Is Exercise Rehabilitation an Effective Adjuvant to Clinical Treatment for Myofascial Trigger Points? A Systematic Review and Meta-Analysis

Abstract

Purpose

To systematically evaluate the effect of exercise rehabilitation as an adjuvant to clinical treatment for myofascial trigger points (MTrPs).

Patients and Methods

ESBCO, PubMed, Science Direct, Web of Science, China Knowledge Network (CNKI), and Wanfang databases were comprehensively searched from database inception date through July 2022. Randomized controlled trials comparing MTrPs treatments that included exercise rehabilitation with a single clinical treatment. Two researchers independently screened articles using inclusion/exclusion criteria, scored methodologic quality, and extracted data including patient demographics, interventions, and outcomes.

Results

We included 14 RCTs (N = 734). Results showed short-term (mean difference [MD], −2.25; 95% confidence interval [CI], −4.08 to −0.41; Z = 2.40; P = 0.02) and long-term (MD = −0.47; 95% CI: −0.80 to −0.17; Z = 3.05; P = 0.02) adjuvant exercise rehabilitation treatments were superior in reducing musculoskeletal pain intensity to single clinical treatment in controls, but long-term versus short-term effectiveness was not significantly different. The exercise rehabilitation group more effectively increased the range of motion (ROM) (standardized mean difference [SMD], 1.04; 95% CI: 0.32 to 1.77; Z = 2.84; P = 0.005) and decreased dysfunction (SMD = −0.93; 95% CI: −1.82 to −0.05; Z = 2.06; P = 0.04) than controls; no significant difference was observed in the pressure pain threshold (PPT) between two groups.

Conclusion

Exercise rehabilitation as an adjuvant to clinical treatment for MTrPs was moderately effective in relieving pain intensity, increasing ROM, and improving dysfunction versus single clinical intervention. These findings must be validated by larger, higher-quality studies.

Keywords:

• trigger points
• exercise
• rehabilitation
• meta-analysis
• randomized controlled trial

Abbreviations

CI, confidence interval; CNKI, China national knowledge infrastructure; MD, mean difference; MPS, myofascial pain syndrome; MTrPs, myofascial trigger points; PPT, pressure pain threshold; RCTs, randomized controlled trials; ROM, range of motion; SMD, standardized mean difference.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to declare.

Additional information

Funding

This research was funded by the Natural Science Foundation of the Jiangsu higher Education Institutions of China (grant number 19KJB310006), the National Natural Science Foundation of China (grant number 32000829) and “Qinglan Project” of the Jiangsu higher Education Institutions of China.