Myoelectric Activity of Upper Trapezius Trigger Point
Condition: Trigger Point Pain, Myofascial
MeSH terms: Myofascial Pain Syndromes
Study type: Interventional

Summary: 
      Myofascial trigger points are a muscular dysfunction at the level of the motor end-plate and
      the sarcoplasmic reticula that, in turn, cause a local contraction with ischemia -induced
      hypoxia. Along with the hypoxia, the resulting energy crisis leads to a sensation of the
      surrounding nociceptors . Extracorporeal shock wave therapy (ESWT) is recently considered an
      effective treatment for myofascial pain syndrome. It's been proved an effective in
      musculoskeletal disease fasciitis

      . It is significant since it is a non-invasive and simple treatment, easy to apply at a large
      surface, and has fewer side effects with low intensity even if it requires relatively high
      cost, ESWT has been proved to be more effective than conventional ultrasound on MTrPs in the
      upper trapezius muscle and showed that ESWT is more effective

      . It has been found that three sessions of ESWT significantly improved pain levels, neck
      disabilities, and the quality of life by reducing the number of MTrPs .

      ESWT could reduce the pain of myofascial pain syndrome by pain signal alteration, promoting
      angiogenesis and increasing perfusion in ischemic tissues induced by sensitization of
      nociceptors and muscle ischemia.

      Ultrasound with deep heat is used in treatment of myofascial trigger point due to the
      properties of achieving vasodilation, accelerating the metabolism, increasing viscoelasticity
      and reducing pain and muscle spasm

      High power pain threshold ultrasound found to be effective in many literatures in treatment
      of myofascial trigger point

      . Study was performed comparing effect of high power pain threshold ultrasound with
      conventional ultrasound proved that high power pain threshold is more effective in treating
      upper trapezius myofascial It was found in the treatment of MPS, HPPT US therapy could be
      considered as a reliable and more effective and has positive effect method than low-dose and
      conventional US therapies

      This study will be presented as a part of ongoing study. The ongoing study investigates the
      effect of different intensities of ultrasound on upper trapezius trigger points. The current
      study will investigate the myoelectric activities of trigger points after application of high
      power pain threshold ultrasound
    

Detailed description: 
      Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal
      muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in
      combination with other pain generators Myofascial pain syndrome is represented by many
      clinical symptoms such as pain, hyperirritable nodule of spot tenderness, referred pain, and
      muscle spasm by trigger points. The upper trapezius is probably the muscle most often beset
      by trigger points It was assumed that the muscle fibers are shortened and taut bands are made
      by calcium influx in damaged fibers or acetylcholine secretion in motor end plates. The
      trigger points are the hyperirritable nodules of spot tenderness in a palpable taut band of
      skeletal muscle that may cause pain to a distant point and also causes distant motor and
      autonomic effects Once myofascial trigger points are activated, changes in the structural
      characteristics and contraction function of the muscle will occur. The most distinctive
      changes are taut bands, tender nodules, referred pain, local twitch response, muscle
      weakness, and restricted range of motion Patients with unilateral pain of an upper trapezius
      muscle exposed to a fatiguing load analyzed with surface electromyography (sEMG) were found
      to have a difference in sEMG response between healthy and symptomatic muscle Surface
      electromyography (EMG) analyzes functional changes in muscle by measuring quantitative
      changes in motor unit action potential that is activated by muscle contraction

      Surface EMG, which was used to evaluate the functionality of trigger points in this study, is
      nonintrusive and convenient; thus, it is widely used in studies on the functional
      characteristics of muscle, by analyzing the electrical activity of muscle Surface EMG
      recording fortrigger points shows changes in recruitment of fast-twitch muscle fibers and
      conduction velocity of motor unit action potential According to Gemmell and Bagust (2009) EMG
      recordings confirm increased spontaneous activity of motor units in patients with myofascial
      pain during the "resting state" of muscles.

      The treatments of myofascial pain are divided into the invasive and the non-invasive therapy.
      The invasive therapy is about the injection of medications, dry needling and non-invasive
      therapy refers to massage, stretching and ultrasound Extracorporeal shock wave therapy (ESWT)
      is recently considered an effective treatment for myofascial pain

      , It is a non-invasive and simple treatment, easy to apply at a large surface, and has fewer
      side effects with low intensity even if it requires relatively high cost.

      ESWT could reduce the pain of myofascial pain syndrome by pain signal alteration, promoting
      angiogenesis and increasing perfusion in ischemic tissues induced by sensitization of
      nociceptors and muscle ischemia .

      High power pain threshold ultrasound resolve acute active trigger points . High power-pain
      threshold ultrasound efficient method for relieving painand disability and increasing range
      of motion Although signiﬁcant in decreasing tissue stiffness Previous study, which is the
      ﬁrst to make a combined evaluation of the effectiveness of low-, moderate- and high dose
      (HPPT) US therapies in MPS, the results obtained considered signiﬁcantly in that greater
      improvements in clinical parameters were generally determined going from low dose to high
      dose and that the effect was achieved in only four sessions of HPPT US therapy. the cycle of
      pain-spasm-ischemia-pain is more effectively resolved when the dosage of US, applied for the
      treatment of trigger points in MPS, is increased the cycle of pain-spasm-ischemia-pain is
      more effectively resolved when the dosage of US, applied for the treatment of trigger points
      in MPS, is increased. Therefore, HPPT US therapy can be considered as a more economical
      treatment than conventional US treatments due to less number of treatment sessions.
    

Intervention name(s): extracorporeal shock wave and conventional treament; high pain threshold ultrasound and conventional treatment for myofascial pain syndrome trigger points; conventional treatment for myofascial pain trigger point
Intervention type(s): Device; Device; Other
Intervention description(s): Extracorporeal shock wave for 700 impulses of 0.056 mJ/mm at a frequency of 10 Hz to the taut band and 300 impulses surrounding the taut band will be applied as low energy 2 sessions per week for 2 weeks The will be used as a radial type of shock wave therapy.
Strengthening, stretching exercises and ischemic compression:
Isometric neck extensor exercise:
Isometric neck flexor exercise:
Isometric neck side bending muscle exercise:
Stretching exercise:
Passive stretching for the neck extensor muscles:
Passive stretching of the neck side-bending muscles:
Ischemic compression; will be applied in continuous mode, with the probe placed directly on the TrP and held motionless. To elicit threshold pain, the US probe will be kept static on the TrP. Intensity gradually will be increased to the level of maximum pain the patient could bear. It will be kept at that level for 3 to 4 seconds, then will be reduced to the half-intensity level for another 15 seconds. This procedure was repeated 3 times.the intensity of US will be dependent on the patient's level of pain. intensity will be applied in the range of 0.5 to 2.0 Watt per/cm2. Patients continually report their pain level and its localization and nature High-power pain threshold US will be applied 4 times, with a 3-day interval 2 sessions per week for 2 weeks .
1)Isometric neck extensor exercise2)Isometric neck flexor exercise3)Isometric neck side bending muscle exercise,Stretching exercise:Passive stretching for the neck extensor muscles ,stretching of the neck side-bending muscles,Ischemic compression; Strengthening, stretching exercises and ischemic compression:
Isometric neck extensor exercise:
Isometric neck flexor exercise:
Isometric neck side bending muscle exercise:
Stretching exercise:
Passive stretching for the neck extensor muscles:
Passive stretching of the neck side-bending muscles:
Ischemic compression
Other intervention name(s): extracorporeal shock wave; HPPT
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: sixty subjects from both genders with their age between 20 and 26 years old
Symptoms of active TrPs unilateral on at least one side of the upper fiber of trapezius muscle presence of at least one trigger point symptoms lasting from 0 to 2 weeks age
The patients will be randomly assigned into three different groups Group (A) will receive extracorporeal shock wave plus stretch, strength exercise and ischemic compression Group (B) will receive high-power pain threshold ultrasound plus stretch, strength exercise and ischemic compression Group (C) will receive conventional treatment (stretch, strength exercise and ischemic compression.
Masking: Single (Participant)
Primary purpose: Treatment