Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: a report of 115 cases

Abstract

[Purpose] Ineffective and prolonged treatment of low back pain is a major social problem resulting in a huge economic burden. The effectiveness of back pain and/or leg pain treatment using active soft tissue release alone or in combination with a trigger point block was examined. [Participants and Methods] Among 115 patients who underwent medical examination at Senshunkai Hospital during the study period, information on treatment outcomes using active soft tissue release alone or in combination with a trigger point block, location of myofascial trigger points, and duration of treatment were extracted for patients with low back pain, leg pain, or low back pain with leg pain. [Results] Myofascial pain syndrome was diagnosed in 73.4% (36/49) in the low back pain group, 50% (16/32) in the leg pain group, and 85.3% (29/34) in the low back pain with leg pain group. Symptom improvement was noted in all three groups with active soft tissue release alone (90.9%, 20/22; 90.0%, 9/10; and 100%, 14/14, respectively) and active soft tissue release + a trigger point block (90.9%, 10/11; 100%, 1/1; and 92.9%, 13/14, respectively). The gluteus medius was the major myofascial trigger point in all groups. [Conclusion] Manual therapy with active soft tissue release and a trigger point block constitutes an effective treatment combination for low back pain and leg pain, but prolonged treatment is required in chronic cases.

Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review

“…Low back pain is defined as pain extending from the lowest rib to the gluteal groove. Nevertheless, GMedS is often complicated with MPS of the multifidus or quadratus lumborum or other muscles 11,20) . Usually pain is not limited to the affected region in the GMed or simple low back pain in GMedS or GTPS.…”

“…GMed contraction evaluated using ultrasound was significantly decreased in a low back pain group 99) . GMed is significantly associated with back pain 93) , and is the most commonly involved muscle in back pain and low back pain 11,12) . 42) Patients with LBP (n=100) 35% were diagnosed as TB/GTPS Collée G et al 43) Patients with LBP (n=40, 124, 40) 18-45% were diagnosed with GTPS Kingzett-Taylor A. et al 44) Patients with buttock, lateral hip, and groin pain (n=250)…”

“…About 30% of cases of leg pain are reported to be GMedS and 50% of GMedS cases present with leg pain 11) . While 77.7% of GTPS is complicated by leg pain 50) , 44.2% of trochanteric bursitis involved leg pain radiating around the knee 25) .…”

“…The term "gluteus medius syndrome (GMedS)" appeared in several reports [8][9][10][11] as the gluteus medius (GMed) was identified as the muscle most commonly associated with low back pain or leg pain and the diagnosis of myofascial pain syndrome (MPS) 11,12) . MPS is simply defined as pain accompanied by confirmation of pain trigger points in specific muscles 13,14) .…”

“…The prevalence of MPS within the context of chronic back pain or non-specific back pain is about 70-90% 11,19,20) , while the prevalence of myofascial trigger points (MTrPs) in GMed namely GMedS within the context of chronic low back pain or nonspecific low back pain is about 38-68% 11,20,21) . GMedS is treated by physiotherapy, manual trigger point therapy, or trigger point block injection 10,11,22) , and in difficult cases by surgical decompression of the GMed or the cluneal nerve 10,23) .…”