The Brain Behind Myofascial Trigger Points

Despite imagery’s regular use in massage therapy there are few studies examining its effectiveness. This experimental study examined the effect of imagery on manual trigger point release. Forty individuals (11 male and 29 female), aged 19-51 (M = 26.13, SD = 8.05) were divided into two groups; one focusing on deep, diaphragmatic breathing and the second on a rich imagery script, imagining their trigger point being a “ball of butter melting”. Manual trigger point release was applied four successively deeper times to the same point in the dominant upper trapezius muscle following the common “searching for 7” pain scale protocol. Significant differences were found in self-reported pain tolerance scores for participants using the breathing (M = 2/10, SD = 1.8/10) versus imagery scripts (M = 1/10, SD = 1.2/10), t(37) = 2.10, p = .043. A trend only approaching statistical significance was observed between treatments in both average press release (imagery: M = 25.6 s, SD = 15.5 s, breathing: M = 30.0 s, SD = 27.3 s, t (38) = 0.62, p = .540) and total treatment time (imagery: M = 2:15 m, SD = 1:08 m, breathing: M = 2:36 m, SD = 2:04 m, t (38) = 0.67, p = .507), with largest differences in the final two presses.

However, analyzing the above while taking local v. referred pain presence into account showed significant main effects of pain on the first press (local/breathing: M = 43.2 s, SD = 24.8 s; local/imagery: M = 31.5 s, SD = 16.1 s; referred/breathing: M = 23.2 s, SD = 12.5 s, referred/imagery: M = 28.1 s, SD = 12.2 s; F _1,30 = 4.53, p = .042) and significant interaction effects of both pain and treatment type on total treatment time (local/breathing: M = 3:32 m, SD = 2:34 m; local/imagery: M = 2:07 m, SD = 1:12 m; referred/breathing: M = 1:50 m, SD = 1:11 m, referred/imagery: M = 2:22 m, SD = 1:08 m; F _1,30 = 4.64, p = .039). Based on this study, therapists should include breathing techniques in manual trigger point release for patients experiencing referred pain and imagery scripts for patients experiencing only local pain.