Effects of myofascial techniques on trigger points of the upper trapezius muscle – a literature review

Uvod: Miofascialne prožilne točke so prekomerno vzdražena mesta v skeletni mišici. Kažejo se kot napet snop mišice, občutljiva tipna zatrdlina v napetem snopu mišice, tipen ali viden lokalni odziv na tipanje, prenesena bolečina in lokalno zmanjšan obseg giba. Delimo jih na aktivne in latentne. Vzrok za nastanek so lahko večje ali ponavljajoče manjše poškodbe, ki so posledica pretirane rabe, preobremenitve ali psihičnega stresa. Prožilne točke so pogosto prisotne v mišici trapezius. Obravnavamo jih lahko z različnimi fizioterapevtskimi tehnikami, med drugim tudi z miofascialnimi tehnikami, ki so cenejše in imajo manj stranskih učinkov. Namen: Predstaviti učinkovitost različnih miofascialnih tehnik pri obravnavi prožilnih točk v zgornjih snopih mišice trapezius na podlagi pregleda literature. Metode dela: Pregled literature po podatkovnih zbirkah PEDro, PubMed, ScienceDirect, DOAJ, MEDLINE, CINAHL, ELSEVIER. Vključili smo randomizirane kontrolirane raziskave v angleškem jeziku, v katerih so proučevali učinek miofascialnih tehnik na prožilne točke v zgornjih snopih mišice trapezius, in so bile objavljene od leta 2010 naprej. Rezultati: V pregled literature je bilo vključenih devet raziskav. Primerjani so bili učinki ishemične kompresije, mišičnoenergetske tehnike, položajno sprostitvene terapije in kombinacije naštetih ter učinki pasivnega raztega in sklepne mobilizacije s primerjalnimi skupinami brez terapije ali z lažno (placebo) obravnavo. Za merjenje učinkov so bili uporabljeni ocena bolečine, meritve praga bolečine s pritiskom, meritve gibljivosti vratne hrbtenice in Indeks zmanjšane zmožnosti zaradi težav z vratno hrbtenico. Ishemična kompresija je preiskovancem zvišala prag bolečine s pritiskom in izboljšala gibljivost vratne hrbtenice. Ta učinek je ostal še en teden po terapiji. Po obravnavi z mišičnoenergetskimi tehnikami se je preiskovancem zvišal prag bolečine s pritiskom in obseg kontralateralne fleksije, po obravnavi s položajno sprostitveno terapijo se je zmanjšala bolečina in zvišal prag bolečine s pritiskom. Učinek na zmanjšanje bolečine, povečanje obsega lateralne fleksije in izboljšanje rezultata Indeksa zmanjšane zmožnosti zaradi težav z vratno hrbtenico je imela kombinacija ishemične kompresije, mišičnoenergetskih tehnik in položajno sprostitvene terapije. Učinkovit postopek za povišanje praga bolečine s pritiskom in povečanje kontralateralne fleksije je bila sklepna mobilizacija. Razprava in zaključek: Z analizo vključenih člankov smo ugotovili, da so pri obravnavi prožilnih točk učinkovite vse tehnike. Za najučinkovitejšo tehniko se je izkazala ishemična kompresija, ki ima tudi najdolgotrajnejši učinek. Za druge tehnike bi bilo smiselno narediti več raziskav, v katerih bi ugotavljali takojšnje in dolgotrajne učinke miofascialnih tehnik.Introduction: Myofascial trigger points are hyperirritable spots in skeletal muscles. They are identified as a taut band, a hypersensitive palpable nodule of a taut band, a palpable or visible local response, referred pain or a local restriction of range of motion. Myofascial trgger points, clinically classified as active and latent, may be a result of macrotrauma or repeated microtrauma, such as overuse, overload or psychical stress. They are often present in the trapezius muscle. We can treat them with many physiotherapy interventions, including myofascial techniques, which are cheaper and have fewer side effects. Purpose: The purpose of this literature review is to portray the effectiveness of different myofascial techniques on the myofascial trigger points of the upper trapezius muscle. Methods: The articles used in the paper were found in the following databases: PEDro, PubMed, ScienceDirect, DOAJ, MEDLINE, CINAHL, ELSEVIER. We included randomized controlled trials in English language, published in 2010 or later and investigating the effects of different myofascial techniques on myofascial trigger points of the upper trapezius muscle. Results: There are nine articles included in the literature review dealing with the effects of ischemic compression, Muscle-Energetic Technique, Positional Release Therapy, the combination of the three techniques mentioned, passive stretch and joint mobilization with control groups without therapy or sham treatment. Effectiveness of myofascial techniques was assessed with Visual Analogue Scale, measures of Pressure Pain Threshold, measures of cervical spine range of motion and assessment on Neck Disability Index. In the group that received ischemic compression, there was an increase in pressure pain threshold and improvement in cervical spine range of motion, especially in contralateral flexion. This effect persisted one week after the treatment. Subjects who received Muscle-Energetic Technique had an increase in pressure pain threshold and improvement of contralateral flexion, whereas in groups with Positional Release Therapy, there was a decrease in pain intensity and increase of Pressure Pain Threshold. There was also a decrease in pain intensity, improvement in lateral flexion and better results in Neck Disability Index in subjects who received a combination of ischemic compression, Muscle-Energetic Technique and Positional Release Therapy. In addition, cervical mobilization showed improvement in PPT and contralateral flexion. Discussion and conclusion: We analysed all studies and determined that all techniques are effective for treating myofascial trigger points. The most effective technique is ischemic compression, which also has the longest-lasting effect. It would be reasonable to conduct more studies for other techniques, determining long-lasting effects of myofascial techniques