The effectiveness of simultaneous thermotherapy with ultrasound and electrotherapy with combined AC and DC current on the immediate pain relief of myofascial trigger points

Objectives: This study is designed to investigate the immediate effectiveness of combining ultrasound [deep heat] therapy and modified electrotherapy for the treatment of myofascial trigger points [TrPs] of upper trapezius [UT] muscle. Methods: Twenty-six patients [12 males and 14 females, average age 42.1 +/- 16.4 years] were studied. All patients had myofascial TrPs in one or two sides of the UT muscles. Fifty skeletal muscles were studied. The involved UT muscles were treated with different methods according to random assignment: Group A muscles were given placebo treatment [Control group]; Group B muscles were treated with only ultrasound [USD]; Group C muscles were given only electrotherapy [ET]; and Group D muscles were given a combination of ultrasound therapy and electrotherapy [USD + ET]. The effectiveness of treatment was assessed by conducting three measurements on each patient before and immediately after treatment: subjective pain intensity [PI], pain threshold [PT], and range of motion [ROM] of UT muscle [lateral bending of cervical spine to the opposite side]. Results: When the effectiveness of treatment was compared with that of the placebo group [Group A], there was no significant improvement [P < 0.05] for Group B muscles. There was significant improvement [P < 0.05] in PI [but not in PT or ROM] in Group C immediately after therapy. In Group D, the improvement in ROM [but not in PI or PT] immediately after therapy was significantly greater [P < 0.05] than Group A, B, or C muscles. Conclusions: The results of this study suggest that, when treating myofascial trigger points of the upper trapezius [UT] muscles, the combination of ultrasound therapy [USD] and electrotherapy [ET] offers a greater immediate increase in the range of motion [ROM] of the muscle than placebo therapy, ultrasound therapy alone, or electrotherapy [ET] alone. In clinical management of myofascial TrPs, one may expect that combining USD and ET helps to reduce the muscle tightness caused by TrPs. Therefore, the use of this combination therapeutic modality to treat myofascial TrPs should be seriously considered.