# Acute Effect of a Single Functional Neurology Intervention on Muscular Trigger Point
## 4 Discussion
A previous meta-analysis showed that manual therapy could effectively reduce pain and improve function in patients with MTrPs, but these techniques often require multiple sessions to achieve significant results [38]. Another study comparing three manual therapy techniques found similar results, indicating the necessity of repeated treatments over an extended period to maintain pain relief and functional improvements [39]. In this line, non-invasive brain stimulation (NIBS) techniques like transcranial direct current stimulation (tDCS) have shown positive effects on motor function, but these often require multiple sessions to achieve significant results. A study demonstrated that gait performance in sub-acute stroke patients improved with bi-cephalic tDCS, but consistent application was necessary to maintain these benefits [40]. Similarly, traditional physiotherapy approaches, such as motor relearning programs or proprioceptive neuromuscular facilitation, usually demand extensive, repeated sessions over several weeks to observe significant improvements in mobility and function [41]. While effective, these approaches require greater time commitment from patients. Regarding pharmacological treatments, including trigger point injections and oral medications, these are also employed for MTrP management. It was found that trigger point injections significantly reduced pain scores compared to medical management alone. However, these injections are invasive and carry risks of side effects such as infection and bleeding [42]. Oral medications, such as NSAIDs or muscle relaxants, can provide temporary relief but often come with gastrointestinal side effects and do not address the underlying neuromuscular dysfunction. Also, medications like NSAIDs or opioids, commonly used for pain relief, can lead to gastrointestinal issues, dependency, or other systemic effects. Moreover, these treatments do not address the underlying neurological dysfunctions contributing to pain, potentially limiting their long-term efficacy [43]. The thermographic results indicate an increase in skin temperature following the functional neurology intervention, which suggests an improvement in blood flow to the affected area [44]. This increase in temperature can be attributed to enhanced vasodilation and metabolic activity, leading to better oxygen and nutrient delivery to the tissues, which is crucial for the healing process. Improved blood flow, or hyperemia, to contract skeletal muscles during interventions is a well-documented physiological response. This process is crucial for delivering oxygen and removing metabolic waste products from the muscle tissue [45]. In the context of MTrPs, these areas often exhibit restricted blood flow due to sustained muscle contractions and local ischemia [30]. This restricted blood flow and sustained muscle contractions lead to focal ischemia, perpetuating the pain cycle. It was described how when capillary circulation is restricted, as seen in sustained low-level contractions, the normal physiological processes come to a standstill, exacerbating local tissue hypoxia and inflammation [46]. The MTrPs are localized contraction knots that form due to muscle overuse or trauma, resulting in compromised local muscle fiber circulation [47]. This compromised circulation further contributes to the development of ischemia and pain. Functional neurology interventions likely enhance neuromuscular control, leading to relaxation of the muscle fibers and subsequent improvement in local blood circulation. This mechanism is supported by the increase in skin temperature observed through thermography, indicating a reversal of the localized hypoperfusion commonly seen in MTrPs [48]. Traditional methods such as dry seedling and thermotherapy also aim to improve blood flow and reduce pain in MTrPs. Dry needing involves the insertion of fine needles into the muscle to provoke a twitch response, which can help break the cycle of muscle spasm and pain [49]. However, this technique is invasive and may not be suitable for all patients.