Physical muscle treatment Therapists may use myotherapy (deep pressure as in Bonnie Prudden's approach, massage or tapotement as in Dr. Griner's approach), mechanical vibration, pulsed ultrasound, electrostimulation, ischemic compression,<unk><unk> -injection (see below), dry-needling, "spray-and-stretch" using a cooling spray (vapocoolant), low-level laser therapy and stretching techniques that invoke reciprocal inhibition within the musculoskeletal system. Practitioners may use elbows, feet or various tools to direct pressure directly upon the<unk><unk> , to avoid overuse of their hands. A successful treatment protocol relies on identifying<unk><unk> s, resolving them and, if all<unk><unk> s have been deactivated, elongating the structures affected along their natural range of motion and length. In the case of muscles, which is where most treatment occurs, this involves stretching the muscle using combinations of passive, active, active isolated (AIS), muscle energy techniques (MET), and proprioceptive neuromuscular facilitation (PNF) stretching to be effective. Fascia surrounding muscles should also be treated to elongate and resolve strain patterns, otherwise muscles will simply be returned to positions where<unk><unk> s are likely to re-develop. The results of manual therapy are related to the skill level of the therapist. If<unk><unk> s are pressed too short a time, they may activate or remain active; if pressed too long or hard, they may be irritated or the muscle may be bruised, resulting in pain in the area treated. This bruising may last for a 1–3 days after treatment, and may feel like, but is not similar to, delayed onset muscle soreness (DOMS), the pain felt days after overexerting muscles. Pain is also common after a massage if the practitioner uses pressure on unnoticed latent or active<unk><unk> s, or is not skilled in<unk>  therapy. Physical exercise aimed at controlling posture, stretching, and proprioception have all been studied with no conclusive results. However, exercise proved beneficial to help reduce pain and severity of symptoms that one felt. Muscular contractions that occur during exercise favor blood flow to areas that may be experiencing less than normal flow. This also causes a localized stretching effect on the fascia and may help relieve the abnormally tight fascia. Evidence that supports these exercises for a treatment is scarce, but physical exercise can be beneficial in reducing the intensity of pain. Researchers of evidence-based medicine concluded as of 2001 that evidence for the usefulness of<unk><unk> s in the diagnosis of fibromyalgia is thin. More recently, an association has been made between fibromyalgia tender<unk> s and active<unk><unk> s.<unk><unk>  injection Injections without anesthetics, or dry needling, and injections including saline, local anesthetics such as procaine hydrochloride (Novocain) or articaine without vasoconstrictors like epinephrine, steroids, and botulinum toxin provide more immediate relief and can be effective when other methods fail. In regards to injections with anesthetics, a low concentration, short acting local anesthetic such as procaine 0.5% without steroids or epinephrine is recommended. High concentrations or long acting local anesthetics as well as epinephrine can cause muscle necrosis, while use of steroids can cause tissue damage. Despite the concerns about long acting agents, a mixture of lidocaine and marcaine is often used. A mixture of 1 part 2% lidocaine with 3 parts 0.5% bupivacaine (trade name:Marcaine) provides 0.5% lidocaine and 0.375% bupivacaine. This has the advantages of immediate anesthesia with lidocaine during injection to minimize injection pain while providing a longer duration of action with a lowered concentration of bupivacaine. In 1979, a study by Czech physician Karl Lewit reported that dry needling had the same success rate as anesthetic injections for the treatment of<unk><unk> s. He dubbed this the 'needle effect'. In the 1950s and 1960s, studies relevant to<unk><unk> s were done by Jonas Kellgren at University College Hospital, London, in the 1930s and, independently, by Michael Gutstein in Berlin and Michael Kelly in Australia. Health insurance companies in the US such as Blue Cross, Medica, and HealthPartners began covering<unk><unk>  injections in 2005. Risks Treatment, whether by self or by a professional, has some inherent dangers. It may lead to damage of soft tissue and other organs. The<unk><unk> s in the upper quadratus lumborum, for instance, are very close to the kidneys and poorly administered treatment (particularly injections) may lead to kidney damage. Likewise, treating the masseter muscle may damage the salivary glands superficial to this muscle. Furthermore, some experts believe<unk><unk> s may develop as a protective measure against unstable<unk> s. Efficacy Studies have shown a moderate level of evidence for manual therapy for short-term relief in the treatment of<unk> s. Dry needling and dry cupping have not shown evidence of efficacy greater than a placebo. There have not been enough in-depth studies to be conclusive about the latter treatment modalities, however. Studies to date on the efficacy of dry needling for MTrPs and pain have been too small to be conclusive.
Myofascial trigger point
Psychogenic pain
Calpainopathy
Phantom pain
Neurogenic claudication
Nerve compression syndrome
Peroneal strike
Myofascial pain syndrome