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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

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Manual therapies in myofascial trigger point treatment: a systematic review

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Review published: .

CRD summary

This review evaluated manual therapy in myofascial trigger point treatment. It concluded that more rigorous studies are needed to determine whether manual therapy has an effect beyond placebo in this patient group. Although there were limitations in the reporting of the review, the authors' suitably cautious conclusion is supported by the evidence presented.

Authors' objectives

To determine whether manual therapies are effective in the management of myofascial pain syndrome.


PubMed (1975 to 2003), EMBASE (1975 to 2003), the Cochrane Database of Systematic Reviews, AMED, Science Direct and PEDro were searched; the search terms were reported.

Study selection

Study designs of evaluations included in the review

Clinical or randomised controlled trials (RCTs) were eligible for inclusion.

Specific interventions included in the review

Studies that evaluated a form of manual therapy treatment were eligible for inclusion. The included studies evaluated spray and stretch technique, soft tissue massage, ischaemic compression, occipital release, active head retraction plus retraction/extension exercises, strain and counterstrain, and myofascial release. The number of treatment sessions ranged from 1 to 10. The comparators were placebo and other active treatments.

Participants included in the review

Studies of participants undergoing treatment for myofascial trigger points were eligible for inclusion. Many parts of the body were examined in the included studies, although in all studies neck and shoulder pain were involved. Studies of those with musculoskeletal dysfunction were excluded.

Outcomes assessed in the review

Explicit inclusion criteria for the outcomes were not reported. The outcome measures evaluated in the included studies were pressure pain threshold, pressure pain tolerance and a visual analogue scale to measure unspecified outcomes.

How were decisions on the relevance of primary studies made?

The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.

Assessment of study quality

Each included study was assigned a quality score between 0 and 10 according to the PEDro quality score method. A point was assigned for each of the following: random allocation, concealed allocation, baseline comparability, blinded assessors, patients and therapists, adequate follow-up, intention-to-treat analysis, between-group comparisons, point estimates and variability. Two blinded reviewers independently assessed the validity of each included study. Any differences were resolved by discussion between all reviewers. Some of the studies appeared to have been located on the PEDro database where studies have already been quality assessed, while the remaining studies were quality assessed by the authors of the review.

Data extraction

Two blinded reviewers independently extracted the data using specifically designed forms. Any differences were resolved by discussion between all reviewers.

Methods of synthesis

How were the studies combined?

The results of the studies were tabulated.

How were differences between studies investigated?

Differences between the studies were apparent from the tables presented.

Results of the review

Seven trials (n=415) were included in the review, of which five were RCTs (n=375). Two were described as clinical trials and appeared to be uncontrolled (n=40). Follow-up was immediate in 5 studies and 6 months in 2 studies.

Two studies scored 6 out of 10 for methodological quality, two scored 5, one scored 3, one scored 2 and one scored 1. The quality rating of 4 studies was assigned by the authors.

The authors did not synthesise the results of the individual studies. They provided a description of the study characteristics and reported that the principal review finding was that few RCTs were available and that the results did not demonstrate rigorous evidence of the effectiveness of manual therapies.

Authors' conclusions

Few RCTs have evaluated the treatment of myofascial pain syndrome using manual therapy, and the hypothesis that manual therapies have efficacy beyond placebo is neither supported nor refuted by the research to date.

CRD commentary

The review question was clear and supported by inclusion criteria for the participants, intervention and study design. Several relevant electronic databases were searched to identify studies, although it was unclear if any language restrictions were applied. Methods used to minimise bias when selecting studies for inclusion were not reported. However, methods were used to minimise reviewer error and bias in the abstraction of data and quality assessment. The quality of the included studies was assessed.

Details of each of the included studies were reported; these highlighted the clinical and methodological differences across the studies and the limitations in the evidence available. This would suggest that the decision not to statistically combine the studies was appropriate, although only a limited attempt was made to synthesise the results beyond tabulation of whether they detected a statistically significant difference. However, this factor is unlikely to have impacted on the authors' conclusion which, despite the limitations highlighted, is supported by the tabulated evidence presented.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further studies are needed to determine whether manual therapy has an effect beyond placebo on myofascial trigger point management.

Bibliographic details

de las Penas C F, Sohrbeck Campo M, Fernandez Carnero J, Miangolarra Page J C. Manual therapies in myofascial trigger point treatment: a systematic review. Journal of Bodywork and Movement Therapies 2005; 9(1): 27-34.

Indexing Status

Subject indexing assigned by CRD


Massage; Musculoskeletal Manipulations /methods; Myofascial Pain Syndromes /therapy /prevention & control; Pain /therapy; Palpation; Treatment Outcome



Database entry date


Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

Copyright © 2014 University of York.
Bookshelf ID: NBK71861


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