Trigger points have been a highly researched source of pain and problems in the body. Why the mini quotes? Well, it can be hard to identify directly what they are and where they are. The information coming out is improving, but there is still a lot of work to do to get a clear picture of who they truly are.
What They Did:
40 overhead participants had unilateral shoulder impingement (dx. with Neer’s and Hawkins test). They were randomly assigned to a group that would receive TpDN in the upper trapezius or infraspinatus muscles. There were three sessions of TpDN treatment, each separated by a 2-day break. The outcome measures they were looking at were changes in Pain intensity (visual analog scale), pain pressure threshold (PPT), and disability in the arm, hand, and shoulder (DASH).
What They Found:
Pain and disability decreased significantly in both groups, along with PPT increasing only in the infraspinatus group. However, no outcome measures showed a significant intergroup difference after treatment.
What It All Means:
The researchers found that using TpDN for active trigger points in the infraspinatus can be as effective as direct TpDN for active trigger points in the upper trapezius in improving pain and disability associated with shoulder pain. This could be beneficial, as it is less painful to go after the infraspinatus rather than the upper trapezius. The upper traps can be extremely tight and painful, and even with TpDN to release them, the release can be intense and a little painful. That does leave some questions, though, about how you are actually treating what you think is the pain if it turns out it isn’t.
Where to Treat?
The results that they found in this study could be confusing. We treated two different areas, and they have a similar effect on pain. So how do we know where the pain is coming from? This is a unique aspect of pain: just because the pain is located in a specific spot, it is most commonly a symptom of a much bigger problem (we discuss below). It would be interesting to show if this improvement could come from treating both areas and if that would have a cumulative effect.
Focus on a Bigger Picture for Treatment
As much as we understand injury and pain, we are only scratching the surface. I stay up to date on the latest developments in sports medicine and related fields, but the pace at which data is released makes it impossible to keep up. That said, even when looking at a specific point of pain, there are many factors that could be contributing. The results of this study show that pain is so multifactorial that you have to look at multiple areas that could be contributing. That may occur even if the referral patterns don’t make sense.
Overall, this is a great step toward figuring out exactly where pain and issues come from. Don’t let conflicting or confusing data slow you down. Keep it in your toolbox, and you’ll never know when you need to apply it.
Source: Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes with Unilateral Shoulder Impingement Syndrome