Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome


Myofascial trigger points (MFTPs) are a common cause of chronic neck and back pain. They are localized segments of muscle that are thought to be subjected to trauma by acute injury or microtrauma from repetitive stress. MFTPs can occur in any skeletal muscle.

Diagnosis is clinical and includes the identification of small knots (2-5 mm in diameter) and tight bands within affected muscles that are painful when palpated. Diagnostic imaging is not helpful and should only be considered to rule out other causes of muscle pain.

It is still unclear whether or not MFTPs are true pathologic entities. It has been hypothesized that muscle injury or stress disrupts the sarcoplasmic reticulum within muscle fibers, releasing free calcium ions. These free calcium ions causes the actin and myosin of the muscle fibers to lock into place as long as adenosine triphosphate is available. The resulting contraction of small parts of the muscle leads to diminished blood flow with subsequent ischemia and release of painful substances such as serotonin, histamine and prostaglandins in the affected area.

MFTPS are a very common condition, especially in the cervical musculature. Up to 85% of back pain and approximately 55% of neck pain and headaches are caused by myofascial pain.

The predominant age is 30 to 50 years. Women are more affected than men. Very often MFTPs are associated with poor posture. Notably MFTPs frequently produce neurological complaints including headache, dizziness, sensory symptoms, as well as gastrointestinal problems.

The treatment of MFTPs should start with a manual technique that involves applying pressure to a trigger point to release the pathologic contraction of the muscle segment and to stretch the segment to restore normal muscle fiber length. This can be accompanied by acupuncture, stress management and relaxation techniques. Pharmacologic treatment is unspecific and may comprise muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, or topical application of local anesthetics or botulinum toxin.

Radial shock wave therapy (RSWT) is very effective for MFTPs and may mimic manual therapy in applying pressure to a trigger point to release the pathologic contraction of the muscle segment. Prevention of recurrence should focus on appropriate ergonomic changes in patients’ day-to-day activities to avoid repetitive stress to the injured muscles.



Bauermeister W. In: Maier M, Gillesberger F:

Abstracts 2003 zur Muskuloskelettalen Stosswellentherapie. Kongressband des 3. Dreiländertreffens der Österreichischen, Schweizer und Deutschen Fachgesellschaften. Books on Demand, Norderstedt, 2003a, pp 24-28.



Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2.5 to 4 bar
Air pressure Power+ 2 to 4 bar
Impulses 500 - 1000 impulses per trigger point
Frequency 12Hz
Applicator 15mm or 15 mm trigger
Skin pressure Light to moderate

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