Treatment of the Myofascial Trigger-Points of Triceps Surae: A Systematic Review

Background: Myofascial Trigger Points (MTrPs) in the triceps surae muscles are very frequent and their presence may be implicated in pain, such as nocturnal night cramps. These points cause important limitations to athletic performance and daily activities. For this reason, treatment of these MTrPs are essential in the clinical field and have been addressed by a large number of therapeutic strategies. Therefore, the aim of this review is to analyze treatments available for the MTrPs in the triceps surae and their effectiveness. Methods: The PubMed and PEDro databases were both used for the study selection process. The terms “Trigger Points AND Gastrocnemius AND Soleus NOT Trapezius” were used and without a time restriction. From the 277 articles screened initially, 12 studies were selected to be included in this review. To assess the quality of the articles, the Jadad Scale and the U.S Preventive Task Force Scale were used. Results: The studies reviewed included healthy subjects as well as patients with disorders, or pain affecting specifically the foot and the ankle. In these studies, both active and latent trigger-points were found. Of all the variables used, the treatment of the MTrPs allows for an improvement in jump performance, quality of life, insomnia, Range of Motion (ROM) of ankle dorsiflexion, mobility, and reduced pain. However, the MTrP therapy has no effects on depression or anxiety. The principal treatments used were injections, electrostimulation, dry needling, ischemic compression, and Extra-Corporeal Shock Wave Therapy (ESWT). Conclusion: MTrPs can be the origin of several alterations. This review shows how the MTrPs treatment can improve those conditions. ISSN: 2469-5718 DOI: 10.23937/2469-5718/1510116 Simon et al. Int J Sports Exerc Med 2019, 5:116 • Page 2 of 7 • aim of this systematic review is to conduct a revision of scientific literature in order to identify which treatment is more effective, and the variables used to assess its effects on the subject ́s condition. Materials and Methods The bibliographic research was conducted using the following databases, MEDLINE and PEDro, inputting the following combination of words: “Trigger Points AND Gastrocnemius AND Soleus” and 418 articles were obtained. Based on title analysis of the first results, many articles were focused on the trapezius muscle. For this reason, the final search was narrowed down using the following combination of words: “Trigger Points AND Gastrocnemius AND Soleus NOT Trapezius”. In the selection of articles, the year of publication was not taken into consideration. Initially, 277 articles were eligible to be included in this revision. The articles were then narrowed down by the reviewers based on the study of the abstract, the title, the keywords and the inclusion criteria. Two independent reviewers made the first analysis, if a consensus was not reached, the opinion of a third reviewer was added. After the first analysis, 18 articles were selected. Finally, after their complete analysis using the full text, 12 of the selected were included in this revision and were studied in detail during in the assessment phase. Figure 1 represents the flowchart of the entire search process that was conducted until May 5th, 2018. The INCLUSION CRITERIA of the present study were: 1. Trials involving gastrocnemius’ MTrPs 2. Research that form part of the rehabilitation field. 3. Articles that can be obtained in full-text version and were published in one of the different languages spoken by the authors such as English, Spanish, Catalan, French, or Italian. With the aim to assess the quality of the different articles included in this revision, the authors used the Jadad Scale, if possible, and the U.S. Preventive Task Force, both of which are standard in this type of investigation. The 3-item scale of Jadad, et al. [13] was used to assess the quality of the clinical trial. Scale scores can range from 0 to 5 points, with higher scores indicating a better quality (Table 1). The standard approach to evaluating the quality of individual studies was based on a hierarchical grading system of research design, in which randomized control trials received the highest score (Table 2) [14,15].