Trigger-Point Therapy Blends Well with Stretching

In a study of physically active young males with tight hamstrings and at least one latent trigger point, the combination of stretching and myofascial trigger-point therapy was shown to decrease pain and improve range of motion, among other positive findings.

The study, "Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points," involved 30 physically active males ranging in age from 19 to 25. All the men presented with hamstring tightness, as determined by the passive knee extension test, and at least one latent trigger point on muscles innervated by the lumbosacral, sciatic, tibial and common peroneal nerves. Those with active trigger points in these areas were excluded from the study.

Subjects were randomly assigned to one of three groups. Group one received only Proprioceptive Neuromuscular Facilitation stretching. Group two received both stretching and myofascial trigger-point therapy. Group three served as the control group and received no intervention.

The main outcome measures for this study were knee range of motion, stretch perception, pressure pain threshold and subjective pain intensity. These measures were assessed at baseline, the immediately after the one-time intervention, then again 10 minutes later and 30 minutes later.

Two physical therapists blinded to the purpose of the study performed the stretching and trigger-point therapy. Both had at least a decade of experience in the field and had completed education programs pertaining to Proprioceptive Neuromuscular

The technique used in group two for the myofascial trigger-point therapy involved nonpainful, cross-fiber friction massage to the latent trigger point, slowly increasing the pressure to reach the first tissue resistance barrier. The level of pressure was maintained until the practitioner could feel this barrier release, then the pressure was again increased until a new barrier was reached.

"The clinician explained that the release would feel like a 'melting' of the [latent trigger point], accompanied by a decrease in pain," state the study's authors. "The process was repeated until there was no [trigger point] tension [or] tenderness or 90 [seconds] had elapsed."

Results of this study revealed a significant improvement in all the main outcome measures when myofascial trigger-point therapy was combined with stretching.

"The results indicate that clinicians can immediately improve knee [range of motion], decrease inversed stretch perception, increase [pressure pain threshold] and reduce subjective pain," state the study's authors, "through a program of modified stretching combined with cross-fiber friction in young and physically active males with latent [trigger points]."

Authors: Athanasios Trampas, Athanasios Kitsios, Evagelos Sykaras, Stamatios Symeonidis and Lazaros Lazarou.

Sources: Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Greece, and 424 Military Hospital of Thessaloniki, Greece. Originally published in Physical Therapy in Sport (2010) 11: 91-98.