Taut Bands in Myofascial Pain

描述（由申请人提供）：我们的初步研究首次对肌筋膜紧绷带进行了基于其刚度值的成像。这是通过磁共振弹性成像（MRE）技术完成的。本应用的目的是进一步验证我们的假设，即肌筋膜拉紧带的MRE刚度测量是可靠的，并且对肌筋膜手工治疗引起的变化敏感。如果MRE技术是可靠和敏感的，它可以用于评估在未来的研究中手工治疗的疗效。目前的研究将解决以下具体目标：具体目标1：确定肌筋膜紧绷带及其周围肌肉组织的MRE刚度测量的可靠性。我们将研究40名患有上斜方肌筋膜疼痛（由临床检查和病史确定）且MRE上至少有一条紧绷带的受试者。最初的MRE检查将描述肌筋膜紧绷带的特征（MRE僵硬图像中紧绷带的位置、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进行第二次MRE检查，并对测量结果进行统计比较以确定可靠性。在第二次MRE前后分别用电痛计和疼痛VAS评分对疼痛进行量化；本次Aim的变化分数将作为Aim 2的对照组。具体目标2：确定触发点压力释放治疗后MRE刚度测量值对疼痛视觉模拟量表（VAS）变化的敏感性。40名患有上斜方肌筋膜疼痛的受试者将使用MRE进行评估。将量化上斜方肌的整体肌肉刚度以及MRE图像中确定的紧带的力学特征（紧带面积的大小和位置以及刚度比）。触痛将由医生使用电痛计和疼痛VAS评分进行评估。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，上斜方肌的僵硬度将通过第二次MRE再次测量。为了验证我们的假设（MRE紧绷带测量值对治疗引起的变化敏感，如疼痛评分降低所示），将统计确定疼痛VAS变化与紧绷带MRE参数变化之间的关联。

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.