Taut Bands in Myofascial Pain

描述(申请人提供)：我们的初步研究首次根据肌筋膜紧绷带的僵硬值对其进行了成像。这是使用磁共振弹性成像(MRE)技术完成的。此应用程序的目的是进一步测试我们的假设，即肌筋膜张紧带的MRE硬度测量是可靠的，并且对手动肌筋膜疗法引起的变化敏感。如果MRE技术是可靠和敏感的，它可以在未来的研究中用于评估手动疗法的疗效。目前的研究将针对以下具体目标：具体目标1：确定肌筋膜张紧带及其周围肌肉组织MRE硬度测量的可靠性。40名患有上斜方肌筋膜疼痛(由临床检查和病史确定)和至少一条MRE紧绷带的受试者将被研究。初步的MRE检查将确定肌筋膜紧绷带的特征(紧绷带在MRE僵硬图像中的位置、紧绷带的面积以及紧绷带与周围肌肉组织之间的僵硬比)。受试者将在两小时后接受第二次MRE检查，并将这些测量结果进行统计比较，以确定可靠性。在第二次MRE前后使用电测痛仪和疼痛VAS评分对疼痛进行量化；此目标的变化分数将用作目标2的对照组。具体目标2：确定MRE僵硬测量对触发点压力释放疗法引起的疼痛视觉模拟评分(VAS)变化的敏感性。40名患有上斜方肌筋膜疼痛的受试者将接受MRE评估。上斜方肌的整体肌肉硬度以及在MRE图像中确定的紧张带的机械特征(紧张带的大小和位置、面积和僵硬比)将被量化。压痛程度将由医生使用电测痛仪和疼痛VAS量表进行评估。然后，受试者将接受TPR疗法的单一治疗。疼痛将由同一个人重新评估，上斜方肌的僵硬将再次通过第二次MRE进行测量。为了检验我们的假设(MRE紧束带测量对治疗引起的变化很敏感，如疼痛评分降低所示)，将从统计学上确定疼痛VAS的变化与紧束带MRE参数变化之间的关联。 公共卫生相关性：肌筋膜疼痛综合征是一种疼痛且经常致残的情况。手动治疗肌筋膜疼痛的确切益处仍不清楚，主要是因为还没有经过验证的方法来检测和测量肌肉中僵硬、疼痛的区域。磁共振弹性成像能够成像和测量肌肉僵硬，因此是一种很有前途的技术，可以准确地检测手法治疗后僵硬绷紧带和触发点的变化。

DESCRIPTION (provided by applicant): Our preliminary study has, for the first time, imaged myofascial taut bands based on their stiffness values. This was accomplished using the Magnetic Resonance Elastography (MRE) technique. The goal of this application is to further test our hypothesis that MRE stiffness measurements of myofascial taut bands are reliable and sensitive to changes resulting from myofascial manual therapies. If the MRE technique is reliable and sensitive, it can be used to assess the efficacy of manual therapies in future studies. The current study will address the following specific aims: Specific Aim 1: To determine the reliability of MRE stiffness measurements of myofascial taut bands and their surrounding muscle tissue. Forty subjects with upper trapezius myofascial pain (as determined by clinical examination and history) and at least one taut band on MRE will be studied. An initial MRE examination will characterize the myofascial taut bands (location of the taut band in the MRE stiffness image, area of the taut band, and stiffness ratio between the taut band and the surrounding muscle tissue). Subjects will undergo a second MRE examination two hours later and the measures statistically compared to determine reliability. Pain will be quantified with an electroalgometer and pain VAS score before and after the second MRE; the change scores from this Aim will be used as a control group in Aim 2. Specific Aim 2: To determine the sensitivity of MRE stiffness measurements to change in a pain visual analog scale (VAS) as a result of Trigger-point Pressure Release therapy. Forty subjects with upper trapezius myofascial pain will be assessed using MRE. The overall muscle stiffness of the upper trapezius as well as the mechanical characterization of taut bands identified in MRE images (size and location of the taut band area and stiffness ratio) will be quantified. Tenderness will be evaluated by a physician using an electroalgometer and a pain VAS scale. Subjects will then be treated with a single treatment with TPR therapy. Pain will be reevaluated by the same individual and stiffness of the upper trapezius will be again measured with a second MRE. To test our hypothesis (that MRE taut band measurements are sensitive to changes resulting from therapy, as indicated by reduced pain score), associations between changes in pain VAS and changes in the MRE parameters of the taut bands will be statistically determined. PUBLIC HEALTH RELEVANCE: Myofascial pain syndrome is a painful and often disabling condition. The exact benefits of manual therapies for myofascial pain remain unknown largely because there are no proven methods of detecting and measuring stiff, painful areas in muscles. Magnetic Resonance Elastography is able to image and measure muscle stiffness and therefore is a promising technique to accurately detect changes in stiff taut bands and trigger points after manual therapy treatment.