Myofascial Factors in Low Back Pain (Continued): Posterior Abdominal Wall: Internal View

Rehabilitation approaches for MPS, including neuromuscular relaxation techniques, heat, or electrical therapy may also help. Physical treatments can also be used in the management of MPS. The “stretch and spray” technique is popular, utilizing a vapocoolant spray applied just before stretching the involved muscle. Other physical therapies include massage therapy or low-level laser therapy. More unusual treatments include mud baths and magnetic fields.

Needling of myofascial trigger points is a common MPS treatment. However, no causal relationship between direct needling of MTrPs and improvement in symptoms is established. A systematic 2001 review discussing randomized controlled trials (RCTs) failed to conclusively demonstrate any therapeutic benefit in wet (injection with botulinum or local anesthetic) versus dry needling. The authors of this meta-analysis concluded that any effect resulting from these therapies is derived from the direct needle insertion into the MTrP. Recent interest in using the 5-hydroxytryptamine 3 (5-HT3) receptor antagonist tropisetron for injection into MTrPs associated with MPS has not been tested with an RCT.

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