Perbandingan Antara Muscle Energy Technique Dengan Static Stretching Terhadap Nyeri Myofascial Pain Syndrome Musculus Upper Trapezius Pada Pekerja Batik Tulis Di Industri Batik Danar Hadi Surakarta

Background: In the process of making batik, neck muscles of batik tulis’s worker was work in undergo static to preserve the head position in forward head posture. One of the problem that appear is myofascial pain syndrome musculus (m.) upper trapezius. Purpose:To determine the effect and difference of muscle energy technique (MET) and static stretching on pain in myofascial pain syndrome m. upper trapezius. Method: This study used a quasi-experimental method with two group pre test and post test design. Samples were taken by purposive sampling technique as much as 32 respondents. Data tested by paired sample t-test and independent sample t-test. Result: This study used a measuring instrument of pain visual analog scale (VAS). Based on paired sample t-test. The results in group I (MET) values of significance (p) = 0.000 (p <0.05) and group II (static stretching) value of p = 0.000 (p <0.05) means MET treatment and static stretching effect on myofascial pain syndrome m. upper trapezius. In independent sample t-test showed the value of p = 0.015 (p <0.05), which means there are differences in group I and group II. Conclusion: There is influence of MET to reduce pain on myofascial pain syndrome m. upper trapezius, there is influence of static stretching to reduce pain on myofascial pain syndrome m. upper trapezius and there is difference effects of MET and static stretching to reduce painon myofascial pain syndrome m. upper trapezius. MET better in reducing myofascial pain syndrome m. upper trapezius than static stretching. Keyword:Muscle Energy Technique, Static Stretching, Myofascial Pain Syndrome Musculus Upper Trapeziu

Myofascial Trigger Points in Children With Tension-Type Headache: A New Diagnostic and Therapeutic Option

The goal of this pilot study was to evaluate the effect of a trigger point–specific physiotherapy on headache frequency, intensity, and duration in children with episodic or chronic tension-type headache. Patients were recruited from the special headache outpatient clinic. A total of 9 girls (mean age 13.1 years; range, 5-15 years) with the diagnosis of tension-type headache participated in the pilot study from May to September 2006 and received trigger point–specific physiotherapy twice a week by a trained physiotherapist. After an average number of 6.5 therapeutic sessions, the headache frequency had been reduced by 67.7%, intensity by 74.3%, and duration by 77.3%. No side effects were noted during the treatment. These preliminary findings suggest a role for active trigger points in children with tension-type headache. Trigger point–specific physiotherapy seems to be an effective therapy in these children. Further prospective and controlled studies in a larger cohort are warranted

Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP

Fibromyalgia: A Unifying Neuroendocrinologic Model for Understanding Its Pathophysiology

Fibromyalgia is believed to affect at least 2% of the population. Despite advances in the scientific understanding of the derangements of central and peripheral pain processing mechanisms in fibromyalgia, no current models of its pathophysiology account for the other clinical conditions associated with it such as fatigue, migraine headache, irritable bowel syndrome, and sleep cycle abnormalities. A neuroendocrinologic model of fibromyalgia is presented that accommodates both its known central and peripheral pain mechanisms as well as the myriad of hormonal, visceral, and psychological symptoms associated with that disorder. This model also provides a unifying pathophysiologic basis of fibromyalgia and chronic muscle pain, and offers the potential for developing new avenues of research and treatment for these enigmatic, frequently disabling medical conditions

Pengaruh Kombinasi Transcutaneous Electrical Nerve Stimulation (TENS) dan Teknik Ischemic Compression Terhadap Myofascial Pain Syndrome

Background:Motorcycle taxi online are becoming the latest transportation trends among the public. Motorcyclists activity on motorcycle taxi online, due to neck position that tend to be flexible when viewing map, shoulder static when driving, wearing helmet done for long time and continuously, then gradually can cause complaints of myofascial pain in neck muscle that is upper trapezius muscle. The purpose of this research is to know the effect of Transcutaneous Electrical Nerve Stimulation (TENS) combination and ischemic compression technique on upper trapezius muscle to myofascial pain syndrome. Methods: This study used quasi experimental by using two groups of pre and post test without control. Respondents were 22 people consisting of two treatment groups with each group amounted to 11 people. This study was conducted for 4 weeks with a dose of 2 times a week. Result: The result of influence test in TENS and TENS + IC group obtained p <0,05 then both groups have influence of TENS in reducing myofascial pain syndrome complaints. Conclusion: The combination of TENS and Ischemic Compression is better than TENS in reducing myofascial syndrome pain complaints on online motorcycle taxi drivers

Pengaruh Kombinasi Transcutaneous Electrical Nerve Stimulation (TENS) dan Teknik Ischemic Compression Terhadap Myofascial Pain Syndrome

Background:Motorcycle taxi online are becoming the latest transportation trends among the public. Motorcyclists activity on motorcycle taxi online, due to neck position that tend to be flexible when viewing map, shoulder static when driving, wearing helmet done for long time and continuously, then gradually can cause complaints of myofascial pain in neck muscle that is upper trapezius muscle. The purpose of this research is to know the effect of Transcutaneous Electrical Nerve Stimulation (TENS) combination and ischemic compression technique on upper trapezius muscle to myofascial pain syndrome. Methods: This study used quasi experimental by using two groups of pre and post test without control. Respondents were 22 people consisting of two treatment groups with each group amounted to 11 people. This study was conducted for 4 weeks with a dose of 2 times a week. Result: The result of influence test in TENS and TENS + IC group obtained p <0,05 then both groups have influence of TENS in reducing myofascial pain syndrome complaints. Conclusion: The combination of TENS and Ischemic Compression is better than TENS in reducing myofascial syndrome pain complaints on online motorcycle taxi drivers

The Pairing of Trigger Point Dry Needling with Rehabilitation Techniques

Trigger point dry needling is a manual treatment modality used for individuals experiencing tightness, pain, and inhibited range of motion in any region of the body. Dry needling can be described as the insertion of a blunt, microfilament non-medicated needle into the skin for the purpose of targeting specific muscles, which contain tight bands known as trigger points. When the needle is inserted into the trigger point the muscle contracts, holds tight to the needle, and elicits a neural twitch response. This ultimately causes the muscle to relax, allowing for reduction in pain and improvements in range of motion. Although the use of dry needling is rising in popularity in the United States, knowledge of its use and effects is limited. Fortunately, more research is being conducted on this form of treatment. In this thesis, the purpose and physiological effects of dry needling will be discussed in detail, along with a comparison between other alternate medical modalities of treatment which target trigger points. In addition, current research on the effectiveness of incorporating dry needling with other manual therapeutic modalities will be discussed. Dry needling has been shown to be very effective in treating trigger points by improving range of motion, decreasing pain, reducing muscle tightness, and increasing muscle oxygenation. Positive effects of dry needling are even more likely to occur when paired with other modes of therapeutic treatment, often in a physical therapy setting but may also be performed by other health professionals including chiropractors, athletic trainers, occupational therapists, and physicians

P2 purinoceptors signaling in fibroblasts of rat subcutaneous tissue

Mestrado em Biologia Molecular e CelularO tecido conjuntivo parece estar envolvido na génese de diversas condições patológicas. O aumento da rigidez do tecido conjuntivo, resultante da fibrose, pode constituir um factor importante no mecanismo patogénico da dor crónica resistente a fármacos (Langevin & Sherman, 2007). Por outro lado, os nucleótidos extracelulares parecem estar envolvidos na fisiopatologia da dor crónica (Burnstock, 2001). Assim, este estudo teve como objectivo averiguar o efeito dos nucleótidos de adenina e uridina na proliferação e síntese de colagénio tipo I de fibroblastos do tecido subcutâneo de rato em cultura. Os resultados obtidos mostram que a incubação com UTP (0.3-100 M, n=5) induz um aumento da proliferação e da produção de colagénio tipo I, o qual é dependente da concentração. Contrariamente, o agonista selectivo dos receptores P2Y2, o MRS 2768 (10 μM, n=3), não teve qualquer efeito no que se refere à proliferação, mas diminuiu significativamente (P<0.05) a síntese de colagénio tipo I. Uma vez que o aumento da produção de colagénio induzida pelo UTP (100 μM) foi proporcional ao aumento do número de células (proliferação celular),podemos especular que este aumento se deve ao aumento do número de células per si do que a uma maior actividade sintética de cada célula. Assim, ao normalizar os valores do colagénio tipo I em relação aos valores obtidos do MTT para os mesmos momentos/dias, deixamos de observar diferenças estatisticamente significativas entre o controlo e as células expostas ao UTP. Uma vez que os receptores P2Y2 não parecem estar envolvidos nesta resposta do UTP (100 μM), esta poderá estar a ser mediada pela activação dos receptores P2Y4 e/ou P2Y6. Considerando que o RB-2 (10 μM, n=5), um antagonista não selectivo que actua preferencialmente no subtipo de receptores P2Y4, não foi capaz de modificar a resposta induzida pelo UTP (100 μM), os receptores P2Y4 parecem também não estar envolvidos. Por outro lado, o MRS 2578 (100 nM), um antagonista selectivo dos receptores P2Y6, atenuou de forma significativa o aumento induzido pelo UTP (100 μM). A corroborar os nossos resultados, uma análise imunocitoquímica mostrou uma imunorreactividade positiva contra os receptores P2Y2 e P2Y6, mostrando um padrão de marcação citoplasmático/membranar, o qual é típico para este tipo de receptores, ao contrário do padrão nuclear exibido pelo anticorpo contra os receptores P2Y4. Relativamente ao envolvimento dos receptores sensíveis ao ADP, os resultados obtidos mostraram que o ADPβS (10-100 μM, n=3-6), um análogo estável do ADP, não parece induzir efeitos significativamente diferentes (P>0.05) na proliferação celular. Contudo, a sua incubação continuada aumentou a produção de colagénio tipo I de forma dependente da concentração (P<0.05). De modo a identificar os receptores purinérgicos envolvidos neste efeito, testamos o ADPβS (100 μM) na presença do MRS 2179 (0.3 μM), do AR-C 66096 (0.1 μM), e do MRS 2211 (10 μM), os quais antagonizam selectivamente os receptores P2Y1, P2Y12 e P2Y13, respectivamente. O efeito facilitatório induzido pelo ADPβS (100 μM) foi atenuado de forma significativa na presença do antagonista dos receptores P2Y1, o MRS 2179 (0.3 μM, n=3), sem ser afectado pelo antagonista dos receptores P2Y12, o AR- C 66096 (0.1 μM, n=3). Pelo contrário, o MRS 2211 (10 μM, n=2) potenciou o aumento da produção de colagénio induzida pelo ADPβS (100 μM), indicando assim que a síntese de colagénio tipo I induzida pelo receptor P2Y1 pode estar a ser parcialmente influenciada por uma activação síncrona do receptor inibitório P2Y13. Por último, uma análise por imunocitoquímica mostrou que estas células apresentam imunorreactividade positiva para os receptores P2Y1 e P2Y13, exibindo um padrão citoplasmático/membranar, contrariamente ao padrão nuclear dos receptores ostentado pelo anticorpo contra os receptores P2Y12. Concluindo, a remodelação da fáscia superficial induzida pelos fibroblastos parece ser regulada por um balanço entre a activação dos receptores P2Y2 e P2Y6, assim como dos receptores P2Y13 e P2Y1. Clarificar as vias que conduzem ao processo de fibrose pode representar uma oportunidade para esclarecer o seu envolvimento na patogénese da dor crónica musculo-esquelética, bem como ser útil no desenvolvimento de novas estratégias terapêuticas.Connective tissue may be involved in the pathogenesis of a wide variety of disease conditions. Increased connective tissue stiffness due to fibrosis may be an important link to the pathogenic mechanism leading to drug-resistant chronic pain (Langevin & Sherman, 2007). In addition, extracellular nucleotides seem to be involved in the pathophysiology of chronic pain (Burnstock, 2001). Therefore, we aimed at investigating the effect of adenine and uridine nucleotides on the proliferation and synthesis of type I collagen by rat fibroblasts from subcutaneous connective tissue. The results showed that continuous incubation of UTP (0.3-100 M, n=5) concentration-dependently increased fibroblasts proliferation, as also increased the synthesis of type I collagen above the control levels. Conversely, the selective P2Y2 agonist, MRS 2768 (10 μM, n=3), was devoid of effect in what concerns proliferation, but significantly (P<0.05) decreased type I collagen synthesis. Since the increase in type I collagen synthesis induced by UTP (100 μM) was proportional to the increase in the amount of cells in the culture (fibroblasts proliferation), we speculated that such an increase could be related to the increase in the cell number rather than a higher synthetic activity. Thus, we performed a more detailed data analysis, in which we normalized type I collagen production taking into consideration the MTT values obtained at the same time points, and we observed no longer significant differences between control and UTP-exposed cells. Discounting the contribution of MRS 2768-sensitive P2Y2 receptors, UTP (100 μM)-induced increase in cells proliferation could be due to P2Y4 and/or P2Y6 receptor activation. Since RB-2 (10 μM, n=5), a non-selective antagonist that acts preferentially on the P2Y4 subtype, did not modify the effect of UTP (100 μM), P2Y4 does not seem to be involved. In turn, MRS 2578 (100 nM), which is a selective P2Y6 antagonist, significantly attenuated UTP (100 μM)-induced increase. To corroborate our results, an immunocytochemistry analysis showed a positive immunoreactivity against the P2Y2 and P2Y6 receptors exhibiting a cytoplasmic/membrane labeling pattern, which is typical for those receptors in many different cells, conversely to the nuclear labeling pattern exhibited by the antibody against the P2Y4. To investigate the involvement of ADP-sensitive P2 receptors on cell proliferation and extracellular matrix production, fibroblast cultures were continuously incubated with the stable ADP analogue, ADPβS (10-100 μM). Results obtained with ADPβS (10-100 μM, n=3-6) showed no significant (P>0.05) differences in fibroblast cells proliferation. However, a continuous incubation with ADPβS (10-100 μM, n=2-5) concentration-dependently increased type I collagen production by fibroblasts (P<0.05). In order to identify which purinoceptor(s) that could be mediating this effect, we tested ADPβS (100 μM) in the presence of MRS 2179 (0.3 μM), AR-C 66096 (0.1 μM), and MRS 2211 (10 μM), which antagonize selectively ADP-sensitive P2Y1, P2Y12 and P2Y13 receptors, respectively. The facilitatory effect of ADPβS (100 μM) was significantly attenuated in the presence of the P2Y1 antagonist, MRS 2179 (0.3 μM, n=3), without being affected by the P2Y12 antagonist, AR- C 66096 (0.1 μM, n=3). In contrast, MRS 2211 (10 μM, n=2) potentiated the effect of ADPβS (100 μM) on type I collagen synthesis, thus indicating that the P2Y1-receptor-induction of type I collagen synthesis may be partially counteracted by synchronous activation of the inhibitory P2Y13 receptor. Finally, an immunocytochemistry analysis showed that these cells exhibit immunoreactivity to P2Y1 and P2Y13 receptors with a cytoplasmic/membrane staining pattern, conversely to the nuclear pattern of P2Y12. Concluding, a delicate balance between the activation of P2Y2 and P2Y6, as well as P2Y13 and P2Y1 purinoceptors, might regulate fibroblast’s induced superficial fascia remodeling. Targeting the pathways leading to fibrosis may represent an opportunity to clarify its involvement in the pathogenesis of musculoskeletal chronic pain and it may be useful for designing novel therapeutic strategies to overcome this disease

Myofascial Release

Fascia represents an intricate system of connective tissue that permeates throughout the human body. Its matrix of continuous fibers support, protect, divide and suspend both superficial and deep anatomical structures. While once thought to be a passive mesh network, new evidence suggests fascia is much more complicated. Now recognized as an active physiological component of the human body, myofascial health and function has been given much attention clinically. Of the techniques aimed to treat and restore fascial structure and function, myofascial release has been found to promote stability, increase range of motion and most importantly alleviate musculoskeletal pain. This form of soft tissue therapy deserves more academic and clinical attention for its positive effects on the fascial health

Perbedaan Contract Relax Streching Dan Myofacial Release Technique Pada Nyeri Trigger Point Syndrome Otot Upper Trapezius

Introduction: Myofascial Trigger Point Syndrome (MTPS) is one of the conditions that can bring in addition to causing pain originating from nerves, bones and joints. MTPS itself is a syndrome that arise due to teraktifasinya one or more trigger points in the muscle fibers. Provision of therapeutic modalities for myofacial upper trapezius trigger point in select that contract relax stretching and myofascial release technique. Purposes: This study aimed to determine differences in contract relax stretching and myofascial release technique, trigger point pain syndrome in the upper trapezius muscle. Methods: This study used a quasi exsperimental design, with the approach of pre-test and post-test two design groups. The population in this study are employees of sub-district Puskesmas Panjalu Ciamis who have diagnosed with myofacial upper trapezius trigger point, the total respondents as many as 10 people, with as many details of group I and group II 5 by 5 people. Testing is done by using the value of the pain VAS. Results were analyzed using the Wilcoxon test and Mann Whitney test. Results: Statistical test using the Wilcoxon test for hypothesis 1 and 2. The Mann Whitney test for hypothesis 3. On the hypothesis 1 and 2 obtained p value: 0.043 or p <0.05 so there is the effect of Contract Relax Stretching and Myofascial Release Technique on reducing myofascial trigger point pain upper trapezius muscle. In the third hypothesis, the value of p: 0.000 or p <0.05 which means there is a significant difference Contract Award Relax Stretching and Myofascial Release Technique to myofascial trigger point pain reduction upper trapezius muscle.Conclusion: The use of Myofascial Release Technique is better than using the Contract Relax Stretching in reducing pain myiofacial upper trapezius muscle trigger points. Keywords: Contract Relax Stretching, Myofascial Release Technique, myofacial upper trapezius muscle trigger point