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Low back pain (LBP) is a highly prevalent disease. Among the various causes of LBP, one of the most frequent is myofascial pain syndrome (MPS) which affects the spinal stabilizer muscles. The aims of this study were to compare the differences in muscular electrical activity and biomechanical properties between the painful and non-painful sides in patients with unilateral MPS and to verify the feasibility of surface electromyography (sEMG) and MyotonPRO for assisting in MPS assessment. Forty patients with unilateral lumbar MPS were recruited via the Department of Rehabilitation Medicine Center of West China Hospital Sichuan University from October 2022 to October 2023. The electrical properties of the bilateral erector spinae muscles were characterized by sEMG signals during a trunk extension task. The following four time-domain features of sEMG were extracted: root mean square (RMS), mean absolute value (MAV), integrated EMG (iEMG), and waveform length (WL). And two frequency domain features were extracted: the median frequency (MDF) and mean power frequency (MPF). The mechanical properties of the muscles were assessed by MyotonPRO at rest. The following biomechanical parameters were acquired: oscillation frequency [Hz], dynamic stiffness [N/m], logarithmic decrement, relaxation time [ms], and Creep. The visual analog scale (VAS) was used to evaluate the pain severity, and the Oswestry Disability Index (ODI) was used to evaluate the severity of disability and disruption to lifestyle activities caused by LBP pain. The outcome measures were obtained prior to the Platelet-rich plasma (PRP) treatment and repeated two weeks after treatment. (1) Prior to the PRP treatment, all sEMG time-domain features on the painful side were significantly higher than those on the non-painful side (RMS, p < 0.001; MAV, p < 0.001; iEMG, p < 0.001; WL, p = 0.001). However, there was no significant difference in the sEMG frequency-domain features (MPF, p = 0.478; MDF, p = 0.758). On the mechanical side, there were significant differences in oscillation frequency (p = 0.041) and logarithmic decrement (p = 0.022) between the painful side and non-painful side, but no significant differences in dynamic stiffness, relaxation time, and creep (both p > 0.05). (2) Two weeks after the PRP treatment, statistically significant decreases were observed in both post-treatment VAS (p < 0.001) and ODI scales (p < 0.001), indicating the PRP treatment clinically significantly reduced the level of. MPS. This change coincided with all sEMG time-domain features, in which the values at the painful side decreased significantly (RMS, p = 0.001; MAV, p = 0.001; iEMG, p = 0.001; WL, p = 0.001). However, no significant difference in the sEMG frequency-domain features (MPF, p = 0.620; MDF, p = 0.850) was found. On the mechanical side, only logarithmic decrement on the painful side increased significantly (p < 0.001). Our combined MyotonPRO and sEMG results indicated that MPS likely leads to increased muscle tone and decreased muscle elasticity, manifested by abnormal time-domain features of sEMG and biomechanical properties. The changes in these objective measurements were agreed with the changes in subjective outcome measures of pain and function currently assessed in the patients with MPS. A single PRP treatment may alleviate muscle dysfunction caused by MPS. These preliminary results demonstrated the potential feasibility of using sEMG and MyotonPRO as tools for assessing the neuromuscular function of MPS.

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Background: This study aims to investigate the effects of dry-needling treatment on the quality of life in athletes with myofascial pain syndrome (MPS). Methods: The participants included in the study were 50 athletes (38 males and 12 females) diagnosed with MPS. The treatments were carried out in four sessions, 5/7 days apart on 55 muscles in total. A 36-item health survey (SF-36) was implemented to determine the participants' quality of life. The chi-square test was used to determine the differences between measurements. Results: Dry-needling treatment has a positive influence on self-perspective of physical functioning (p = 0.011, on average), physical problems (p = 0.001, on average), emotional problems (p = 0.004, on average), social functioning (p = 0.001, on average), pain (p = 0.001, on average), and mental health and vitality (p = 0.001, on average) in athletes with MPS. The only quality-of-life dimension not influenced by the dry-needling treatment is the general health perception (p = 0.340, on average). Conclusions: Dry-needling therapy has positive effects on the perception of quality of life in athletes with MPS.

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BACKGROUND: Physiotherapists encounter challenges in diagnosing myofascial trigger points (MTrPs), which are crucial for managing myofascial pain but difficult due to their complex referred pain patterns. We aimed to assess if an interactive software (MyofAPPcial) can enhance the ability of physical therapists specialized in musculoskeletal disorders (as clinicians and as researchers and educators) to identify referred pain patterns associated with specific MTrPs and to explore their opinion about incorporating this technology regularly into their professional setting. METHODS: After developing the app, a descriptive cross-sectional survey study was conducted. Participants were asked about their demographic characteristics, professional experience, two knowledge tests (first without and later with MyofAPPcial support) and the 18-item mHealth app usability questionnaire. RESULTS: Fifty-nine participants completed the survey (47.5% clinicians and 62.5% researchers/educators). Groups were comparable in terms of age, gender and professional experience (p > .05). However, clinicians coursed shorter specific MPS trainings (p = .007) and handle more cases a week (p < .001). In the first knowledge test, participants in both the groups were more accurate in identifying pain maps of highly prevalent MTrPs than those with a moderate or low prevalence (p < .001), with no differences between the groups for individual items (all, p > .05) nor the total score (p > .05). In the second knowledge test, perfect scores were obtained for all items in both the groups. Finally, MyofAPPcial scored high satisfaction and app usefulness, with no difference between clinicians and researchers/educators (except greater convenience of use for researchers/educators p = .02). CONCLUSIONS: MyofAPPcial enhances physiotherapists' ability to accurately identify MTrPs, with a good acceptation among clinicians and researchers/educators.

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Background: Chronic pelvic pain remains challenging for physicians to manage due to central and peripheral sensitization and multiple pain generators including the bladder, pelvic floor, and pudendal nerve. Pain management providers have used nerve blocks for years for diagnosis and treatment. We developed a desensitization algorithm that provides a stepwise approach to improve patients pain scores. Methods: This is a prospective observational cohort study of 182 women aged 15-90 years old with chronic pelvic pain using an algorithm from 2016 to 2018. Treatment started with an Anesthetic Challenge Test of the bladder to guide us through a protocol of intravesical therapy and/or pudendal nerve blocks as a second step. Results: ACT POSITIVE patients, who received intravesical therapy: 84% had a Visual Analog Score pain improvement of at least 50%, 64% improved at least 80% (41% pain-free). Those desiring additional relief that received further Pudendal Blocks: 83% had final improvement of at least 50% (67% pain-free). ACT NEGATIVE patients received Pudendal Blocks with 80% of subjects achieving at least 50% relief, 65% improved at least 80% (35% pain-free). All final groups showed a statistically significance of P < .05% when compared to their initial pain scores. Conclusion: Management of women with chronic pelvic pain would ideally start with treating a specific diagnosis which, in most cases, is difficult to establish since the majority have more than one pain generator. Our algorithm simplified the approach and reduced the severity of pain scores prior to any further necessary surgical interventions.

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Introduction: Short-track speed skating (short track) is an Olympic sport characterized by a specific body position and counterclockwise movement on the track. Based on previous studies, we hypothesized that athlete body positions employed in this sport could lead to asymmetric overuse disorders of the left lower limb muscles. An increased number of latent trigger points (LTrPs) was confirmed in individual muscles of the overloaded left limb of short-track athletes. This study aimed to compare the number of LTrPs and the level of resting muscle tone between elite junior short-track athletes and healthy non-athletes. Methods: The experimental (EXP) group comprised 15 elite short-track junior athletes from the Polish national team and the control (CON) group comprised 15 healthy young volunteers. In both groups, the left leg was tested for (i) the presence of LTrPs and (ii) resting muscle tone (RMT), assessed using surface electromyography in six muscles. Results: The EXP group showed a higher number of LTrPs in the left lower limb, compared with the CON group. The muscle that was most significantly affected in the athletes was the vastus lateralis obliquus [χ 2 (1, N = 30), p < 0.001, V Cramer = 0.71]. This muscle also differed significantly between the groups in terms of the RMT (p = 0.033, Cohen's d = 0.87). Conclusions: Elite short-track junior athletes presented with increased RMT and an increased number of LTrPs in the vastus lateralis oblique muscle, compared with healthy non-athletes.

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BACKGROUND: Myofascial pain syndrome (MPS) is a chronic condition caused by sensitive pressure regions within the muscles known as myofascial trigger points (MTrPs). OBJECTIVE: The purpose of this randomized controlled trial (RCT) was to assess the effectiveness of adding dry needling (DN) to activate MTrPs in the upper trapezius muscle compared with usual physiotherapy among individuals with chronic neck pain. METHODS: Thirty participants were recruited from a private clinic in Saudi Arabia. Their mean age was 29.7 ± 4.4 years. The subjects were randomized into two groups: the experimental group (application of DN to the MTrPs coupled with usual physiotherapy (n = 15)) and the control group (usual physiotherapy alone (n = 15)). The primary outcomes were pain (assessed using the visual analog scale) and disability (Neck Disability Index), and the secondary outcomes were neck active range of motion (AROM; assessed using cervical ROM) and depression (Beck's Depression Inventory). RESULTS: Significant between-group difference in pain intensity was observed immediately post-intervention. Participants in the experimental group had significantly higher pain (mean difference = 1.27, 95% confidence interval [CI] 0.20, 2.33, p = 0.022, Cohen's d = 0.889) than those in the control group. There was no significant difference between both groups in pain intensity during the follow-up. There were no between-group differences in disability immediately post-intervention. However, there was a between-group difference in disability at follow-up; participants in the experimental group had significantly lower disability (mean difference = -3.13, 95%CI -5.07, -1.20, p = 0.003, Cohen's d = 1.211) than those in the control group. Immediately post-intervention, the experimental group showed greater flexion AROM compared to the control group, with no differences in other AROM measures. At follow-up, the experimental group exhibited significantly higher neck AROM in extension, flexion, right and left side bending, and lower depression, while no differences were observed in right- and left-rotation AROMs between groups. CONCLUSIONS: The addition of DN to standard physiotherapy effectively improved disability, AROM (extension, flexion, and side bending), and depression among patients with chronic neck pain.

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The diagnosis of myofascial pain syndrome is usually made after structural-morphological explanations have been ruled out. The lack of positive findings to guide treatment inevitably leaves room for interpretation despite the extensive use of all imaging, neurophysiological or serological diagnostics. Under these circumstances, a careful differential diagnosis must be made between functional and structural aspects, both of which in many cases must be assessed in their different relevance. Particular attention must be paid to indications of vegetative-sympathetic adjustment disorders.The great importance of a clinical, experience-based approach to this symptom pattern becomes clear here, especially if the technical diagnostic data is of no help. The dominance of imaging findings naturally promotes a structure-based, mechanistic understanding of the illness. In contrast, the emotional, vegetative mood of the patient should be given greater consideration as a diagnostic and therapeutic focus. Treatment measures should have a high success rate, as persistent reductions in stimulus thresholds may lead to prognostically unfavorable chronification.

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Background: This systematic review aimed to answer the question, "What is the efficacy of acupuncture treatment in patients with temporomandibular disorder (TMD) with myofascial pain?". Data sources and study selection: This study followed PRISMA guidelines and was registered in PROSPERO. The electronic search strategy was applied to the Scopus, PubMed, Embase, and Science Direct databases. As inclusion criteria, were selected randomized clinical articles that evaluated patients with myofascial pain symptoms treated by acupuncture without the restriction of time and language. Results: The search in the databases resulted in 286 articles, after removing the duplicates 251 were analyzed by title and abstract. Twenty were selected for full reading and 10 were included in the systematic review. The studies evaluated acupuncture treatments by puncture and laser, auriculotherapy by puncture and laser, and an occlusal device for treating myofascial TMD. Conclusions: Comparing acupuncture with placebo acupuncture, it was observed that it is effective for subjective pain relief and palpation of orofacial structures with immediate results; it should be noted that there is still no specific protocol and that the duration of treatment must be personalized. When comparing it with the occlusal device, the associated treatment has enhanced the results. Future studies are suggested by the current literature gap that prevents the determination of clinical guidelines for effective acupuncture treatment in TMD patients with myofascial pain. Practical implications: Laser and needle puncture acupuncture treatment and laser and needle puncture auriculotherapy have shown favorable results in short-term myofascial pain relief. The need for long-term studies to assess benefits and reduce possible biases is highlighted. Clinical trial registry name: PROSPERO (CRD42021271505).

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Driving stress is a multifaceted phenomenon, and the experience of driving invokes stress. Driving causes the activation of stress-response mechanisms, leading to short-term and long-term stress responses resulting in physiological and behavioral changes. The aim of this study was to evaluate driving stress-initiated effects on orofacial functions and health behaviors in the Riyadh population. A cross-sectional survey was conducted in Riyadh using a pre-validated set of questionnaires for habitual information, a driving stress assessment using a driving-behavior inventory, and an assessment of parafunctional habits and effects on orofacial functions. The results indicate that nearly 50% of the sample spends more than two hours commuting, and more than 50% of the sample has inadequate sleep and insufficient exercise. Oral parafunctional habits like nail biting (p = 0.039) and lip or object biting (p = 0.029) had a significant correlation with aggressive driving behaviors, whereas the grinding of teeth (p = 0.011), the clenching of jaws (p = 0.048), lip or object biting (p = 0.018), and pain in mastication (p = 0.036) had a positive correlation with driving dislikes. Driving stress can be detrimental to one's health and not only impacts health behaviors but also induces oral parafunctional habits and adversely affects orofacial regions and functions. Acute driving stress responses may be transient. However, prolonged driving stress can be maladaptive and can increase the risk of chronic diseases including chronic temporomandibular joint disorders and parafunctional habit-related changes in the oral cavity.

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OBJECTIVES: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling. METHODS: Myofascial pain syndrome in the popliteus muscle may change motor control in the affected and related muscles due to changes in proprioceptive and nociceptive afferents, which can exacerbate patellofemoral pain syndrome. The primary purpose of the current study was to explore the electromyographic activity of the local and proximal muscles of the knee joint in patellofemoral pain syndrome accompanied by secondary myofascial pain syndrome specifically affecting the popliteus muscle following dry needling. RESULTS: During step-up, the onset and offset latencies of the local and proximal muscles of the knee joint, except for the offset latency of the gluteus maximus muscle (p-value=0.162), significantly decreased in the intervention group compared to the control group (p-value<0.046). Additionally, there were no significant differences (p-value>0.116) between the groups in the amplitude ratio of the local and proximal muscles of the knee joint during both step-up and step-down. CONCLUSIONS: The present study revealed that dry needling of the popliteus muscle with secondary myofascial pain syndrome associated with patellofemoral pain syndrome constructively modified the local and proximal motor control of the knee joint during step-up.

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Introduction: Myofascial pelvic pain (MFPP) is a prevalent yet frequently overlooked condition characterized by myofascial trigger points located within the pelvic floor muscles. Women with MFPP often experience severely reduced quality of life due to impaired sexual health. Here, we examined the relationship between MFPP and sexual function. Materials and Methods: Eighty-three women with a benign gynecological condition were included in this pilot study. For each patient, we obtained a complete medical history, measured different types of subjective pain intensity using a visual analog scale, performed a validated standardized examination of the pelvic floor muscles for measuring MFPP, and used the German Female Sexual Function Index (FSFI-d) questionnaire. Results: Compared to women without MFPP (46 out of 83; 55.4%), the women with MFPP (37 out of 83; 44.6%) reported experiencing pain on more days per month (8 vs. 3 days/month; p = 0.002) and higher median VAS scores for dyspareunia (4 vs. 0; p < 0.001). We also found a significant inverse correlation between the severity of MFPP and overall FSFI-d scores (r = -0.35; p < 0.001), particularly in the FSFI-d subdomains of pain (r = -0.364; p < 0.001), lubrication (r = -0.230; p = 0.005), and arousal (r = -0.360; p < 0.001). Conclusions: Due to the higher prevalence of dyspareunia and pelvic pain, MFPP significantly impacts several aspects of female sexual health and function. This information, combined with increased awareness regarding MFPP, may provide a foundation for designing individualized therapies, thereby improving the quality of life of women affected by MFPP.

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Musculoskeletal disorders, especially chronic muscle pain, have a significant impact on public health, affecting millions worldwide. This review examines recent advancements in the diagnosis and management of myofascial pain, with a focus on the refined application of trigger point theory. This theory now incorporates an intricate model that blends biomechanical and neurophysiological mechanisms, essential for understanding the initiation and persistence of pain, and necessitating targeted therapeutic interventions. Utilizing a methodical approach, this paper categorizes muscle pain into three types: Muscle Belly Pain, Origin-Insertion Pain, and Referred Pain, as delineated in the most recent edition of "Myofascial Pain and Dysfunction-The Trigger Point Manual." Such classification enhances diagnostic precision and therapeutic effectiveness by establishing a specific treatment protocol for each type of pain. The paper discusses the implications of various treatments, such as dry needling and manual therapy, which are informed by empirically derived trigger point charts. These charts are instrumental in pinpointing the exact locations of pain sources and customizing treatment plans. Moreover, this review critically assesses the evolving nature of trigger point charts and champions a holistic approach to pain management. It underscores the necessity of integrating biomechanics, kinesiology, and compensatory mechanisms to provide a comprehensive understanding that allows practitioners to address not only symptomatic pain but also the root causes of musculoskeletal disorders, thereby enhancing long-term patient care outcomes in clinical environments.

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Objective: To assess the therapeutic efficacy of botulinum toxin type A (BTX-A) for managing myofascial pain related to temporomandibular disorders (TMDs). Methods: This study was conducted according to the PRISMA 2020 statement guidelines. The PubMed, Embase, and Cochrane Library databases were searched. Only randomized controlled trials were included. The primary outcome was a pain score on the visual analog scale, and the secondary outcomes were maximum mouth opening and adverse effects. The Cochrane risk of bias tool was used to assess risk bias. A meta-analysis of studies with the same interventions, controls, assessment methods, and follow-up durations was performed. Results: A total of 519 studies were retrieved, of which 20 randomized controlled trials were included in the qualitative analysis and six were included in the meta-analysis. The results showed that, compared with placebo, BTX-A injection was more effective at relieving myofascial pain, and its effect was similar to that of conventional methods. However, there was no difference in maximum mouth opening between the two groups. After the study assessment with the RoB 2.0 tool, six studies showed a low risk of bias, 13 studies showed some concerns regarding the reported results, and only one study showed a high risk of bias. Adverse effects of BTX-A injection were observed in four studies. Conclusions: In conclusion, BTX-A is effective at relieving pain in TMD patients but does not improve mouth opening. To minimize adverse effects, we recommend a low dose of BTX-A for TMD patients who do not experience complete pain relief from conservative treatments.

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OBJECTIVE: Use clinical pain measurement tools to investigate and compare the prevalence of pelvic loin disoders in women with and without endometriosis. STUDY DESIGN: Chronic pelvic pain (CPP) associated with endometriosis has diverse origins, including musculoskeletal factors. Musculoskeletal dysfunction in the pelvic region is theorized to result from sustained muscular contraction, triggered by altered visceral stimuli and adoption of antalgic postures, causing secondary damage to muscles, ligaments, and joints. CPP significantly impacts quality of life, relationships, sexuality, and mental health. However, limited data exists on musculoskeletal impacts of endometriosis and CPP. It was made a case-control study at Maternidade Escola Assis Chateaubriand from August 2017 to January 2021. Evaluated 71 women: 41 in endometriosis group (EG) and 30 in control group (CG). Data collection included sociodemographic questionnaires, musculoskeletal physiotherapeutic evaluations, pain mapping, pressure pain thresholds, kinesiophobia, and disability measurements. Statistical analysis was performed using Spearman's Rho test to determine correlations. RESULTS: Mean age of participants was 31 years. EG exhibited lower pain threshold variations in lumbopelvic trigger points than CG (P < .05). Significant muscle flexibility differences between groups were observed; EG had reduced flexibility (P < .05). Most common pain areas were hypogastrium in EG (48.78 %) and left lumbar in CG (30 %). EG had higher kinesiophobia values (P = .009). There was a weak association between kinesiophobia-pressure threshold association observed in CG's lumbar pelvic region. CONCLUSION: Women with Endometriosis and CPP exhibit higher prevalence of musculoskeletal disorder, lower pain thresholds, decreased lumbopelvic muscle range of motion, higher kinesiophobia scores, and increased disability indices with low back pain compared to healthy women.

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BACKGROUND: Injections of botulinum toxin type A (BoNT-A) have been proposed as an additional treatment modality for patients suffering chronic temporomandibular disorder (TMD)-related myofascial pain (MFP). BoNT-A impairs muscle function, along with its analgesic effect, and a minimal effective dose should be used. The objective of this randomized placebo-controlled crossover study was to evaluate the clinical benefit of a moderate dose (50 U) of BoNT-A. METHODS: Sixty-six subjects were randomized into two groups, one which received BoNT-A first and a second which received a saline solution (SS) first. Follow-ups were performed 2, 11, and 16 weeks after the injections. Diagnostic criteria for temporomandibular disorders (DC/TMD) diagnostic algorithms were used to evaluate characteristic pain intensity (CPI) and pain-related disability based on the Graded Chronic Pain Scale (GCPS). Electromyographic and bite force were also evaluated. RESULTS: The within-group analysis showed a significant improvement in pain intensity and pain-related disability after BoNT-A (p < 0.001, p = 0.005, p = 0.011) and SS (p = 0.003, p = 0.005, p = 0.046) injections up to week 16. The between-group analysis of pain-related variables revealed no differences between groups at any time. Nonetheless, BoNT-A, but not SS, caused a significant decline in muscle performance. The number needed to treat (NNT) regarding a clinically significant pain reduction (≥30%) was 6.3, 57.0, and 19.0 at 2, 11, and 16-week follow-ups favoring BoNT-A. CONCLUSIONS: Injections of 50 U of BoNT-A might improve MFP symptoms, but the specific effect of the drug on pain compared to the placebo is not obvious.

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PURPOSE: This study explored the relationship between central sensitization symptoms, assessed using the Central Sensitization Inventory (CSI), and psychophysical factors in patients with chronic masticatory myofascial pain (MMP) transitioning from the acute to chronic stages. METHODS: In this study, 23 patients with MMP and 22 healthy volunteers were assessed using psychophysical tests, including measurements of pressure pain threshold (PPT) and temporal summation of pain (TSP). Additionally, CSI scores were recorded to evaluate central sensitization symptoms. RESULTS: Patients with chronic MMP showed significantly lower PPT in all masticatory muscles and extratrigeminal areas compared with controls. However, there was no significant correlation between CSI scores and psychophysical test results in patients with MMP. CONCLUSION: The significant enhancement of TSP in patients with subchronic MMP suggests a potential role in the onset of myofascial pain. The main finding suggests that sub-chronic symptom patients show higher CSI scores despite no sensory testing changes, indicating that central sensitization possibly precedes observable symptoms.

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Two cases of complicated pain exist: posterior screw fixation and myofascial pain. Intramuscular pulsed radiofrequency (PRF) may be an alternative treatment for such patients. This is a two-stage animal study. In the first stage, two muscle groups and two nerve groups were subdivided into a high-temperature group with PRF at 58 °C and a regular temperature with PRF at 42 °C in rats. In the second stage, two nerve injury groups were subdivided into nerve injury with PRF 42 °C on the sciatic nerve and muscle. Blood and spinal cord samples were collected. In the first stage, the immunohistochemical analysis showed that PRF upregulated brain-derived neurotrophic factor (BDNF) in the spinal cord in both groups of rats. In the second stage, the immunohistochemical analysis showed significant BDNF and tropomyosin receptor kinase B (TrkB) expression within the spinal cord after PRF in muscles and nerves after nerve injury. The blood biomarkers showed a significant increase in BDNF levels. PRF in the muscle in rats could upregulate BDNF-TrkB in the spinal cord, similar to PRF on the sciatica nerve for pain relief in rats. PRF could be considered clinically for patients with complicated pain and this study also demonstrated the role of BDNF in pain modulation. The optimal temperature for PRF was 42 °C.

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BACKGROUND: There are no data on the additional contribution of dry needling (DN) for trigger points (TPs) accompanying patients with cervical spondylosis (CS). OBJECTIVE: To analyse the contribution of DN applied to concomitant active TPs in the upper trapezius muscle on the treatment outcomes of physiotherapy in CS. METHODS: In this prospective randomized controlled study, 70 patients with CS and active TPs in the upper trapezius muscle were included. The first group received physiotherapy for 5 days per week for 3 weeks. The second group received DN with the same program. All participants were evaluated before treatment (day 0) and at the end of treatment (day 21) in terms of pain, functional status, quality of life, anxiety/depression scores, and number of TPs. RESULTS: 33 patients in the first group and 32 patients in the second group completed the study. While the change over time was found significant in all variables, the change was not different between groups. The group-time interaction effect was not found to be statistically significant in any variable. Percentage changes of all variables were similar between the groups. CONCLUSION: DN treatment added to the physiotherapy did not contribute to recovery in patients with CS.

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BACKGROUND: Myofascial pain syndrome (MPS) is a particular type of temporomandibular joint disorder. Research findings comparing various treatment approaches are scarce and controversial. Therefore, this study aimed to compare the effectiveness of ultrasound therapy, stabilization splint, TheraBite device, and masticatory muscle exercises in reducing pain intensity and improving mandibular mobility in patients with MPS. METHODS: It was a single-blind, randomized, parallel-group, active-controlled trial that took place between April 2023 and October 2023 at the Department of Fixed Prosthodontics, Damascus University. Patients older than 18 years old with myofascial pain accompanied by limited jaw opening and pain lasting for at least 6 months were included. Eighty patients were randomly assigned into four groups using online randomization software: ultrasound therapy, stabilization splint, TheraBite device, and masticatory muscle exercises. Only outcome assessors were masked to treatment allocation. The exercise regimen was the exercise program for patients with TMD. The following primary outcome measures were considered at the baseline (t0), at the first (t1), second (t2), and fourth (t3) week of treatment, and at the second (t4) and fifth (t5) month of follow-up: pain intensity using the visual analogue scale, maximum interincisal opening, right lateral movement, and left lateral movement measured in millimeters. RESULTS: The pain level changed from severe to mild at t3 in ultrasound therapy, stabilization splint, and TheraBite device groups. In the masticatory muscle exercises group, it changed to moderate, with a significant difference between ultrasound therapy (p = 0.012) and stabilization splint (p = 0.013) groups. In addition, the mandibular mobility continued to improve at the subsequent follow-up periods (t4 and t5). CONCLUSIONS: All therapies are equally effective after 5-month follow-up. However, ultrasound therapy and stabilization splints have the benefit of achieving rapid improvement. TRIAL REGISTRATION: ISRCTN20833186.

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Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the subjects was used to determine the Frankfort plane and to study its degree of inclination. Myofascial pain syndrome is one of the most common causes of musculoskeletal pain. Trigger points are hyperirritable spots located in a palpable taut band of skeletal muscle that is painful on compression or stretch and causes a local twitch in response to snapping or palpation of the band. Objectives: The aim of this study was to analyze the relationship between the Frankfort plane and the presence of myofascial trigger points causing cervical myofascial pain. Methods: This is a cross-sectional descriptive observational study. All subjects underwent a photographic study to determine the degree of Frankfort plane inclination, and the posterior cervical musculature was palpated to find myofascial trigger points that were measured with a pressure algometer in three cervical locations on the right and left sides. Results: Our study included 47 subjects who had suffered at least one episode of cervical pain in their lifetimes. The mean age was 22.3 ± 2.9 years. Statistically significant results were found in the first right location and sports practice (p = 0.007), in the second right location and gender (p = 0.0097), in the second right location and sports practice (p = 0.0486), in the third right location and gender (p = 0.0098), and in the first, second, and third left locations and gender (p = 0.0083; p = 0.024; p = 0.0016, respectively). In the correlation between the Frankfort plane and the presence of myofascial trigger points, all locations were positive, with the first right location being statistically significant (p = 0.048). Conclusions: A positive relationship was found between the Frankfort plane and the presence of myofascial trigger points. The greater the angle of the Frankfort plane, the less the myofascial pain.