| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 103 === Background: Myofascial pain syndrome (MPS) has higher prevalence in female office workers and can find myofascial trigger points (MTrP) in taut bands, especially with their upper trapezius. Formation of MTrP was proposed as motor endplate dysfunction leading to sustained sarcomere contraction that compresses the vessels and causes “energy crisis”. Recent studies showed that MTrPs could be distinguished by sonoelastography as a hypoechoeic ellipsoidal focal area and the active MTrPs also had significant larger cross-sectional area than normal and latent MTrPs. However, no studies to date use MTrPs'' cross-sectional areas as an objective outcome measure to investigate treatment effects and there is still no agreement on which treatment is the most effective non-invasive treatment for MTrPs. Besides, traditional Gua-Sha intervention has been proven to be beneficial to chronic neck pain and microcirculation could increase up to four folds after Gua-Sha, but there is still no quantitative study investigating the effect of Gua-Sha intervention on MTrPs.
Purposes: To quantify and compare the immediate, two days and one week follow up treatment effects of Gua-Sha and ischemic compression interventions on female upper trapezius active MTrPs.
Methods: The study recruited female subjects who had active MTrP on their upper trapezius. After baseline general examination, subjects were divided into Gua Sha group (GSG) and ischemic compression group (ICG) with stratified randomization based on their visual analogue scale (VAS) scores. The outcome measures including: cross-sectional area through sonoelastographic measurement, passive range of motion (PROM), Chinese version neck disability index (NDI), pressure pain threshold (PPT), VAS and pain intensity when apply 20N compression force. All outcomes were recorded at baseline, immediate (IM), 2 days and 7 days after treatment as follow-up. Differences in demographic data at baseline between two groups were assessed with two- tailed independent T tests. Intention to treat analysis and two way mixed ANOVA (2 groups x 4 time points) were used in this study. If there were no interactions but main effect, one way repeated measures ANOVA would be used within each group.
Results: Results showed that GSG had significantly reduced MTrP area at IM and sustain to 7 days compared to baseline (28.19 ± 9.8 mm2, 19.48 ± 6.24 mm2, 21.84 ± 6.46 mm2 and 20.63 ± 6.44 mm2). ICG only had significantly reduced MTrP area at IM compared to baseline (25.2 ± 11.32 mm2 to 21.06 ± 8.29 mm2). GSG showed significantly improved PROM at IM (37.67 ± 4.84˚ to 39.97 ± 5.55˚) and ICG showed significantly reduced PPT at 2 days and 7 days after treatments (26.14 ± 10.56 N, 22.23 ± 9.36 N and 21.68 ± 8.37 N, indicating lower force threshold to induce pain). Pain intensity when applying 20N compression force also showed more severe symptom in ICG at 7 days compared to baseline. And both groups showed improvements on NDI at 2 days and VAS at 2 days and 7 days’ time points. But there were no significant differences between two groups on all outcome measures.
Conclusion: Gua Sha demonstrated superior short-term effects in more outcome measures than ischemic compression in pain and functional status in female patients with MPS.
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