Prevalence of Myofascial Trigger Points in the Hip in Patellofemoral Pain

Tensegrity Physical Therapy | August 22, 2019 | Filed under:

Prevalence of Myofascial Trigger Points in the Hip in Patellofemoral Pain is an article in the Physical Medicine and Rehabilitation by a team including our very own Sean Roach.

Objectives

To determine the prevalence of myofascial trigger points (MTrPs) in the gluteus medius (GMe) and quadratus lumborum (QL) for subjects with patellofemoral pain (PFP), and to examine the relationship between MTrPs and force production of the GMe after treatment.

Design

Randomized controlled trial.

Setting

A physical therapy clinic.

Participants

Subjects (N=52; mean age ± SD, 30±12y; mean height ± SD, 172±10cm; mean mass ± SD, 69±14kg) volunteered and were divided into 2 groups: a PFP group (n=26) consisting of subjects with PFP, and a control group (n=26) with no history of PFP.

Interventions

Patients with PFP received trigger point pressure release therapy (TPPRT).

Main Outcome Measures

Hip abduction isometric strength and the presence of MTrPs.

Results

Prevalence of bilateral GMe and QL MTrPs for the PFP group was significantly higher compared with controls (P=.001). Subjects in the PFP group displayed significantly less hip abduction strength compared with the control group (P=.007). However, TPPRT did not result in increased force production.

Conclusions

Subjects with PFP have a higher prevalence of MTrPs in bilateral GMe and QL muscles. They demonstrate less hip abduction strength compared with controls, but the TPPRT did not result in an increase in hip abduction strength.

Methods

The study consisted of 52 volunteer subjects (24 men, 28 women; mean age ± SD, 30±12y; mean height ± SD, 172±10cm; mean mass ± SD, 69±14kg). The PFP group (n=26) consisted of subjects with PFP. The control group (n=26) did not have a history of PFP. The human subjects review board at Rocky Mountain University of Health Professions and the University of Oregon approved the protocol for the study. All subjects provided written informed consent before their participation in the study, and the rights of the subjects were protected. Subjects selected for this study met the following criteria for the PFP group: generalized anterior, anterior/medial knee or retropatellar pain for 1 month or longer associated with prolonged sitting, ascending/descending stairs, sports activity, and/or running. Exclusion criteria for both groups included a history of patellar dislocation, cartilage or ligamentous damage, surgery for trauma to the knee, and a known history of osteoarthritis. All subjects completed the Anterior Knee Pain Scale (AKPS), which is a validated questionnaire tool used to subjectively measure normal knee function.17 The AKPS includes 13 self-reported questions that address functional tasks such as running, walking, and climbing stairs.17

References

  1. Wilk, K.E., Davies, G.J., Mangine, R.E., Malone, T.R. Patellofemoral disorders: a classification system and clinical guidelines for nonoperative rehabilitation. J Orthop Sports Phys Ther. 1998;28:307–322
  2. Brody, L.T., Thein, J.M. Nonoperative treatment for patellofemoral pain. J Orthop Sports Phys Ther. 1998;28:336–344
  3. Powers, C.M. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33:639–646
  4. Ireland, M.L., Willson, J.D., Ballantyne, B.T., Davis, I.M. Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther. 2003;33:671–676
  5. Finnoff, J.T., Hall, M.M., Kyle, K., Krause, D.A., Lai, J., Smith, J. Hip strength and knee pain in high school runners: a prospective study. PM R. 2011;3:792–801
  6. Powers, C.M. The influence of abnormal hip mechanics on knee injury: a biomechanical perspective. J Orthop Sports Phys Ther. 2010;40:42–51
  7. Simoneau, G. Kinesiology in walking. 2nd ed. Mosby, Philadelphia; 2002
  8. Souza, R.B., Draper, C.E., Fredericson, M., Powers, C.M. Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther. 2010;40:277–285
  9. Byrne, C., Twist, C., Eston, R. Neuromuscular function after exercise-induced muscle damage: theoretical and applied implications. Sports Med. 2004;34:49–69
  10. Gerwin, R.D., Dommerholt, J., Shah, J.P. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004;8:468–475
  11. Travell, J.G., Simmons, D.G., Simons, L.S. Myofascial pain and dysfunction: the triggerpoint manual upper half of the body. 2nd ed. Williams & Wilkins, Baltimore; 1999
  12. Lucas, K.R., Rich, P.A., Polus, B.I. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points. Clin Biomech (Bristol, Avon). 2010;25:765–770
  13. Ibarra, J.M., Ge, H.Y., Wang, C., Martinez Vizcaino, V., Graven-Nielsen, T., Arendt-Nielsen, L. Latent myofascial trigger points are associated with an increased antagonistic muscle activity during agonist muscle contraction. J Pain. 2011;12:1282–1288
  14. Travell, J.G., Simons, D.G. Myofascial pain and dysfunction: the trigger point manual the lower extremities. Williams & Wilkins, Baltimore; 1992
  15. Henriksen, M., Aaboe, J., Simonsen, E.B., Alkjaer, T., Bliddal, H. Experimentally reduced hip abductor function during walking: implications for knee joint loads. J Biomech. 2009;42:1236–1240
  16. in: J. Porterfield, C. DeRosa (Eds.) Mechanical low back pain. 2nd ed. WB Saunders, Philadelphia; 1991
  17. Kujala, U.M., Jaakkola, L.H., Koskinen, S.K., Taimela, S., Hurme, M., Nelimarkka, O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159–163
  18. Njoo, K.H., Van der Does, E. The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain. 1994;58:317–323
  19. Hou, C.R., Tsai, L.C., Cheng, K.F., Chung, K.C., Hong, C.Z. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 2002;83:1406–1414
  20. Hanten, W.P., Olson, S.L., Butts, N.L., Nowicki, A.L. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000;80:997–1003
  21. Phillips, S., Mercer, S., Bogduk, N. Anatomy and biomechanics of quadratus lumborum. Proc Inst Mech Eng H. 2008;222:151–159
  22. Perry, J. Gait analysis: normal and pathological function. Slack, Thorofare; 1992
  23. Neumann, D. Kinesiology of the musculoskeletal system: foundations for rehabilitation. 1st ed. Mosby, St. Louis; 2002
  24. Itoh, K., Asai, S., Ohyabu, H., Imai, K., Kitakoji, H. Effects of trigger point acupuncture treatment on temporomandibular disorders: a preliminary randomized clinical trial. J Acupunct Meridian Stud. 2012;5:57–62
  25. Itoh, K., Katsumi, Y., Hirota, S., Kitakoji, H. Effects of trigger point acupuncture on chronic low back pain in elderly patients—a sham-controlled randomised trial. Acupunct Med. 2006;24:5–12
  26. Itoh, K., Katsumi, Y., Hirota, S., Kitakoji, H. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complement Ther Med. 2007;15:172–179
  27. Dommerholt, J., delMayoral, O.M., Grobli, C. Trigger point dry needling. J Man Manip Ther. 2006;14:17
  28. Lucas, K.R. The impact of latent trigger points on regional muscle function. Curr Pain Headache Rep. 2008;12:344–349

You can find the full article at the US National Library of Medicine National Institutes of Health. https://www.ncbi.nlm.nih.gov/pubmed/23127304