Ann Rehabil Med.  2021 Aug;45(4):284-293. 10.5535/arm.21018.

Combined Effects of Extracorporeal Shockwave Therapy and Integrated Neuromuscular Inhibition on Myofascial Trigger Points of Upper Trapezius: A Randomized Controlled Trial

• Mohamed DAA
• Kamal RM
• Gaber MM
• Aneis YM

• KMID: 2519635
• DOI: http://doi.org/10.5535/arm.21018

Abstract

Objective
To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius.
Methods
Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR).
Results
Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05).
Conclusion
Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

Keyword

Myofascial trigger point, Upper trapezius, Neurophysiological assessment, Extracorporeal shockwave therapy, Integrated neuromuscular inhibition

Figure

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  Fig. 1. Flow diagram of participants.

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  Fig. 2. (A) Pain intensity, (B) pressure pain threshold (PPT), (C) functional disability (ANDI), (D) sympathetic skin response (SSR) latency, and (E) neuromuscular junction response (CMAP) in the three groups pre- and post-intervention. VAS, visual analog scale; ANDI, Arabic neck disability index; CMAP, compound muscle action potential.

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