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DOI: 10.1055/s-0035-1564091
Review Triggerpunktbehandlung
Review Management of Trigger PointsPublication History
eingereicht: 22 July 2015
angenommen: 19 August 2015
Publication Date:
10 November 2015 (online)
![](https://www.thieme-connect.de/media/physmed/201505/lookinside/thumbnails/869_10-1055-s-0035-1564091-1.jpg)
Zusammenfassung
Schmerz durch Triggerpunkte wird im klinischen Alltag durch verschiedene Interventionen wie Sprühen und Dehnen, ischämische Kompression, postisometrische Relaxation und trockenes Nadeln behandelt. Da es keine Übereinkunft bezüglich des Nutzens und der Effektivität dieser unterschiedlichsten Interventionen gibt, wird in diesem Review die aktuelle Studienlage dargestellt. Es erfolgt die elektronische Suche von randomisierten, kontrollierten Studien in der Pubmed Bibliothek unter Ausschluss von Reviews oder Interventionsbezug ohne konkrete Umsetzung. Arbeiten bezüglich Sprühen und Dehnen sowie postisometrischer Relaxation konnten nicht eingeschlossen werden, es ergaben sich 14 relevante Studien zu ischämischer Kompression und trockenem Nadeln. Erfasst wurden u. a. epidemiologische Daten, Messparameter (Outcome), zugrunde liegende Messverfahren und deren Messzeitpunkte sowie das behandelte Areal. Bis auf eine Arbeit findet sich bei sämtlichen Studien nach Behandlung eine Verbesserung der Messparameter, was die grundsätzliche Wirksamkeit von ischämischer Kompression und trockenem Nadeln belegt. Die Heterogenität der Studien, die eine allgemeingültige Aussage über die Praktikabilität im klinischen Alltag erschwert, zeigt sich besonders in der Umsetzung der Therapie an sich. Weitere Studien, die sich vor allem am allgemeinen Konsens bezüglich Outcome orientieren, sollten für Sprühen und Dehnen und postisometrische Relaxation durchgeführt werden.
Abstract
Pain by myofascial triggerpoints is, in clinical practice, treated by different interventions such as spray and stretch, ischemic compression, postisometric relaxation and dry needling. Since there is no agreement about the effectiveness and sufficiency of these various treatments, this review showed the momentary status of studies. The research was performed in the electronic database pubmed, it determined randomised trials excluding reviews and a lack of specific intervention. No inclusion was possible to RCT`s with reference to spray and stretch and postisometric relaxation, while 14 studies of ischemic compression and dry needling were eligible and included. All but one RCT showed an improvement of outcome measures proving the fundamental effectiveness of ischemic compression and dry needling. Concerning the feasibility in clinical routine, the heterogneity in practice of intervention shows the difficulty to find a general conclusion. Regarding the methods of spray and stretch and postisometric relaxation, there is a need of further studies with an agreed set of measured outcomes.
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Literatur
- 1 Baldry PE. Acupuncture, triggerpoints and musculoskeletal pain. Edinburgh, UK: Churchill Livingstone; 2005
- 2 Baldry PE. Management of myofascial trigger point pain. Acupunct Med 2002; 20: 2-10
- 3 Bandy WD, Irion JM. The effect of time on static stretch on the flexibility of the hamstring muscles. Phys Ther 1994; 74: 845-850 discussion 850-852
- 4 Bandy WD, Irion JM, Briggler M. The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Phys Ther 1997; 77: 1090-1096
- 5 Barbagli P, Bollettin R, Ceccherelli F. Acupuncture (dry needle) versus neural therapy (local anesthesia) in the treatment of benign back pain. Immediate and long-term results. Minerva Med 2003; 94: 17-25
- 6 Buchmann J, Neustadt B, Buchmann-Bartel K et al. Objective measurement of tissue tension in myofascial trigger point areas before and during the administration of anesthesia with complete blocking of neuromuscular transmission. Clin J Pain 2014; 30: 191-198 DOI: 10.1097/AJP.0b013e3182971866.
- 7 Cagnie B, Dewitte V, Coppieters I et al. Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: a cohort study. J Manipulative Physiol Ther 2013; 36: 482-489 DOI: 10.1016/j.jmpt.2013.07.001.. Epub 2013 Aug 28
- 8 Couto C, de Souza IC, Torres IL et al Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: a randomized sham-controlled clinical trial. Clin J Pain 2014; 30: 214-223 DOI: 10.1097/AJP.0b013e3182934b8d.
- 9 Diracoğlu D, Vural M, Karan A et al. Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: a double-blind, randomized, placebo controlled study. J Back Muscoloskelet Rehabil 2012; 25: 285-290 DOI: 10.3233/BMR-2012-0338.
- 10 Fernández-de-Las-Peñas C. Alonso-Blanco The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: a pilot study Fernández-de-Las-Peñas et al 2006. J Bodywork Move Ther 2006; 10 pp 3-9
- 11 Fleckenstein J, Zaps D, Rüger LJ et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord 2010; 11: 32 Published online 2010 Feb 11 DOI: 10.1186/1471-2474-11-32. PMCID: PMC2836281
- 12 Fryer G, Hodgson L. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. Journal of Bodywork an Movement Therapies 2005; 9: 248-255
- 13 Ga H, Choi JH, Park CH et al. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. J Altern Complement Med 2007; 13: 617-624
- 14 Gunn CC, Milbrandt WE, Little AS et al. Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up. See comment in PubMed Commons below Spine (Phila PA 1976) 1980; 5: 279-291
- 15 Gulick DT, Palombaro K, Lattanzi JB. Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points. J Bodyw Mov Ther 2011; 15: 319-325 DOI: 10.1016/j.jbmt.2010.06.007.. Epub 2010 Jul 22
- 16 Hains G, Descarreaux M, Hains F. Chronic shoulder pain of myofascial origin: a randomized clinical trial using ischemic compression therapy. J Manipulative Physio Ther 2010; 33: 362-369 DOI: 10.1016/j.jmpt.2010.05.003.
- 17 Hains G. Chiropractic management of shoulder pain and dysfunction of myofascial origin using ischemic compression techniques. J Can Chiropr Assoc 2002; 46: 192-200 PMCID: PMC2504982
- 18 Han JS. Electroacupuncture: an alternative to antidepressants for treating affectivediseases?. Int J Neurosci 1986; 29: 79-92
- 19 Hanten WP, Olson SL, Butts NL et al. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther 2000; 80: 997-1003
- 20 Hou CR, Tsai LC, Cheng KF et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002; 83: 1406-1414
- 21 Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil 1994; 73: 256-263
- 22 Huang YT, Lin SY, Neoh CA et al. Dry needling for myofascial pain: prognostic factors. J Altern Complement Med 2011; 17: 755-762 DOI: 10.1089/acm.2010.0374.. Epub 2011 Jul 11
- 23 Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine 1993; 18: 1803-1807
- 24 Kannan P. Management of myofascial pain of upper trapezius: a three group comparison study. Glob J Health Sci 2012; 4: 46-52 DOI: 10.5539/gjhs.v4n5p46.
- 25 Kostopoulos D, Rizopoulos K. Effect of topical aerosol skin refrigerant (spray and stretch technique) on passive and active stretching. J Bodyw Mov Ther 2008; 12: 96-104 DOI: 10.1016/j.jbmt.2007.11.005.. Epub 2008 Jan 2
- 26 Lewit K. The needle effect in the relief of myofascial pain. Pain 1979; 6: 83-90
- 27 Lewit K, Simons DG. Myofascial pain: relief by post-isometric relaxation. Arch Phys Med Rehabil 1984; 65: 452-456
- 28 Lewit K. Manipulative therapy in rehabilitation oft he locomotor system. 2nd edn. Oxford: Butterworth Heinemann; 1991
- 29 Lin JG, Chen WL. Acupuncture analgesia: a review of its mechanisms of actions. American Journal of Chinese Medicine 2008; 36: 635-645
- 30 Macdonald AJ, Macrae KD, Master BR et al. Superficial acupuncture in the relief of chronic low back pain. Ann R Coll Surg Engl 1983; 65: 44-46
- 31 Maher RM, Hayes DM, Shinohara M. Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elastography. Arch Phys Med Rehabil 2013; 94: 2146-2150 DOI: 10.1016/j.apmr.2013.04.021.. Epub 2013 May 14
- 32 Mense S. Differences between myofascial trigger points and tender points. Schmerz 2011; 25: 93-103 quiz 104 DOI: 10.1007/s00482-010-0965-4.
- 33 Mejuto-Vázquez MJ, Salom-Moreno J, Ortega-Stantiago R et al. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44: 252-260 DOI: 10.2519/jospt.2014.5108.. Epub 2014 Feb 25
- 34 Khayatzadeh MM, Rostami HR, Amirsalari S et al. Investigation of quality of life in mothers of children with cerebral palsy in Iran: association with socio-economic status,marital satisfaction and fatigue. Disabil Rehabil 2013; 35: 803-808 DOI: 10.3109/09638288.2012.708818.. Epub 2012 Aug 20
- 35 Oliveira-Campelo NM, de Melo CA, Slburquerque-SendÍn F et al. Short- and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: a randomized controlled trial. J Manipulative Physiol Ther 2013; 36: 300-309 DOI: 10.1016/j.jmpt.2013.04.008.. Epub 2013 Jun 12
- 36 Rayegani SM, Bayat M, Bahrami MH et al. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clin Rheumatol 2014; 33: 859-864 DOI: 10.1007/s10067-013-2448-3.. Epub 2013 Dec 19
- 37 Reitinger A, Radner H, Tilscher H et al. Morphologische Untersuchung an Triggerpunkten. Man Med 1996; 34: 256-262
- 38 Ruiz-Sáez M, Fernández-de-Las-Peñas C, Blanco CR et al. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. J Manipulative Physiol Ther 2007; 30: 578-583
- 39 Simons DG. Myofascial pain syndrome: one term but two concepts: a new understanding [Editorial]. J Musculoskel Pain 1995; 3: 7
- 40 Simons DG. Clinical and Etiological Update of Myofascial Pain from Trigger Points. Journal of Musculoskeletal Pain 1996; 4: 93-122 DOI: 10.1300/J094v04n01_07.
- 41 Simons DG, Travell J, Simons LE. Myofascial pain and dysfunction: the trigger point manual. 2nd ed. Baltimore, MD: Williams and Wilkins; 1999
- 42 Simons DG, Mense S. Diagnose und Therapie myofaszialer Triggerpunkte. Der Schmerz 2003; 17: 419-424
- 43 Srbely JZ, Dickey JP, Lee D et al. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med 2010; 42: 463-468 DOI: 10.2340/16501977-0535.
- 44 Tekin L, Akarsu S, Durmuş O et al. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. 2013; 32: 309-315 DOI: 10.1007/s10067-012-2112-3. Epub 2012 Nov 9
- 45 Vanderweeën L, Oostendorp RA, Vaes P et al. Pressure algometry in manual therapy. Man Ther 1996; 1: 258-265
- 46 Ziaieifar M, Arab AM, Karimi N et al. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. J Bodyw Mov Ther 2014; 18: 298-305 DOI: 10.1016/j.jbmt.2013.11.004.. Epub 2013 Nov 9
- 47 Zugasti Martín-Pintado A, Rodríguez-Fernández AL, García Muro F et al. Arch Phys Med Rehabil 2014; 95: 1925.e1-1932.el DOI: 10.1016/j.apmr.2014.05.021. Epub 2014 Jun 10