580 California St., Suite 400
San Francisco, CA, 94104
More questions than answers
1997, Primary Health Care
https://doi.org/10.7748/PHC.7.5.3.S6visibility
…
description
2 pages
Sign up for access to the world's latest research
checkGet notified about relevant papers
checkSave papers to use in your research
checkJoin the discussion with peers
checkTrack your impact
Abstract
AI
AI
This paper explores the complexities and unanswered questions surrounding various manual therapy techniques, such as ischaemic compression and myofascial release, in addressing muscular pain and dysfunction. It questions the physiological mechanisms at play during treatment and discusses the relationship and philosophical distinctions between chiropractic and osteopathy practices. The lack of comparative studies on these modalities is highlighted, advocating for a more integrated approach to treatment that could provide clearer answers to ongoing clinical questions.
Key takeawaysAI
AI
- The text explores the efficacy of various manual therapy techniques on muscular pain relief.
- No comparative studies exist to evaluate the effectiveness of techniques like myofascial release and high-velocity thrusts.
- Jones' spontaneous positional release demonstrates an alternative approach to pain resolution without invasive pressure.
- The distinction between chiropractic and osteopathic practices is increasingly blurred due to overlapping treatment methodologies.
- Integration of diverse therapeutic methods may offer comprehensive benefits yet lacks empirical validation in comparative studies.
Related papers
Effectiveness of Dry-Needling Over Ischemic Compression on Trigger Points in Quadratus Lumborum Muscle- a Randomized Clinical Trial
2018
OBJECTIVE:To find out the effect of Dry needling and Ischemic compression on Quadratus lumborum muscle trigger point METHODOLOGY: STUDY DESIGNexperimental study-randomised clinical trial Settings: SCPTRC OPD, Srinivas hospital, Mangalore. Participants: 40 subjects were participated in this study. Dry needling and Ischemic compression were given for two groups of 20 subjects for one session. OUTCOME MEASURES: Pain pressure threshold. RESULTS: Both groups showed p value of 0.001 thus it is statistically significant. CONCLUSION: The results of this clinical trial suggest that single sessions of TrP DN shows greater improvement in terms of pressure threshold and range of motion than TrP IC. Both the groups shows similar changes in pain and functional disability.
Comparison of pressure release, phonophoresis and dry needling in treatment of latent myofascial trigger point of upper trapezius muscle
Journal of Back and Musculoskeletal Rehabilitation, 2019
BACKGROUND: Latent myofascial trigger point (LMTP) is a small hypersensitive area in skeletal muscles that becomes painful under compression or stimulation. LMTPs are relevant for various musculoskeletal disorders. Although several treatments have been introduced to treat LMTP, the most efficient one is yet to be found. OBJECTIVE: The main purpose of the present study was to compare pressure release, phonophoresis of betamethasone and dry needling on the upper trapezius latent myofascial trigger point. METHODS: Sixty participants (mean ± SD age, 23.6 ± 2.1 y), with at least one latent myofascial trigger point in the upper trapezius muscle, participated in this study. Subjects were randomly divided into three groups (pressure release, phonophoresis with betamethasone and dry needling groups) for two weeks. Pain intensity, pain pressure threshold and active cervical range of motion were assessed. RESULTS: Significant pain decrease, active cervical range of motion and pain pressure threshold increase were observed in the three groups (p < 0.001). The dry needling and phonophoresis groups reported more significant improvement compared to the pressure release group (p < 0.001). There was no difference between the dry needling and phonophoresis groups. CONCLUSIONS: Considering the significant, positive effects of all three methods, dry needling and phonophoresis seem to be more effective than pressure release.
The Effect of Dry Needling on Range of Motion of Neck Lateral Flexion in Subjects With Active Trigger Point in Upper Trapezius Muscle
Jentashapir Journal of Health Research, 2014
Background: Myofascial trigger point is one of the most common causes of musculoskeletal disorders. Myofascial trigger point in upper trapezius has been reported as a symptom in patients with neck and upper thoracic pain. Objectives: The purpose of this study was to investigate the effect of dry needling compared with ischemic pressure on trigger point in upper trapezius muscle. Materials and Methods: 28 subjects with myofascial trigger point in upper trapezius participated in this study. The subjects were randomly assigned to two groups: dry needling (n = 13) and ischemic pressure (n = 15). The neck lateral flexion range of motion was measured before and after treatment in both groups using a standard goniometer. Paired t-test was used to determine any significant difference in range of motion after treatment sessions compared with pre-treatment score in control and experimental group. Analysis of Covariance (ANCOVA) was calculated to determine the significance of differences between the control and experimental groups in posttest scores, with pre-treatment scores used as covariates in the analysis. Results: Statistical analysis (paired t-test) revealed significant increase in neck lateral flexion range of motion in contra-lateral side after treatment sessions in control and experimental group compared with pre-treatment score (P < 0.05). However, only dry needling was effective in increase of range of motion in Ipsi-lateral side (P = 0.001). In the ANCOVA, controlling for pre-test scores, no significant difference was found between the two groups in the after treatment sessions (P = 0.06) and (P = 0.15). Conclusions: The application of DN produces an improvement in ILF and CLF can be prescribed for subjects with MTP in UT muscles.
Research Paper: The Efficacy of Superficial and Deep Dry Needling Techniques on Functional Parameters in Subjects With Upper Trapezius Myofascial Pain Syndrome
2018
Background: Few studies have compared superficial and deep dry needling techniques in treatment of trigger points in patients with Myofascial Pain Syndrome (MPS). Objectives: To compare the effects of Superficial Dry Needling (SDN) and Deep Dry Needling (DDN) on Range of Motion (ROM) and functional ability in subjects with upper trapezius MPS. Materials & Methods: This is a quasi-experimental study conducted on 50 patients with MPS of upper trapezius muscle. They were randomly divided into two groups of 25 treated with SDN and DDN. They were examined in Physiotherapy Clinic of Iran University of Medical Sciences during 2016-2017. Neck disability and cervical ROM were measured using Neck Disability Index (NDI) instrument a goniometer, respectively. The subjects were evaluated before the treatment, after the treatment, and 7-and 15-day follow-up periods. The Independent t-test and ANOVA were used to compare the two groups at different times of evaluation. Results: There was no significant difference between SDN and DDN groups in terms of age (P=0.41), weight (P=0.99), and height (P=0.51). Interaction effect between group and time on the lateral cervical ROM over the unaffected side and NDI were significant (P<0.001). The simple main effect of time and group on NDI and ROM were also significant (P<0.001). Conclusion: The changes in the ROM and NDI were observed over time when SDN and DDN techniques were used, but these changes were more significant in patients treated with DDN, especially in the follow-up periods. Keywords: Myofascial Pain Syndrome, Disability, Neck pain, Range of Motion
The privilege of being vaccinated against misinformation
Academia Letters, 2021
Comparative studies of the mountain Kinnekulle vegetation
Academia Biology, 2024
In the present paper, we report the results of environmental monitoring of the mountain Kinnekulle habitat area (Västra Götaland county, Sweden) and discuss its nature conservation value. As part of our comparative study of Kinnekulle’s flora, between 2018 and 2023 we have studied population dynamics of plants growing there. In the present study, we compare our plant inventory results and those provided by Carl Linnaeus in his book “Västgöta Resa År 1746” (“The trip to Västra Götaland, 1746”), providing evidence that most of the plants listed by Linnaeus can still be found in the Kinnekulle area (58–94% occurrence). A part of the paper is a historical tribute to Carl Linnaeus and his trip to the Kinnekulle area. An English translation of Linnaeus’ text on Kinnekulle’s nature and plant inventory list can be found in the supplement materials of the paper.
Evaluation of practices and attitudes of caregivers influencing adherence to seasonal malaria chemoprevention in children under five years of age: the case of Rural Embangweni, Mzimba District, Malawi
Academia Medicine, 2024
This research aimed to investigate medication adherence to seasonal malaria chemoprevention (SMC) and to evaluate the caregivers’ behaviors and attitudes throughout the 2022 SMC campaign in Embangweni, Mzimba District. SMC aims to administer a three-day course of anti-malarial drugs periodically during the months when malaria risk is highest. However, SMC’s effectiveness relies on medication adherence, without which morbidity cannot be reduced. In this study, a random cluster sampling approach was employed to extract data from internal monitoring, with caregivers’ self-reports as the primary information. The caregivers’ adherence levels, beliefs, and behaviors were then assessed and analyzed using Bernard Vrijens’ taxonomy. In total, 95% of caregivers (<italic>n</italic> = 2,457) were knowledgeable about using drugs to prevent malaria at the outset of treatment when 93.0% of children (<italic>n</italic> = 2,299) received their initial dose. However, only 66% of caregivers (<italic>n</italic> = 2,457) indicated that the community health workers supervised the treatment directly. At the beginning of the treatment phase, 89.4% of the children (<italic>n</italic> = 2,127) took their medication on the second day and 80.2% (<italic>n</italic> = 2,295) took their medication on the third day. Caregivers cited “forgetting”, “lack of time”, and “absence of the mother” as the primary reasons for halting the three-day prescription. The results of this research indicated that caregivers demonstrated a high level of adherence in completing the entire three-day course of medication and ensuring SMC coverage. However, the survey also highlighted areas of improvement in some caregivers’ attitudes, practices, and knowledge concerning adherence to medication throughout the SMC initiative.
The Vision of Unity and Love
The Old Man Placed the Elusive Robes of Silence and Stillness Softly onto His Shoulders. With Eyes Closed and the Gate of Awareness Opened Wide, with His Lens of Perception Fully Unveiled, He Slowly Caressed a Rosary of Meditation, a Bindu of Self-Reflection, and the Circles and Lines of a Divine Inspiration. Then with a Lucid Sense of Anticipation Directed Within, He Peered through the Window of Heh and Gazed upon the Vision of Unity and Love. Come and See! For the Threads of Joy and Love Woven into the Fabric of your Life are Keys to your Healing and Cleansing. Just as that Fellowship of Unity Growing in the Garden of your Soul is a Door to your Happiness and Fulfillment, Above and Below. And to Become the Source and Blossoming of Both in This World will Build a Spiritual Bridge of Interconnectedness into that World To Come! A Sanctuary of Faith and Hope wherein the Beauty of Yichud and the Passion of Ahavah become the Physical Rungs upon a Sacred Ladder Joining the Light of Heaven to that Energy which Manifests the Beauty of Our Earth. Oh, my Beloved! Come and See!
More questions than answers?
Consider what is actually happening when
ischaemic compression/inhibitory
pressure/acupressure/local myofascial
release techniques are applied to painful,
contracted, muscular areas. What is taking
place in the recipient tissues?
•
•
•
•
•
Journal of Bodywork and Movement Therapies (1997)
1(2), 63
© Pearson Professional Ltd 1997
Are they being deprived temporarily of
their blood supply so that a 'flushing'
of fresh oxygenated blood can occur
subsequently, after release of the
pressure, so easing the ischaemia
assumed to be contributing to pain and
restriction? (Travell & Simons 1992)
Or are neurological ilffluences being
brought to bear, so that pain messages
are blocked or modified via gate control
mechanisms? (Melzack & Wall 1988)
Or are energy factors involved, with the
degree and duration of the pressure
applied determining whether energy is
added to or deducted from the
equation? (Academy of Traditional
Chinese Medicine 1975)
Or is myofascial elongation occurring
as a result of sustained pressure on the
tissues? (Barnes 1990)
Or are all four, and perhaps other
physiological processes - such as
endorphin release (Baldry 1993) - at
work simultaneously in response to
sustained digital pressure applied to
dysfunctional soft tissues?
An osteopath, chiropractor, physical
therapist, acupuncturist, Rolfer, shia tsu
practitioner or neuromuscular therapist might
each take different views as to what it is that
they were doing as such pressure was being
applied, despite the fact that to the observer
they would appear to be doing precisely the
same thing. What does science say?
At present answers are few and
questions many in areas such as this, for
although research has examined aspects of
the benefits of such treatment approaches,
no comparative studies have been
published. Logic would suggest that
elements of all the concepts described are
involved in whatever benefits derive from
direct manual pressure approaches.
It should be emphasized that there are
also other ways of dealing with local
J O U R N A L OF B O D Y W O R K AND M O V E M E N T T H E R A P I E S
dysfunction. Jones (1981) showed that
applying minimal pressure to painful
'points' and then using the pain as
perceived by the patient as a monitor while
the area, or body as a whole, was positioned
in such a way as to remove the pain being
experienced, allowed a self-generated
resolution ('spontaneous positional release')
of the pain to take place. At the same
time an easing of whatever stress pattern
was producing/maintainingthe pain
would occur.
While manual pressure is a direct,
somewhat invasive and potentially
tranmatising approach, which demands an
adaptive response from the body, indirect,
functional approaches (such as Jones
strain/counterstrain) avoid demanding a
response and instead offer an opportunity
for change. Many find these methods more
acceptable both philosophically and in
practice, but are these feelings justified
(Chaitow 1996)? Once again we await
research to show what seems to be
indicated by clinical experience.
Consider also the question of the
relationship between joint and muscle
problems. In order to normalize a
restricted joint should the soft tissues
which support and control its motion
receive attention to release, stretch and
normalize them - so helping to restore
joint function (Stiles 1984, Janda 1988)?
Or should the joint be
manipulated/adjusted to restore more
normal motion, at the same time
beneficially (reflexively) influencing the
soft tissues (Liebenson 1990)? Ask this
question of an osteopath or a chiropractor
and you will probably receive conflicting
answers. Which view is correct? Or are
both correct?
As chiropractors adopt an increasingly
receptive view in respect of the importance
(at least in rehabilitation settings) of soft
tissue techniques, and as osteopaths
incrementally utilize an ever wider range
of soft tissue approaches (as well as
applying high velocity thrusts when these
are deemed appropriate) the distinction
between osteopathy and chiropractic in
practice blurs somewhat, even if there
J A N U A R Y 1997
Chaitow
remain philosophical distinctions rooted in
the histories of these two professions. For
a chiropractor the need to mobilize a joint
which is restricted in motion would
usually seem to be a primary and
paramount objective, with high velocity
thrust-type adjustments as the predominant
tool. For the osteopath, while one
objective would be for restricted joint
mobilization to take place, this would be
as part of a comprehensive normalization
of function in which soft tissues would
receive at least as much attention as the
joint (Greenman 1989). Many modem
osteopaths would, as likely as not, avoid
active joint manipulation, opting instead
for positional release or muscle energy
type approaches to achieve these ends
(Stiles 1984, Greenman 1989).
Many physical therapists adopt an
eclectic middle ground between these
positions, using both approaches according
to individual preferences. Who is correct?
Or are all such approaches likely to achieve
similar results? Studies of each system
seem to show benefits, but they have not
been compared in studies that evaluate the
relative benefits of skilled soft tissue
(MET, myofascial release, positional
release, etc.), normalization of joints as
compared with high velocity thrust
mobilization approaches (Brodin 1982).
So why not integrate the methods?
As the Journal of Bodywork and
Movement Therapies develops, these and
other issues will be addressed and
hopefully answers will begin to
predominate instead of questions.
Leon Chaitow
Editor
REFERENCES
Academy of Traditional Chinese Medicine 1975
An outline of Chinese acupuncture. Foreign
Language Press, Beijing
Baldry PE 1993 Acupuncture, trigger points and
musculoskeletal pain. Churchill Livingstone,
Edinburgh
Barnes JB 1990 Myofascial release: the search
for excellence. Rehabilitation Services Inc.,
Paoli, PA
Brodin H 1982 Lumbar treatment using MET.
Osteopathic Annals 10:23-24
Chaltow L 1996 Positional release techniques.
Churchill Livingstone, Edinburgh
Greeuman P 1989 Principles of manual
medicine. Williams and Wilkins, Baltimore
Janda V 1988 In: Grant R (ed) Physical therapy
of the cervical and thoracic spine. Churchill
Livingstone, New York
Jones L 1981 Strain and counterstraln. Academy
of Applied Osteopathy, Colorado Springs,
USA
Liebenson C 1990 Active muscular relaxation
techniques (part 2). Journal of Manipulative
and Physiological Therapeutics 13:2-6
Melzack R, Wall P 1988 The challenge of pain.
Penguin, New York
Stiles E 1984 Manipulation - a tool for your
practice? Patient Care 18:16-42
Travell J, Simons D 1992 Myofascial pain and
dysfunction (The Trigger Point Manual).
Williams and Wilkins, Baltimore
0
JOURNAL
OF BODYWORK
AND MOVEMENT
THERAPIES
JANUARY 1997
FAQs
AI
What physiological changes occur during ischaemic compression techniques?add
The paper reveals that ischaemic compression may temporarily reduce blood supply, facilitating a subsequent re-oxygenation and relief of pain after pressure release.
How does spontaneous positional release differ from traditional manual pressure techniques?add
Research indicates that spontaneous positional release, as described by Jones, utilizes minimal pressure and patient-perceived pain to promote self-resolution instead of invasive pressure.
What is the role of soft tissue techniques in joint dysfunction treatment?add
The findings suggest that both soft tissue normalization and joint manipulation are essential, with contemporary approaches increasingly integrating both for comprehensive treatment.
Why is there a lack of comparative studies on manual pressure techniques?add
The study highlights a gap in research literature, indicating the absence of comparative evaluations of manual pressure methods and their outcomes across different treatment philosophies.
How are the practices of chiropractors and osteopaths converging?add
The paper notes an increasing overlap in treatment techniques, as chiropractors embrace soft tissue methods while osteopaths adopt high-velocity adjustments, blurring traditional distinctions.