The role of generalized muscule hyperfacilitation in pathogenesis and clinical picture of myofascial pain syndrome. Possible option of its correction
Authors: Boldin A. V. , Agasarov L. G. , Tardov M. V. , Bokova I. A. 
Published: February 2020

Introduction. Psychoemotional stress contributes to the increase of the muscle tone and the development of general muscle hyperfacilitation. This in turn makes the diagnostics by manual muscle testing impossible and complicates the course of myofascial pain syndrome, which explains the interest of practitioners in methods of its correction. However, possible methods of correction described in literature do not always lead to the desired result, which is the cause of the further search for solutions to this problem. The goal of research — was to determine the clinical effi cacy of Bach remedies selected with the help of vegetative resonance testing and manual muscle testing in treatment of patients with myofascial pain syndrome against the background of generalized hyperfacilitation.Materials and methods. A prospective, controlled, randomized trial was conducted in the period from January to December 2018 at the Department of Restorative Medicine, Rehabilitation and Balneology at the Sechenov First Moscow State Medical University. The work is based on the results of observation and treatment of 60 patients aged 21 to 65 years. Before and after the treatment practitioners performed osteopathic diagnostics, manual muscle testing according to the methodology, used in applied kinesiology. Assessment of psychological status was carried out using the Spielberger–Khanin test and Well-being-activity-mood questionnaire (WAM questionnaire). The level of pain manifestation was assessed with the use of the visual analogue scale (VAS). All patients were divided into two statistically comparable groups of 30 people using the method of simple randomization. Patients of both groups underwent osteopathic correction of dysfunctions with a frequency of one time per week, only 3–5 sessions. Patients of the 1st group, in addition to osteopathic treatment, underwent therapy with individually selected Bach remedies.Results. In all patients of the 1st group, generalized muscle hyperfacilitation regressed already by the 2nd–3rd procedure, while in the 2nd group it was eliminated only by the 4th procedure in 12 (40%) patients, and in the remaining patients it stopped only by the end of the course. The study of the regression of myofascial pain syndrome showed a difference in the rate of occurrence of the analgesic effect in the groups. So, patients of the 1st group experienced a persistent antinociceptive effect after the 2nd procedure, and in the 2nd group a similar effect was noted only by the 4th–5th session. In patients of the 1st group, the severity of pain after treatment averaged 10,4±4,5 points according to VAS, in patients of the 2nd group it averaged 20,3±4,3 points (p<0,01). The results of psychological testing according to the Spielberger–Khanin questionnaire also revealed a positive dynamics in the psychoemotional state of patients of both groups. After treatment, in 27 (90 %) patients of the 1st group, the results of the test showed the norm (<30 points), while in the 2nd group the test showed the norm only in 19 (63,3 %) patients. A comparative analysis of the results of psychological testing by the WAM method, performed at the end of the treatment, showed a positive dynamics in the psychoemotional state (categories of well-being, activity, mood) in patients of both groups, but in the 1st group the changes were more pronounced (p=0,05). It should be noted that only in patients of the 1st group this indicator was in the range of 5–5,5 points after the treatment, which corresponds to the norm criteria for this questionnaire.Conclusion. The use of Bach remedies individually selected with the help of manual muscle testing and the vegetative resonance testing helps to increase the effectiveness of the treatment of myofascial pain syndrome in patients with generalized muscle hyperfacilitation formed against the background of the chronic stress.