Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial : American Journal of Physical Medicine & Rehabilitation

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Original Research Articles CME Article . 2017 Series . Number 12

Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages

A Randomized, Placebo Controlled Trial

Moraska, Albert F. PhD; Schmiege, Sarah J. PhD; Mann, John D. MD; Butryn, Nathan RMT; Krutsch, Jason P. MD

Author Information

From the College of Nursing, University of Colorado at Denver, Aurora (AFM, SJS); Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill (JDM); Boulder College of Massage Therapy, Boulder, Colorado (NB); and Colorado Pain, Golden (JPK).

All correspondence and requests for reprints should be addressed to: Albert F. Moraska, PhD, College of Nursing, University of Colorado at Denver, 13120 E 19th Ave, C288-19, Aurora, CO 80045.

Supported by NIH/NCCAM grant number R21 AT00469 and by NIH/CATS Colorado CTSI grant number UL1 TR000154, Bethesda, MD. Contents are the authors' sole responsibility and do not necessarily represent official NIH views.

The trial is registered at ClinicalTrials.gov, number NCT01244555.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

American Journal of Physical Medicine & Rehabilitation 96(9):p 639-645, September 2017. | DOI: 10.1097/PHM.0000000000000728

Abstract

Objective 

This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache.

Design 

Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments.

Results 

PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (P < 0.0001 for suboccipital; P < 0.004 for upper trapezius). Post hoc analysis within the massage group showed (1) an initial, immediate increase in PPT (all P values < 0.05), (2) a cumulative and sustained increase in PPT over baseline (all P values < 0.05), and (3) an additional immediate increase in PPT at the final (12th) massage treatment (all P values < 0.05, except upper trapezius left, P = 0.17).

Conclusions 

Single and multiple massage applications increase PPT at MTrPs. The pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed.

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) Understand the contribution of myofascial trigger points to myofascial pain; (2) Describe an effective treatment for decreasing tenderness of a myofascial trigger point; and (3) Discuss the relative values of single vs. multiple massage sessions on increasing pressure-pain thresholds at myofascial trigger points.

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 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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