Carel Bron1,2*, Arthur de Gast3, Jan Dommerholt4, Boudewijn Stegenga5, Michel Wensing1, Rob AB Oostendorp1
Background: Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial
trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies
have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of
MTrPs in patients with chronic shoulder pain.
Methods: A single-assessor, blinded, randomized, controlled trial was conducted. The intervention group received
comprehensive treatment once weekly consisting of manual compression of the MTrPs, manual stretching of the
muscles and intermittent cold application with stretching. Patients were instructed to perform muscle-stretching
and relaxation exercises at home and received ergonomic recommendations and advice to assume and maintain
good posture. The control group remained on the waiting list for 3 months. The Disabilities of Arm, Shoulder and
Hand (DASH) questionnaire score (primary outcome), Visual Analogue Scale for Pain (VAS-P), Global Perceived Effect
(GPE) scale and the number of muscles with MTrPs were assessed at 6 and 12 weeks in the intervention group
and compared with those of a control group.
Results: Compared with the control group, the intervention group showed significant improvement (P < 0.05) on
the DASH after 12 weeks (mean difference, 7.7; 95% confidence interval (95% CI), 1.2 to 14.2), on the VAS-P1 for
current pain (mean difference, 13.8; 95% CI, 2.6 to 25.0), on the VAS-P2 for pain in the past 7 days (mean difference,
10.2; 95% CI, 0.7 to 19.7) and VAS-P3 most severe pain in the past 7 days (mean difference, 13.8; 95% CI, 0.8 to 28.4).
After 12 weeks, 55% of the patients in the intervention group reported improvement (from slightly improved to
completely recovered) versus 14% in the control group. The mean number of muscles with active MTrPs decreased
in the intervention group compared with the control group (mean difference, 2.7; 95% CI, 1.2 to 4.2).
Conclusions: The results of this study show that 12-week comprehensive treatment of MTrPs in shoulder muscles
reduces the number of muscles with active MTrPs and is effective in reducing symptoms and improving shoulder
function in patients with chronic shoulder pain. Click here to learn more.