Myofascial Triggerpoint Release: Can Massage Help Chronic Shoulder Pain?

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Manual technique provides long-lasting pain relief and improves muscle function.
Manual technique provides long-lasting pain relief and improves muscle function.

Myofascial triggerpoint release (MTR) is an effective technique for reducing chronic shoulder pain, according to a study published in the Journal of Bodywork & Movement Therapies.1

Researchers found that four, 10-minute MTR sessions over a 2-week period significantly decreased mean scores on the Brief Pain Inventory (2.26 ± 1.84 vs baseline, 6.0 ± 1.51; P < .0001), an effect that was sustained after 4 weeks (1.64 ± 1.84, P < .0001) and 13 months (0.6 ± 1.84; P = .051), respectively.

Commonly used to treat low back pain, MTR is a manual technique used to stimulate various mechanoreceptors and deactivate active trigger points in affected tissues, lead author Christopher-Marc Gordon, PT, hcpc UK, HP, from the Center for Integrative Therapy in Stuttgart, Germany, told Clinical Pain Advisor.

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"[Though] relatively easy to teach and learn and highly effective, few doctors use techniques like [MTR]" Dr Gordon stated, noting that the method is mainly used by physical therapists and chiropractors to increase range of movement and reduce pain.

According to the authors, shoulder pain is the third most common musculoskeletal disorder in primary care consultations — and one of the major reasons patients schedule an appointment. Trapezius muscle trigger points can also cause other symptoms, such as headaches, through referred pain.2

"Clinicians should learn this 10-minute MTR method to treat their patients," Dr Gordon emphasized.

Improved Muscle Function, Quality of Life

In the study, researchers included 23 patients with chronic shoulder pain of at least 3 months' duration. Participants were treated with MTR at the 3 most sensitive sites on the upper trapezius muscle.

Myometer readings revealed that MTR significantly improved muscle stiffness (P = .012) and elasticity (P = .001) on the treated side, but not the untreated side.

The findings indicate that MTR therapy may be helpful in improving shoulder mobility and inducing reorganization of healthy muscle functioning, the authors write, noting that MTR may be beneficial for disorders associated with loss of muscle strength.

MTR was also linked to significant improvements in algometer-measured pressure-pain threshold and depth on both the treated and untreated side (P = .001 for both). According to the authors, this effect could be due to altered neural signal transmission at the spinal cord level and/or activation of the descending pain modulatory network.

Secondary outcome measures for the intervention included self-reported levels of suffering, stress, and quality of life — all of which showed statistically significant improvement after MTR.

"The fascia — which encloses all muscles — is very well innervated with sensory nerve endings, so if the tissue is cramped, adhesive triggerpoint activity can be high [and] patients are likely to succumb to greater pain and stress,"Dr Gordon explained.

"Myofascial release helps to restore proper self-regulation to this pathology," Dr Gordon said, adding that the technique is most likely to benefit patients with non-inflammatory pathology, such as those with rotator cuff lesions or having multiple triggerpoint sites in the shoulder girdle.

Although disparaging the findings as “nothing new,” Thomas K. Bond, MD, MS, told Clinical Pain Advisor that the study gives "further credit" to the presence and interaction of the fascia as a main component of the biotensegrity model.

Dr Bond, an orthopedic and musculoskeletal pain specialist, is president-elect of the American Association of Orthopedic Medicine, and was not involved in the study.

Larger, controlled studies are needed to replicate these findings, the authors conclude.

The study was funded by patient donations. The authors report no conflicts of interest.

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