Trigger points are a common cause of severe and disabling pain in chiropractic practice. While trigger points may be found in any skeletal muscle the majority are found in the upper trapezius. Relatively few studies have investigated non-invasive treatments for upper trapezius trigger points. Common manual therapy treatments utilized for upper trapezius trigger points in chiropractic include manual pressure and myofascial release. The purpose of this study was to compare the effect of a single treatment of ischaemic compression and activator trigger point therapy on active upper trapezius trigger points.
Fifty-two subjects with active upper trapezius trigger points met the participation criteria and were randomised to an ischaemic compression or activator trigger point therapy group. The primary outcome measure was Patient Global Impression of Change. Secondary outcome measures were an 11-point numerical rating scale for change in pain, and change in pressure pain threshold using an algometer for trigger point sensitivity. While the treating clinician and subjects were not masked to treatment assignment, the examiner was blind to treatment assignment until data analyses were completed. An independent t-test was used to compare the groups at baseline on the continuous variables. The Mann—Whitney U-test was used to compare the groups at baseline on the non-continuous variables. Relative risk ratios of improvement for the primary and secondary outcome measures were calculated with 95% confidence intervals for clinical significance.
Seventy volunteers were screened with 25 subjects randomised to the ischaemic compression group and 27 to the activator trigger point therapy group. There was no significant difference between the groups in any of the baseline variables. On the primary outcome measure both groups improved (78% of those in the activator group and 72% in the ischaemic compression group). Relative risk for improvement of 1.00 suggested that those treated with the Activator instrument were no more likely to improve than those treated with ischaemic compression (95% CI = 0.73—1.37). For the secondary outcome measure of pain reduction 41% of those treated with the Activator instrument improved compared to 36% of those in the ischaemic compression group. Those treated with the Activator instrument were 13% more likely to improve than those treated with ischaemic compression. However this relative risk of 1.13 in favour of the activator group was not significant (95% CI = 0.57— 2.26). For the secondary outcome of reduction in trigger point sensitivity 32% of those in the ischaemic compression group improved compared to 30% in the activator group. Those treated with ischaemic compression were 8% more likely to improve; however, the relative risk of 1.08 was not significant (95% CI = 0.48—2.44). As risk of improvement on the outcome measures between the groups was not significantly different, number needed to treat was not calculated.
Based on the primary outcome measure the results suggest that both ischaemic compression and Activator trigger point therapy have an equal immediate clinically important effect on upper trapezius trigger point pain.
Clin Chiropr. (2008) 11(4):175-181.
Author information: Gemmel H, Allen A. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF, United Kingdom.
To determine the immediate effect of activator trigger point therapy (ATrPT) and myofascial band therapy (MBT) compared to sham ultrasound (SUS) on non-specific neck pain, cervical lateral flexion and pain pressure threshold of upper trapezius trigger points.
Randomised, placebo-controlled clinical trial.
Anglo-European College of Chiropractic (AECC) in Bournemouth, England.
Forty-five subjects between 18 and 55 years of age with non-specific neck pain of at least 4 on an 11-point numerical rating scale (NRS), an upper trapezius trigger point (TrP) and decreased cervical lateral flexion to the opposite side of the active upper trapezius TrP were recruited from the AECC student body.
The subjects were randomly assigned to one of three treatment groups: activator trigger point therapy, myofascial band therapy or sham ultrasound (control group). Neck pain level was determined using a numerical rating scale, degree of lateral flexion (LF) was determined using a cervical range of motion (CROM) goniometer and pain pressure thresholds (PPT) were measured with a pain pressure algometer. All subjects attended one treatment session and outcome measures were repeated within 5 min after treatment.
A one-way ANOVA indicated there was no statistically significant difference between the groups at baseline in age, pain level, lateral cervical flexion or pain pressure threshold ( p > 0.05). For the primary outcome measure of pain reduction the odds of a patient improving with activator trigger point therapy was 7 times higher than a patient treated with myofascial band therapy or sham ultrasound (95% CI:1.23—45.03). The number needed to treat (NNT) with activator trigger point therapy for one patient to improve was 3 (95% CI: 1.4—10.6).
Activator trigger point therapy appears to be more effective than myofascial band therapy or sham ultrasound in treating patients with non-specific neck pain and upper trapezius trigger points.
Clin Chiropr. (2008) 11(1):23-29.
Author information: Blikstad A, Gemmell H. Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth BH5 2DF, UK.
The authors suggest Activator Methods care as a natural way to treat fibromyalgia and chronic myofascial pain.
The symptoms include chronic, widespread musculoskeletal pain, accompanied by multiple tender or trigger points, painful or restricted movement, and persistent fatigue. For an estimated 26 million Americans, the underlying condition is fibromyalgia syndrome (FMS) or myofascial pain syndrome (MPS) or both, in the form of FMS/MPS Complex.
Despite the widespread occurrence of .these conditions, the average FMS or MPS patient suffers for five years and spends thousands of dollars on medical bills before receiving an accurate diagnosis. And, even then, effective treatment may still prove elusive, as few doctors are trained to understand or respond to these conditions.
Fibromyalgia & Chronic Myofascial Pain Syndrome offers the first comprehensive patient guide for managing these conditions. You’ll start by learning what FMS and MPS are, evaluating your own symptoms, and identifying the tender and/or trigger points that are crucial for treating them. The manual covers chronic pain, sleep problems, and other “Internal affairs,” shows you how you can use your mind to counteract physical symptoms and the numbing effects of “fibrofog,” and provides an extensive set of healing tools-including information on the latest medications, a nutritional program, and tips for using bodywork and other less commonly known treatments. Its comprehensive survival strategies include suggestions for coping with family and work situations, getting support, and dealing with the health care system.
Reference: Devin J. Starlanyl, M.D.; Mary Ellen Copeland, M.S., M.A.; Fibromyalgia & Chronic Myofascial Pain Syndrome – A SURVIVAL MANUAL; New Harbinger Publications, Inc pages 144, 244-246