Effects of the Combined Treatment of Extracorporeal Shock Wave Therapy (ESWT) and Stabilization Exercises on Pain and Functions of Patients with Myofascial Pain Syndrome

Abstract

Abstract. [Purpose] In order to develop a more effective treatment method for pain and function in myofascial pain syndrome, we examined the effects of ESWT, stability exercises, and combined treatment.[Subjects] The subjects were randomly divided into a stabilization exercise group (n=12), an ESWT (Extracorporeal Shock Wave Therapy) group (n=12), and a combined treatment group (n=12).[Methods] The stabilization exercise group performed shoulder joint stabilization exercises. The ESWT group received ESWT for the upper trapezius. The combined treatment group received a combined treatment of shoulder joint stabilization exercises and ESWT. Pain and function were measured using the visual analog scale (VAS), pressure pain threshold (PPT), neck disability index (NDI), and the Constant Murley Scale (CMS).[Results] The VAS Score showed statistically significant improvements in all of the groups. All of the CMS evaluation items except muscle strength in the stabilization exercise group, and all of the CMS items in the ESWT group and the combined treatment group, exhibited statistically significant improvements. The combined treatment group of ESWT and stabilization exercises showed statistically significant improvements in all VAS of CMS evaluation items, and the NDI test after the four-week intervention.[Conclusion] The combined treatment was more effective at reducing pain than ESWT, and stabilization exercise would be useful for physical therapists treating myofascial pain syndrome in a clinical setting.

High-Energy Flux Density Extracorporeal Shock Wave Therapy Versus Traditional Physical Therapy Modalities in Myofascial Pain Syndrome: A Randomized-controlled, Single-Blind Trial

“…53,54 Of note, H-ESWT may cause side effects such as permanent tendon damage, whereas low-EFD ESTW (L-ESWT) has a lower therapeutic effect. 55 In our study, none of the patients experienced such side effects.…”

“…Similarly, Ji et al 23 used focused L-ESWT for four sessions in MPS patients and found ESWT to be an effective therapeutic modality with reduced VAS scores and pain threshold (PT). In another study, Cho et al 55 used combined therapy as radial L-ESWT for 12 sessions and stabilization shoulder exercise and found greater improvements in pain and functional scores with combined therapy. In addition, Gur et al 21 used focused H-ESWT and compared three sessions with a single session of therapy.…”

Update of Extracorporeal Shockwave Therapy in Myofascial Pain Syndrome

“…Most research in shockwave therapy has focused on understanding the mechanism which results in the establishment of a mechano-sensitive feedback loop between the acoustic impulse and the stimulated cells, and involves specific transduction pathways and gene expression. Taking as valid the Energy Crisis Hypothesis, and considering the mechano-transduction effect of ESWT in other diseases [9][10][11][12][13][14][24][25][26][27][28][29] it could be posited that ESWT in MPS may increase perfusion, promote angiogenesis and alter the pain signaling in ischemic tissues caused by the influx of calcium. On the other hand, recent articles have demonstrated that free nerve endings degenerate after the application of ESWT, and that ESWT produces a transient dysfunction of nerve excitability at the neuromuscular junction, [9][10][11][12][13][14][24][25][26][27][28][29] by bringing about the degeneration of AChR.…”

“…And finally, following a pure mechanistic approach, shockwaves might be able to break-up the Actin-Myosin links, as they are propagating perpendicularly to the sarcomere contractions. [9][10][11][12][13][14][24][25][26][27][28][29] There are evidences of the efficacy of Extracorporeal Shockwave Treatment on Myofascial Pain Syndrome as in the Table 1. Müller-Ehrenberget et al 24 revealed the efficacy of focused ESWT on MPS (Piezoelectric device: Piezo Son100) for alleviating pain in 95% of the 30 patients at 3 months, (800 impulses of energy level:0.04-0.26 mJ/mm2;6 Hz; average 7 treatments, 2 sessions per week) 24 Jeon et al 25 demonstrated that 3 sessions of 1500 pulses of low energy (0.10 mJ/ mm2 ) with focused ESWT (Electrohydraulic: Evotron RFL0300) weekly is as effective as TENS and TP injection on 30 patients with MPS in trapezius muscle, measuring the results in terms of pain (visual analog scale e VAS e and McGill Pain Questionnaire), as well as on the Roles and Maudsley scale.…”

“…They treated at taut band (700 impulses) and the surrounding area (300 impulses) at energy levels of 0.056 mJ/mm2, with 2 sessions per week for 2 weeks. 26 Cho et al 27 found that multimodal therapy, combining ESWT with shoulder exercises, demonstrating pain reduction and functional recovery. 27 Moghtaderi et al 28 concluded that using fESWT (Duolith SD1) for both regions (3000 impulses of energy level: 0.2 mJ/mm 2 at plantar fascia and 400 impulses of energy level: 0.2 mJ/mm 2 at gastrocsoleus) is more effective than treating only 3000 impulses of energy level: 0.2 mJ/mm 2 at plantar fascia in plantar fasciitis.…”