title: Ultrasound and laser as stand-alone therapies for myofascial trigger points: a randomized, double-blind, placebo-controlled study.
abstract: OBJECTIVE
  Ultrasound (US) and low-level laser therapy (LLLT) are commonly employed for myofascial trigger points (MTP) despite lack of evidence for usage as stand-alone treatments. The aim of the study was to determine, on MTP of the upper trapezius muscle (uTM), the effects of US and LLLT per se, as delivered in accordance with the procedures reported by surveys about their usage among physiotherapists.
  
  
  METHODS
  Design was set as a double-blind, randomized, placebo-controlled study. Sixty participants with at least one active MTP in uTM (28 women and 32 men; mean age 24.5 ± 1.44 years) were recruited and randomly assigned to one out of five groups: active US (n = 12), placebo US (n = 12), active LLLT (n = 11), placebo LLLT (n = 11) and no therapy (control, n = 14). The participants and outcome assessor were blinded to the group assignment and therapy delivered. Three outcome measures were assessed at baseline, after a 2-week treatment and 12 weeks after the end of the intervention (follow-up): pressure pain threshold, subjective pain on a numerical rating scale and muscle extensibility performing a cervical lateral flexion. All subjects assigned to the intervention groups were treated five times weekly for overall 10 treatments given. Two-way ANOVA was used to compare differences before and after intervention and among groups at each time-point.
  
  
  RESULTS
  After the 2-week intervention, all groups showed pressure pain threshold, numerical rating scale and cervical lateral flexion significant improvements (p < 0.05), which were confirmed at the follow-up. When performing multiple comparisons, controls scored significantly less than both the active therapies and placebos, whereas no differences were detected between active therapies and placebos.
  
  
  CONCLUSIONS
  Ultrasound and LLLT provided significant improvements in pain and muscle extensibility, which were superior to no therapy but not to placebos, thus raising concerns about the suitability, both economically and ethically, of administering such common physical modalities as stand-alone treatments in active MTP of the uTM.
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Manca
authors.forename: E
authors.initials: E
authors.lastname: Limonta
authors.forename: G
authors.initials: G
authors.lastname: Pilurzi
authors.forename: F
authors.initials: F
authors.lastname: Ginatempo
authors.forename: E R
authors.initials: ER
authors.lastname: De Natale
authors.forename: B
authors.initials: B
authors.lastname: Mercante
authors.forename: E
authors.initials: E
authors.lastname: Tolu
authors.forename: F
authors.initials: F
authors.lastname: Deriu
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D009209:Myofascial Pain Syndromes / Q000503:physiopathology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D017288:Pain Threshold; D026741:Physical Therapy Modalities; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*
keywords: Evidence based practice; Management and Professional issues; Musculoskeletal; Physiotherapy; RCT