Furthermore, consideration for the current training load and up-coming competition is needed. Optimum timing and longer follow-up periods of such interventions should be explored. LEVEL OF EVIDENCE 2b. SUMMARY Treating latent TrPs in the lower kinetic chain may improve muscle activation. Unlike DN, rESWT does not cause post- treatment soreness. Consideration of training load and up-coming competition is needed to deliver the optimum treatment strategy for athletes with latent TrPs.
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Affiliation(s)
- Richie Walsh
- Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland; HealthCORE, Institute of Technology Carlow, Carlow, Ireland.
| | - Sharon Kinsella
- Department of Science and Health, Institute of Technology Carlow, Carlow, Ireland; HealthCORE, Institute of Technology Carlow, Carlow, Ireland
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Kostenko EV, Zuev DS, Zaitseva TN. [The role of extracorporeal shock wave therapy in the combined restorative treatment of the patients presenting with myofascial pain syndrome]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2018; 95:62-68. [PMID: 30168516 DOI: 10.17116/kurort20189504162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The myofascial pain syndromes (MPS) is ranked among the most frequent clinical manifestations of acute and chronic pain in the lumbar region. The authors of the article undertook the analysis of scientific publications from the Pubmed, Medline, and Scopus databases that appeared during the recent years. The analysis has demonstrate that extracorporeal shock wave therapy (ESWT) can be considered as a method of choice to be used in the framework of the complex programs of the treatment and rehabilitation of the condition of interest. The specific etiopathogenetic features of ESWT are considered in terms of the contemporary views with special reference to their influence on the choice of the treatment strategies and concrete methods for the treatment of the myofascial pain syndromes. It is shown that extracorporeal shock wave therapy makes it possible to enhance the blood flow and circulation and increase the permeability of cell membranes thereby facilitating the activation of the regenerative processes in the structural elements of the vertebral-motor segment undergoing the dystrophic changes. Moreover, ESWT produces the anti-inflammatory effects and causes muscle relaxation. There is strong evidence of the possibility to use such modern modalities of manual needs tlomethods of ESWT and manual therapy in patients with MFBS that requires further research. The expected effects of the combined application of extracorporeal shock wave therapy and manual therapy for the treatment of the patients presenting with myofascial pain syndrome remain to be verified in the further studies.
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Affiliation(s)
- E V Kostenko
- Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Health Department, Moscow, Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D S Zuev
- Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Health Department, Moscow, Russia
| | - T N Zaitseva
- Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Health Department, Moscow, Russia
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Zhou Y, Loh E, Dickey JP, Walton DM, Trejos AL. Development of the circumduction metric for identification of cervical motion impairment. J Rehabil Assist Technol Eng 2018; 5:2055668318777984. [PMID: 31191942 PMCID: PMC6453104 DOI: 10.1177/2055668318777984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/16/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Chronic neck pain results in considerable personal, clinical, and societal burden. It consistently ranks among the top three pain-related reasons for seeking healthcare. Despite its prevalence, neck pain is difficult to both assess and treat. Quantitative approaches are required since diagnostic imaging techniques rarely provide information on movement-related neck pain, and most common clinical assessment tools are limited to single plane motion measurement. METHODS In this study, the ability of an inertial measurement unit to document the cervical motion characteristics of 28 people with chronic neck pain and 23 healthy controls was assessed. A total of six circumduction metrics and one neck circumduction trajectory model were proposed as identification metrics. RESULTS Five metrics demonstrated significant differences between the two groups. The neck circumduction trajectory model successfully distinguished between the two groups. DISCUSSION The evaluation of the proposed metrics provides proof of concept that novel metrics can be captured with relative ease in the clinical setting using an inexpensive wearable sensor headband. The derivation of the proposed model may open new lines of inquiry into the clinical utility of assessing the multiplanar movement of cervical circumduction. The results obtained from this study also provide additional insight for the development of a sensitive, quantifiable and real-world neck evaluation strategies.
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Affiliation(s)
- Yue Zhou
- Biomedical Engineering Program, Western
University, London, ON, Canada
| | - Eldon Loh
- Department of Physical Medicine and
Rehabilitation, Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada
| | - James P Dickey
- School of Kinesiology, Western
University, London, ON, Canada
| | - David M Walton
- Health and Rehabilitation Studies,
Western University, London, ON, Canada
| | - Ana Luisa Trejos
- Biomedical Engineering Program, Western
University, London, ON, Canada
- Department of Electrical and Computer
Engineering, Western University, London, ON, Canada
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40
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Kim YW, Chang WH, Kim NY, Kwon JB, Lee SC. Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study. Yonsei Med J 2017; 58:644-649. [PMID: 28332373 PMCID: PMC5368153 DOI: 10.3349/ymj.2017.58.3.644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/12/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To assess the effect of extracorporeal shock wave therapy (ESWT) for healthy participants with hamstring tightness. MATERIALS AND METHODS This study was performed at a university rehabilitation hospital. Twenty nine healthy adults with hamstring tightness were enrolled and randomly allocated into four groups (ESWT, stretching exercise, ESWT with stretching exercise, and control). The effects of individual treatments were compared by the finger-to-floor test and popliteal angle. RESULTS The ESWT group, stretching exercise group and ESWT with stretching exercise group had decreased finger-to-floor distances and right popliteal angles immediately after intervention, compared with the control group (p<0.05). At 4 weeks after completion of the interventions, finger-to-floor distances and the right popliteal angle in only the ESWT with stretching exercise group showed a significant improvement, compared with the control group (p=0.008 and 0.023). CONCLUSION While ESWT and stretching both reduced hamstring tightness immediately after interventions, only ESWT with stretching exercise maintained the significantly improved relief of hamstring tightness significantly after 4 weeks.
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Affiliation(s)
- Yong Wook Kim
- Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Na Young Kim
- Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Beom Kwon
- Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Taheri P, Vahdatpour B, Andalib S. Comparative study of shock wave therapy and Laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius. Adv Biomed Res 2016; 5:138. [PMID: 27656607 PMCID: PMC5025921 DOI: 10.4103/2277-9175.187398] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/12/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The aim of this study is to compare the effects of laser therapy and shock wave therapy for symptoms treatment among patients with MPS in the upper trapezius muscle. MATERIALS AND METHODS In a clinical trial study, 46 patients were selected based on the clinical criteria and physiathrist diagnosis. Subjects were randomized into two groups as follows: Twenty individuals were assigned to exercise-medication-laser therapy group, and 26 to exercise-medication-shock wave therapy group. The pain was assessed based on visual analog scale (VAS), neck disability index (NDI), and SPADI in three stages: Before treatment, subsequently after treatment, and a month after treatment. RESULTS One man and 19 women, age group of 45.3 ± 7.7 years, were assigned into laser therapy group. Two men and 24 women, average age group of 42.3 ± 10.4 were assigned into shock wave therapy group. A significant difference was found among our study groups before treatment and after starting treatment for VAS, NDI, and SPDI indices, that is, two methods of treatments were effective (P < 0.001). However, among these two treatment methods, laser therapy provided higher effect on VAS and NDI as compared to the radial shock wave method (P < 0.05) in 2 weeks from starting the treatment (consequent to treatment). CONCLUSION According to this study results, we can conclude that shock wave and laser therapy results on similar effect in long-term for relieve of pain and eliminating symptoms in patients with myofascial but laser provides a faster optimal results.
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Affiliation(s)
- Parisa Taheri
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Vahdatpour
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Andalib
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
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Cho YS, Joo SY, Cui H, Cho SR, Yim H, Seo CH. Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study. Medicine (Baltimore) 2016; 95:e4575. [PMID: 27512886 PMCID: PMC4985341 DOI: 10.1097/md.0000000000004575] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. METHODS A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm (0.05-0.15 mJ/mm) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. RESULTS The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). CONCLUSION ESWT significantly reduced scar pain in burn patients after wound recovery.
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Affiliation(s)
- Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
| | - Huisong Cui
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine
| | - Haejun Yim
- Department of Burn Surgery, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University
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Kim JI, Lee HJ, Park HY, Lee WH, Kim YS. Is Extracorporeal Shock Wave Therapy Effective in the Treatment of Myofascial Pain Syndrome? Clin Shoulder Elb 2016. [DOI: 10.5397/cise.2016.19.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ramon S, Gleitz M, Hernandez L, Romero LD. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. Int J Surg 2015; 24:201-6. [DOI: 10.1016/j.ijsu.2015.08.083] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/31/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
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Yang YJ, Lee SJ, Choi M. Pressure pain threshold and visual analogue scale changes in the high and low energy extracorporeal shock wave. ACTA ACUST UNITED AC 2014. [DOI: 10.14474/ptrs.2014.3.2.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- You-Jin Yang
- Department of Rehabilitation Medicine, Wonju Medical Center, Wonju, Republic of Korea
| | - Seung-Joon Lee
- Medical Fitness Center, Jung Hospital, Wonju, Republic of Korea
| | - Matthew Choi
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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Notarnicola A, Quagliarella L, Sasanelli N, Maccagnano G, Fracella MR, Forcignanò MI, Moretti B. Effects of extracorporeal shock wave therapy on functional and strength recovery of handgrip in patients affected by epicondylitis. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2830-2840. [PMID: 25308950 DOI: 10.1016/j.ultrasmedbio.2014.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 04/27/2014] [Accepted: 07/15/2014] [Indexed: 06/04/2023]
Abstract
Extracorporeal shock wave therapy (ESWT) is effective in the treatment of tendinopathy. We designed a prospective observational clinical study to assess the correlation between clinical and functional measures and recovery of strength after ESWT for epicondylitis. We analyzed 26 patients. We measured progressive improvement in visual analogue scale values (p < 0.0005) and Mayo Elbow Performance Index scores (p = 0.004) for the pathologic limb. Monitoring of handgrip failed to reveal changes in values at any follow-up (p > 0.05). We found no correlation between degree of clinical function and muscle deficit during follow-up. After ESWT, there was a tendency toward a decrease in grip strength, especially in the dominant limb. This could be related to the effects of ESWT, which reduces spasticity in painful hypertonic muscles. These data may be useful in defining the expectations for function during ESWT for epicondylitis, particularly for elite athletes.
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Affiliation(s)
- Angela Notarnicola
- Course on Motor and Sports Sciences, Faculty of Medicine and Surgery, University of Bari, Bari, Italy; Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy.
| | - Livio Quagliarella
- Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
| | - Nicola Sasanelli
- Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
| | - Giuseppe Maccagnano
- Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
| | - Maria Rosaria Fracella
- Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
| | - Maria Immacolata Forcignanò
- Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
| | - Biagio Moretti
- Course on Motor and Sports Sciences, Faculty of Medicine and Surgery, University of Bari, Bari, Italy; Orthopedics Section, Department of Basic Medical Sciences, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Bari, General Hospital, Bari, Italy
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Gollwitzer H, Opitz G, Gerdesmeyer L, Hauschild M. [Greater trochanteric pain syndrome]. DER ORTHOPADE 2014; 43:105-16; quiz 117-8. [PMID: 24414233 DOI: 10.1007/s00132-013-2208-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Greater trochanteric pain is one of the common complaints in orthopedics. Frequent diagnoses include myofascial pain, trochanteric bursitis, tendinosis and rupture of the gluteus medius and minimus tendon, and external snapping hip. Furthermore, nerve entrapment like the piriformis syndrome must be considered in the differential diagnosis. This article summarizes essential diagnostic and therapeutic steps in greater trochanteric pain syndrome. Careful clinical evaluation, complemented with specific imaging studies and diagnostic infiltrations allows determination of the underlying pathology in most cases. Thereafter, specific nonsurgical treatment is indicated, with success rates of more than 90 %. Resistant cases and tendon ruptures may require surgical intervention, which can provide significant pain relief and functional improvement in most cases.
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Affiliation(s)
- H Gollwitzer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland,
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Tung CW, Cheon WC, Tong A. Novel treatment of chronic perineal pain in a woman by extracorporeal shock wave therapy: a case report and published work review. J Obstet Gynaecol Res 2014; 41:145-8. [PMID: 25164767 DOI: 10.1111/jog.12487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/26/2014] [Indexed: 12/01/2022]
Abstract
In published work review, extracorporeal shock wave therapy (ESWT) has been showed to be effective in treating chronic perineal/pelvic pain in men, but there was no published report on its use in women. We report a case of female chronic perineal pain successfully treated by ESWT. A 51-year-old woman presented with persistent perineal scar pain after excision of a vulval-vaginal nodule despite oral analgesics and gabapentin. After 11 cycles of ESWT, she reported termination of analgesics consumption and decreased perineal pain score from 8 to 2. The Short Form 36 Questionnaire demonstrated improvement in physical and mental health conditions. There was no complication encountered. We postulate that the effect of ESWT in this patient was based on reduction of muscle tone and alternating the threshold of pain memory, similar to the mechanisms in male patients. Further study is required to determine the use of ESWT in treating female chronic perineal pain.
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Affiliation(s)
- Chi Wai Tung
- Department of Obstetrics and Gynecology, Queen Elizabeth Hospital, HKSAR, China
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Jung YJ, Park WY, Jeon JH, Mun JH, Cho YS, Jun AY, Jang KU, Seo CH. Outcomes of ultrasound-guided extracorporeal shock wave therapy for painful stump neuroma. Ann Rehabil Med 2014; 38:523-33. [PMID: 25229031 PMCID: PMC4163592 DOI: 10.5535/arm.2014.38.4.523] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/16/2014] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm(2), while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS The changes in the McGill pain questionnaire were 38.8±9.0 prior to treatment and 11.8±3.1 following the treatment. The corresponding values for the control group were 37.2±7.7 and 28.5±10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0±1.5 and 2.8±0.8 in the ESWT group, respectively, and 7.2±1.4 and 5.8±2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm(2)) were not significantly different between groups (p>0.05). CONCLUSION The study findings imply that ESWT for stump neuroma is superior to conventional therapy.
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Affiliation(s)
- Yun Jae Jung
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Won Yong Park
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jong Hyun Jeon
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jeong Hyeon Mun
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred-Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ah Young Jun
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ki Un Jang
- Department of Rehabilitation Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred-Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Clinical study on extracorporeal shock wave therapy plus electroacupuncture for myofascial pain syndrome. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2014. [DOI: 10.1007/s11726-014-0748-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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