Trigger Point Manual Therapy for the Treatment of Chronic Noncancer Pain in Adults: A Systematic Review and Meta-Analysis

OBJECTIVE: To determine the effectiveness of trigger point manual therapy (TPMT) for reducing chronic noncancer pain and associated problems in adults, by analyzing all relevant randomized controlled trials (RCTs). DATA SOURCES: We searched databases and clinical trials registers from their inception to May 2017. STUDY SELECTION: We included RCTs in any language that recruited patients older than 18, with pain of 3 months' duration or more. We assessed pain, function, and patient-reported improvement as outcomes. DATA EXTRACTION: Two authors independently extracted and verified data. Meta-analysis was completed where possible, otherwise data were synthesized narratively. DATA SYNTHESIS: We combined all data using a random-effects model and assessed the quality of evidence using GRADE. A total of 19 trials (involving 1047 participants) met inclusion criteria, representing TPMT treatment of musculoskeletal, pelvic, and facial pain. No effect was found for short-term pain relief (mean standardized difference -0.53; 95% confidence interval [CI], -1.08 to 0.02). One small study showed a longer-term benefit for pain (mean standardized difference -2.00; 95% CI, -3.40 to -0.60) but with low confidence in the effect. Significant gains emerged for function (mean standardized difference -0.77; 95% CI, -1.27 to -0.26) and in patient global response (odds ratio 3.79; 95% CI, 1.86-7.71) from 4 studies, but not for health-related quality of life. CONCLUSIONS: Evidence for TPMT for chronic noncancer pain is weak and it cannot currently be recommended

Transabdominal ultrasound to assess pelvic floor muscle performance during abdominal curl in exercising women

Introduction and hypothesis: The aim of this study was to assess pelvic floor muscle (PFM) function using transabdominal ultrasound (TAUS) in women attending group exercise classes. Specific aims were to: (1) identify the ability to perform a correct elevating PFM contraction and (2) assess bladder-base movement during an abdominal curl exercise. Methods: Ninety women participating in group exercise were recruited to complete a survey and TAUS assessment performed by two qualified Continence and Women’s Health physiotherapists with clinical experience in ultrasound scanning. The assessment comprised three attempts of a PFM contraction and an abdominal curl exercise in crook lying. Bladder-base displacement was measured to determine correct or incorrect activation patterns. Results: Twenty-five percent (n  = 23) of women were unable to demonstrate an elevating PFM contraction, and all women displayed bladder-base depression on abdominal curl (range 0.33–31.2 mm). Parous women displayed, on average, significantly more bladder-base depression than did nulliparous women [15.5 (7.3) mm vs 11.4 (5.8) mm, p < 0.009). Sixty percent (n  = 54) reported stress urinary incontinence (SUI). There was no association between SUI and the inability to perform an elevating PFM contraction (p = 0.278) or the amount of bladder-base depression with abdominal curl [14.1 (7.6) mm SUI vs 14.2 (6.7) mm non-SUI]. Conclusions: TAUS identified that 25 % of women who participated in group exercise were unable to perform a correctly elevating PFM contraction, and all depressed the bladder-base on abdominal curl. Therefore, exercising women may be at risk of PFM dysfunction when performing abdominal curl activities