Immediate effects of ischemic compression therapy on shoulder myofascial trigger points




Myofascial pain; Pressure pain threshold; Shoulder pain.


Objective: To primarily evaluate the immediate effect of ischemic compression therapy (ICT) on pain, mobility and strength of shoulder muscles in individuals with Subacromial Impingement Syndrome (SIS). Secondly, to assess whether the strength and mobility assessment protocol influences the amount of MTPs. Methods: A single-arm study with a total of 15 individuals (6 women and 9 men, 34.4±10.43 years; 24.20±2.18 kg/m2) with clinical symptoms of unilateral SIS. All individuals were assessed for the amount of MTPs in the upper trapezius, lower trapezius, supraspinatus, infraspinatus, pectoralis minor and middle deltoid muscles; pressure pain threshold (PPT) in the upper trapezius, lower trapezius, infraspinatus and middle deltoid muscles; range of motion (ROM) of the shoulder; and isometric strength of shoulder muscles. Results: There was a reduction in the total amount of MTPs (p<0.01) and an increase in the PPT in the middle deltoid muscle (p=0.03) in the comparisons between pre and post treatment, while there was no difference in ROMs (p>0.05) and strength measures (p>0.24); however, the pain was less during the sagittal elevation ROM (p<0.01) and internal rotation (p=0.04), and during the performance of strength in arm elevation and external rotation (p=0.01). There was generally no difference in the variables assessed between baseline and pre-treatment (p>0.06). Conclusion: The ICT immediately reduced the amount of MTPs and pain during mobility and strength, but did not change the PPT, ROM or strength variables. The evaluation of mobility and strength did not have a negative effect on the evaluated variables.

Author Biographies

Jose Diego Sales do Nascimento, Federal University of Rio Grande do Norte

Master Science in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.


Francisco Alburquerque-Sendín, University of Córdoba

Professor, Department of Sociosanitary Sciences, Radiology and Physical Medicine, University of Córdoba, Spain.

Laysla Carla de Castro Ferreira, Federal University of Rio Grande do Norte

Physical Therapist, Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.



Akbaba, Y. A., Mutlu, E. K., Altun, S., Turkmen, E., Birinci, T., & Celik, D. (2019). The effectiveness of trigger point treatment in rotator cuff pathology: A randomized controlled double-blind study. Journal of Back and Musculoskeletal Rehabilitation, 32(3), 519–527.

Alburquerque-Sendín, F., Camargo, P. R., Vieira, A., & Salvini, T. F. (2013). Bilateral Myofascial Trigger Points and Pressure Pain Thresholds in the Shoulder Muscles in Patients With Unilateral Shoulder Impingement Syndrome. The Clinical Journal of Pain, 29(6), 478–486.

Altindag, O., Gur, A., & Altindag, A. (2008). The relationship between clinical parameters and depression level in patients with myofascial pain syndrome. Pain Medicine, 9(2), 161–165.

Bailón-Cerezo, J., & Torres-Lacomba, M. (2013). Presencia de puntos gatillo miofasciales y discinesia escapular en nadadores de competición con y sin dolor de hombro: estudio piloto transversal. Fisioterapia, 36(6), 266–273.

Borstad, J., & Woeste, C. (2015). The role of sensitization in musculoskeletal shoulder pain. Brazilian Journal of Physical Therapy, 19(4), 251–256.

Bron, C., De Gast, A., Dommerh

olt, J., Stegenga, B., Wensing, M., & Oostendorp, R. A. (2011). Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Medicine, 9(1), 8.

Bron, C., Dommerholt, J., Stegenga, B., Wensing, M., & Oostendorp, R. a B. (2011). High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskeletal Disorders, 12(1), 139.

Bron, C., Franssen, J., Wensing, M., & Oostendorp, R. A. B. (2007). Interrater Reliability of Palpation of Myofascial Trigger Points in Three Shoulder Muscles. Journal of Manual & Manipulative Therapy, 15(4), 203–215.

Cagnie, B., Dewitte, V., Coppieters, I., Van Oosterwijck, J., Cools, A., & Danneels, L. (2013). Effect of ischemic compression on trigger points in the neck and shoulder muscles in office workers: A cohort study. Journal of Manipulative and Physiological Therapeutics, 36(8), 482–489.

Camargo, P. R., Ávila, M. A., Asso, N. A., & Salvini, T. F. (2010). Muscle performance during isokinetic concentric and eccentric abduction in subjects with subacromial impingement syndrome. European Journal of Applied Physiology, 109(3), 389–395.

Celik, D., & Mutlu, E. K. (2013). Clinical implication of latent myofascial trigger point. Current Pain and Headache Reports, 17(8), 353.

Çelik, D., & Mutlu, E. K. (2012). The relationship between latent trigger points and depression levels in healthy subjects. Clinical Rheumatology, 31(6), 907–911.

Chien, C., Bagraith, K. S., Khan, A., Deen, M., & Strong, J. (2013). Comparative Responsiveness of Verbal and Numerical Rating Scales to Measure Pain Intensity in Patients With Chronic Pain. The Journal of Pain, 14(12), 1653–1662.

Cohen, J. (1988). The concepts of power analysis. In J. Cohen (Ed.), Statistical Power Analysis for the Behavioral Sciences (pp. 1–17). New Jersey: Academic Press.

Diercks, R., Bron, C., Dorrestijn, O., Meskers, C., Naber, R., de Ruiter, T., … van der Woude, H. J. (2014). Guideline for diagnosis and treatment of subacromial pain syndrome. Acta Orthopaedica, 85(3), 314–322.

Faul, F., Erdfelder, E., & Buchener, A.-G. L. and A. (2007). G * Power 3 : A flexible statistical power analysis program for the social , behavioral , and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.

Fernández-de-las-Peñas, C., & Dommerholt, J. (2018). International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain Medicine, 19(1), 142–150.

Fischer, A. A. (1986). Pressure threshold meter: its use for quantification of tender spots. Archives of Physical Medicine and Rehabilitation, 67(11), 836–838.

Furlanetto, L. M., Mendlowicz, M. V, & Romildo Bueno, J. (2005). The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients. Journal of Affective Disorders, 86(1), 87–91.

Ge, H. Y., Arendt-Nielsen, L., & Madeleine, P. (2012). Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Medicine (United States), 13(7), 957–964.

Ge, H. Y., Fernández-de-las-Peñas, C., Madeleine, P., & Arendt-Nielsen, L. (2008). Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle. European Journal of Pain, 12(7), 859–865.

Ge, H. Y., Monterde, S., Graven-Nielsen, T., & Arendt-Nielsen, L. (2014). Latent myofascial trigger points are associated with an increased intramuscular electromyographic activity during synergistic muscle activation. Journal of Pain, 15(2), 181–187.

Goedhart, J. (2016). Calculation of a distribution free estimate of effect size and confidence intervals using VBA / Excel.

Hains, G., Descarreaux, M., & Hains, F. (2010). Chronic Shoulder Pain of Myofascial Origin: A Randomized Clinical Trial Using Ischemic Compression Therapy. Journal of Manipulative and Physiological Therapeutics, 33(5), 362–369.

Hao, Q., Devji, T., Zeraatkar, D., Wang, Y., Qasim, A., Siemieniuk, R. A. C., … Guyatt, G. (2019). Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform a BMJ Rapid Recommendation. BMJ Open, 9(2), e028777.

Hidalgo-Lozano, A., Fernández-de-las-Peñas, C., Alonso-Blanco, C., Ge, H.-Y., Arendt-Nielsen, L., & Arroyo-Morales, M. (2010). Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Experimental Brain Research, 202(4), 915–925.

Hidalgo-Lozano, A., Fernández-de-las-Peñas, C., Díaz-Rodríguez, L., González-Iglesias, J., Palacios-Ceña, D., & Arroyo-Morales, M. (2011). Changes in pain and pressure pain sensitivity after manual treatment of active trigger points in patients with unilateral shoulder impingement: A case series. Journal of Bodywork and Movement Therapies, 15(4), 399–404.

Hung, C. J., Jan, M. H., Lin, Y. F., Wang, T. Q., & Lin, J. J. (2010). Scapular kinematics and impairment features for classifying patients with subacromial impingement syndrome. Manual Therapy, 15(6), 547–551.

Jobe, F. W., & Jobe, C. M. (1983). Painful athletic injuries of the shoulder. Clinical Orthopaedics and Related Research, (173), 117–124.

Leggin, B. G., Michener, L. A., Shaffer, M. A., Brenneman, S. K., Iannotti, J. P., & Williams, G. R. (2006). The Penn Shoulder Score: Reliability and validity. Journal of Orthopaedic and Sports Physical Therapy, 36(3), 138–151.

Lewit, K., & Simons, D. G. (1984). Myofascial pain: relief by post-isometric relaxation. Archives of Physical Medicine and Rehabilitation, 65(8), 452–456.

Lin, J., Chen, W.-H., Chen, P.-Q., & Tsauo, J.-Y. (2010). Alteration in Shoulder Kinematics and Associated Muscle Activity in People With Idiopathic Scoliosis. Spine, 35(11), 1151–1157.

Lucas, K. R., Rich, P. a., & Polus, B. I. (2010). Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: The effects of Latent Myofascial Trigger Points. Clinical Biomechanics, 25(8), 765–770.

Martinez-Calderon, J., Struyf, F., Meeus, M., Morales-Ascencio, J. M., & Luque-Suarez, A. (2017). Influence of psychological factors on the prognosis of chronic shoulder pain: protocol for a prospective cohort study. BMJ Open, 7(3), e012822.

McClure, P. W., & Michener, L. A. (2014). Staged Approach for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder). Physical Therapy, 95(5), 791–800.

McClure, P. W., Michener, L. A., & Karduna, A. R. (2006). Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Physical Therapy, 86(8), 1075–1090.

Michener, L. A., Kardouni, J. R., Sousa, C. O., & Ely, J. M. (2015). Validation of a sham comparator for thoracic spinal manipulation in patients with shoulder pain. Manual Therapy, 20(1), 171–175.

Michener, L. A., Sharma, S., Cools, A. M., & Timmons, M. K. (2016). Relative scapular muscle activity ratios are altered in subacromial pain syndrome. Journal of Shoulder and Elbow Surgery, 25(11), 1861–1867.

Michener, L. a., Walsworth, M. K., Doukas, W. C., & Murphy, K. P. (2009). Reliability and Diagnostic Accuracy of 5 Physical Examination Tests and Combination of Tests for Subacromial Impingement. Archives of Physical Medicine and Rehabilitation, 90(11), 1898–1903.

Neer, C. S. (1972). Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. The Journal of Bone and Joint Surgery. American Volume, 54(1), 41–50.

Nuttall, F. Q. (2015). Body Mass Index. Nutrition Today, 50(3), 117–128.

Prushansky, T., Dvir, Z., & Defrin-assa, R. (2004). Reproducibility Indices Applied to Cervical Pressure Pain Threshold Measurements in Healthy Subjects. 20(5), 341–347.

Saccol, M. F., Almeida, G. P. L., & de Souza, V. L. (2016). Anatomical glenohumeral internal rotation deficit and symmetric rotational strength in male and female young beach volleyball players. Journal of Electromyography and Kinesiology, 29, 121–125.

Simons, D. G. (2002). Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies, 6(2), 81–88.

Struyf, F., Cagnie, B., Cools, A., Baert, I., Brempt, J. Van, Struyf, P., & Meeus, M. (2014).

Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability. Journal of Electromyography and Kinesiology, 24(2), 277–284.

Taylor, D. C., Brooks, D. E., & Ryan, J. B. (1997). Viscoelastic characteristics of muscle: passive stretching versus muscular contractions. Medicine and Science in Sports and Exercise, 29(12), 1619–1624.

Trouvin, A., & Perrot, S. (2019). New concepts of pain. Best Practice & Research Clinical Rheumatology, 33(3), 101415.

Walton, D. M., Macdermid, J. C., Nielson, W., Teasell, R. W., Chiasson, M., & Brown, L. (2011). Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. The Journal of Orthopaedic and Sports Physical Therapy, 41(9), 644–650.




How to Cite

Nascimento, J. D. S. do ., Alburquerque-Sendín, F. ., Ferreira, L. C. de C., & Sousa, C. de O. (2020). Immediate effects of ischemic compression therapy on shoulder myofascial trigger points. Research, Society and Development, 9(11), e2539119801.



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