The effect of triggerpoint compression for acute low back pain

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low back pain

From a clinical perspective, myofascial trigger points certainly describe a phenomenon — aching spots, that seem to at least be partially helped by massage. The issue is that there is still uncertainty on the subject of triggerpoints (eg. what they are and the subjective nature of their identification) (Quniter et al. 2015).

To help provide some insight and perspective for therapists, I am working on compiling studies that look at the practical application of triggerpoint compression. Here is a study out of Japan that looks at the effects of compression at myofascial trigger points in patients with acute low back pain: Takamoto, K., Bito, I.,  Urakawa, S., Sakai, S., Kigawa, M., Ono, T., Nishijo, H. (2015). Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain 19, 1186–1196.

The effect of Triggerpoint compression for acute low back pain 

In this randomized controlled study published in the European Journal of Pain Takamoto et al. tested the effect of six consecutive treatments (three times per week for 2 weeks) of compression at myofascial triggerpoints in the low back. 63 patients with acute low back pain were randomly assigned to one of three groups:
• the MTrP group who received compression at MTrPs (N = 23)
• the non-MTrP group who received compression at non-trigger points (N = 21)
• the last group received superficial massage (N = 19)

Researchers in this study demonstrated that patients who received compression at myofascial triggerpoints exhibited a significant reduction in pain and an increase in range of motion compared to the control treatments. The mechanism by which compression at MTrPs alleviates local pain is not clear, there are a couple of proposed mechanisms of action that are discussed in relation to this study: 

  • Local compression improved blood flow: In a separate study researchers demonstrated that compression and its release improves localized blood flow, it is proposed that improved perfusion and oxygen delivery to the muscle, encourages the removal of cellular exudates and drainage of metabolic waste (Moraska et al., 2013).
     
  • An increase in parasympathetic activity: In a previous study, the same research group demonstrated an increase in parasympathetic activity following local compression of myofascial triggerpoints. This alteration within the autonomic nervous system result in changes to regional perfusion (Takamoto et al., 2009).

Keypoints

I would be remiss if I did not mention the value of an biopsychosocial model of health and illness. This model acknowledges that biological factors (i.e. anatomy, physiology, and neurophysiology), the psychological (i.e. thoughts, emotions, and behaviors) and social (i.e. work and playing status, culture, and religion) factors play a significant role in the experience and reduction of pain. With that in mind, this paper highlights the point that pain distribution from trigger points are a useful sign that helps clinicians investigate pain patterns, even if our explanations about what a triggerpoint is has changed. Furthermore, this paper demonstrates the role that massage therapists can play in the management of acute low back pain. 

References

Chen, Q., Wang, H., Gay, R. E., Thompson, J. M., Manduca, A., An, K., . . . Basford, J. R. (2016). Quantification of Myofascial Taut Bands. Archives of Physical Medicine and Rehabilitation. Archives of Physical Medicine and Rehabilitation.

Gerwin, R. (2016). Myofascial Trigger Point Pain Syndromes. Seminars in Neurology.

Grosman-Rimon, L., Parkinson, W., Upadhye, S., Clarke, H., Katz, J., Flannery, J., . . . Kumbhare, D. (2016). Circulating biomarkers in acute myofascial pain. Medicine.

Moraska, A.F., Hickner, R.C., Kohrt, W.M., Brewer, A. (2013). Changes in blood flow and cellular metabolism at a myofascial trigger point with trigger point release (ischemic compression): A proof-of-principle pilot study. Arch Phys Med Rehabil.

Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology.

Shah, J., Thaker, N., Heimur, J., Aredo, J., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. Pm&r.

Simons, D. G. (2008). New Views of Myofascial Trigger Points: Etiology and Diagnosis. Archives of Physical Medicine and Rehabilitation.

Takamoto, K., Bito, I.,  Urakawa, S., Sakai, S., Kigawa, M., Ono, T., Nishijo, H. (2015). Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain 19, 1186–1196.

Takamoto, K., Sakai, S., Hori, E., Urakawa, S., Umeno, K., Ono, T., Nishijo, H. (2009). Compression on trigger points in the leg muscle increases parasympathetic nervous activity based on heart rate variability. J Physiol Sci.