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. 2024 Dec 20;12(12):2909.
doi: 10.3390/biomedicines12122909.

The Use and Benefits of Focused Shockwaves for the Diagnosis of Myofascial Pain Syndrome by Examining Myofascial Trigger Points in Low Back Pain

Hannes Müller-Ehrenberg  1 , Federico Giordani  2 , Alessandra Müller-Ehrenberg  3 , Richard Stange  4
Affiliations

The Use and Benefits of Focused Shockwaves for the Diagnosis of Myofascial Pain Syndrome by Examining Myofascial Trigger Points in Low Back Pain

Hannes Müller-Ehrenberg et al. Biomedicines. .

Abstract

Background/Objectives: Low back pain (LBP) is a widespread public health issue, with myofascial pain syndrome (MPS) being a common cause, affecting 67-100% of patients. However, there are significant challenges in the diagnostic process due to the subjective and unreliable nature of manual palpation. Focused Extracorporeal Shockwave Therapy (F-ESWT), traditionally used for MPS treatment, offers a reproducible and non-invasive mechanical stimulus, making it a potential diagnostic tool. This study evaluated F-ESWT's diagnostic efficiency in chronic LBP patients by focusing on "recognition" and "referral" of pain. Methods: twenty-eight participants were screened for myofascial trigger points (MTrPs) in the lumbar, gluteal, and thigh regions. Identified MTrPs were stimulated using F-ESWT, and patient feedback was recorded. Results: data showed high diagnostic accuracy for muscles such as the quadratus lumborum, gluteus medius, and gluteus minimus muscles, achieving "referral" rates of 96%, 95%, and 92% and "recognition" rates of 84%, 86%, and 85%, respectively. Other structures like adductors, iliopsoas, erector spinae, and biceps femoris muscle showed consistent but lower diagnostic rates. Conclusions: the study's findings indicate that F-ESWT effectively reproduces pain patterns, offering a precise, reproducible, and non-invasive diagnostic approach for MPS in chronic LBP. However, they also highlight the necessity for detailed diagnostic criteria in managing myofascial pain.

Keywords: Extracorporeal Shockwave Therapy (ESWT); diagnosis; low back pain; myofascial pain syndrome; myofascial trigger points; pain.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic representation of (a) radial pressure wave (R-PP) and (b) focused shockwaves (F-ESWT) applied on a section of the soft tissues (from top to bottom: skin, adipose tissue and fascia, muscles). Focused zone (green) and wave propagation (black lines) are shown for both technologies. Copyright by Federico Giordani.
Figure 2
Figure 2
Example of the application of F-ESWT on the gluteal muscle.
Figure 3
Figure 3
Referral of pain pattern of gluteus minimus muscle. The green area indicates the most common location of MTrPs, and the red/orange areas indicate the typical areas of the pain referral. Copyright by Hannes Müller-Ehrenberg.
Figure 4
Figure 4
(a) pain recognition and (b) pain referral for each muscle by fESWT stimulation.
Figure 5
Figure 5
Heatmap of the frequency of pain recognition and pain referral by F-ESWT stimulation.
See this image and copyright information in PMC

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