Effectiveness of physical therapy on the treatment of myofascial trigger points in individuals with cervicalgia: a single-blind randomized clinical trial

Author(s)

Almir Vieira Dibai Filho

• Document type: Doctoral Thesis
• Press: Ribeirão Preto.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina de Ribeirão Preto
• Defense date: 16 fev. 2016

Examining board members

Rinaldo Roberto de Jesus Guirro; Thais Cristina Chaves; Fabiola Dach Éckeli; Ana Beatriz de Oliveira

• Advisor: Rinaldo Roberto de Jesus Guirro

Abstract

Although the scientific literature has presented recent studies focusing on different physical therapy approaches to the treatment of myofascial trigger points in individuals with cervicalgia, some of the resources that are still used in the clinical practice of physical therapy are done so without due scientific basis. Therefore, the objective of the present study was to evaluate the use of static ultrasound and diadynamic currents on myofascial trigger points together with a manual therapy program to treat individuals with cervicalgia. For such, we selected sixty volunteers of both genders between the ages of 18 and 45 years, with chronic cervicalgia and the presence of bilateral active myofascial trigger points on the upper trapezius. Thus, individuals were randomly allocated into one of three groups, with twenty participants each: Group 1 (manual therapy), Group 2 (manual therapy + static ultrasound) or Group 3 (manual therapy + diadynamic currents). The volunteers were submitted to ten treatment sessions, consisting of two weekly sessions for five weeks, and were assessed at four points: before the treatment sessions, 48 hours after the first physical therapy session, after ten treatment sessions, and four weeks after the last session. As measuring instruments, we employed the Pain Numeric Rating Scale, the Neck Disability Index, algometry, the Pain Related Self-Statement Scale, fleximetry, infrared thermography and surface electromyography. In our analysis over time, we observed a significant reduction in pain intensity, disability and catastrophizing, and a significant increase in pressure pain threshold in the three groups (p < 0.05). Groups 2 and 3 showed a significant increase in flexion range of motion, left and right rotation, and a significant reduction in skin temperature on the left after implementing the physical therapy resources (p < 0.05). Furthermore, only Group 2 presented a significant improvement in right lateral tilt range of motion and a significant reduction in skin temperature on the right (p < 0.05). There was no group-versus-time interaction for pain intensity, disability, catastrophizing, pressure pain threshold, cervical range of motion, and skin temperature (F-value range: 0.089-1.961, p-value range: 0.106-0.977). Moreover, we found no differences between groups regarding electromyographic activity (p > 0.05). In conclusion, the use of static ultrasound or diadynamic currents on myofascial trigger points on the upper trapezius in association with a manual therapy program does not generate greater benefits than a manual therapy program alone among individuals with chronic neck pain. (AU)

• FAPESP's process: 13/09753-1 - Effectiveness of physiotherapeutic resources in the treatment of myofascial trigger points in patients with neck pain: blinded randomized clinical trial
• Grantee: Almir Vieira Dibai Filho
• Support type: Scholarships in Brazil - Doctorate