Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature.

In my practice here in Laurel, Maryland, patients are often amazed that we can find, just by palpating, the "painful spots". Trigger points are extremely sensitive spots in muscle bands that trigger painful responses and are characterized by heightened discomfort in the patient and a noticeable hardness to the doctor or therapist. Trigger points are not just tender nodules, but they affect the surrounding muscle and tissues. Trigger point therapy (TPT) involves the application of pressure to these painful, tender areas in order to relieve their pain and dysfunction as well as pain in other parts of the body. The patients will find that trigger point therapy in combination with other physiotherapy modalities and chiropractic manipulation often provides pain relief. Here is a study in support of manual-type therapies and some physiologic therapeutic modalities for trigger points.

OBJECTIVES: Myofascial pain syndrome (MPS) and myofascial trigger points (MTrPs) are important aspects of musculoskeletal medicine, including chiropractic. The purpose of this study was to review the most commonly used treatment procedures in chiropractic for MPS and MTrPs.

METHODS: The Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) was charged with developing literature syntheses, organized by anatomical region, to evaluate and report on the evidence base for chiropractic care. This article is the outcome of this charge. As part of the CCGPP process, preliminary drafts of these articles were posted on the CCGPP Web site www.ccgpp.org (2006-8) to allow for an open process and the broadest possible mechanism for stakeholder input. PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and databases for systematic reviews and clinical guidelines were searched. Separate searches were conducted for (1) manual palpation and algometry, (2) chiropractic and other manual therapies, and (3) other conservative and complementary/alternative therapies. Studies were screened for relevance and rated using the Oxford Scale and Scottish Intercollegiate Guidelines Network rating system.

RESULTS: A total of 112 articles were identified. Review of these articles resulted in the following recommendations regarding treatment: Moderately strong evidence supports manipulation and ischemic pressure for immediate pain relief at MTrPs, but only limited evidence exists for long-term pain relief at MTrPs. Evidence supports laser therapy (strong), transcutaneous electrical nerve stimulation, acupuncture, and magnet therapy (all moderate) for MTrPs and MPS, although the duration of relief varies among therapies. Limited evidence supports electrical muscle stimulation, high-voltage galvanic stimulation, interferential current, and frequency modulated neural stimulation in the treatment of MTrPs and MPS. Evidence is weak for ultrasound therapy.

CONCLUSIONS: Manual-type therapies and some physiologic therapeutic modalities have acceptable evidentiary support in the treatment of MPS and TrPs.

Source: http://www.ncbi.nlm.nih.gov/pubmed/19121461

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic