title: Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial.
abstract: OBJECTIVE
  This study aimed to assess the effects of single and multiple massage treatments on pressure-pain threshold (PPT) at myofascial trigger points (MTrPs) in people with myofascial pain syndrome expressed as tension-type headache.
  
  
  METHODS
  Individuals (n = 62) with episodic or chronic tension-type headache were randomized to receive 12 twice-weekly 45-min massage or sham ultrasound sessions or wait-list control. Massage focused on trigger point release (ischemic compression) of MTrPs in the bilateral upper trapezius and suboccipital muscles. PPT was measured at MTrPs with a pressure algometer pre and post the first and final (12th) treatments.
  
  
  RESULTS
  PPT increased across the study timeframe in all four muscle sites tested for massage, but not sham ultrasound or wait-list groups (P < 0.0001 for suboccipital; P < 0.004 for upper trapezius). Post hoc analysis within the massage group showed (1) an initial, immediate increase in PPT (all P values < 0.05), (2) a cumulative and sustained increase in PPT over baseline (all P values < 0.05), and (3) an additional immediate increase in PPT at the final (12th) massage treatment (all P values < 0.05, except upper trapezius left, P = 0.17).
  
  
  CONCLUSIONS
  Single and multiple massage applications increase PPT at MTrPs. The pain threshold of MTrPs have a great capacity to increase; even after multiple massage treatments additional gain in PPT was observed.
  Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Understand the contribution of myofascial trigger points to myofascial pain; (2) Describe an effective treatment for decreasing tenderness of a myofascial trigger point; and (3) Discuss the relative values of single vs. multiple massage sessions on increasing pressure-pain thresholds at myofascial trigger points.
  Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
authors.affiliation: From the College of Nursing, University of Colorado at Denver, Aurora (AFM, SJS); Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill (JDM); Boulder College of Massage Therapy, Boulder, Colorado (NB); and Colorado Pain, Golden (JPK).
authors.forename: Albert F
authors.initials: AF
authors.lastname: Moraska
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schmiege
authors.forename: John D
authors.initials: JD
authors.lastname: Mann
authors.forename: Nathan
authors.initials: N
authors.lastname: Butryn
authors.forename: Jason P
authors.initials: JP
authors.lastname: Krutsch
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008405:Massage / Q000379:methods*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009209:Myofascial Pain Syndromes / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D009778:Occipital Lobe / Q000503:physiopathology; D010147:Pain Measurement; D017288:Pain Threshold; D011312:Pressure; D016037:Single-Blind Method; D064171:Superficial Back Muscles / Q000503:physiopathology; D018781:Tension-Type Headache / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D061028:Trigger Points / Q000503:physiopathology*; D014850:Waiting Lists; D055815:Young Adult