Jornal Internacional de Medicina Física e Reabilitação
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Abstrato

The Role of Myofascial Trigger Points in the Treatment of Reversible Functional Scoliosis

Jussi Timgren

Background: The pathophysiology of reversible functional scoliosis caused by pelvic obliquity is still widely overlooked. The focus of this retrospective study is to observe the occurrence of myofascial trigger points (MTrPs) in patients with reversible pelvic obliquity causing functional scoliosis and leg length discrepancy (LLD).

Method: A retrospective study of 100 consecutive first-visit patients in a physiatric practice was undertaken. The total number of patients included in the study, 111, was determined so that that the number of participants having a reversible pelvic obliquity, amounted up to 100. A Palpation Meter ^® was used to determine the height difference in the iliac crests and scapular angles before and after the aligning manoeuvres instructed to be performed by the patient. The method of establishing pelvic symmetry using patients own muscle strength (Muscle Energy Technique) has been described in authors two previous articles and is here reiterated. The incidence of three known types of functional scoliosis associated with pelvic obliquity was registered: innominate upslip, innominate anterior rotation and torsion of the sacrum. Each of them causes a distinct pattern of functional scoliosis. MTrPs were identified by local muscle palpation, indicated by their referred pain patterns. The MTrPs were treated with dry needling. Only the MTrPs where needling caused a local twitch response or symptomatic pain radiation was registered. Besides, the M. iliopsoas mobility was assessed lying prone

Findings: Eighty-four of them had identifiable MTrPs localized in 36 different muscles. The muscle most frequently harbouring TrPs was the gluteus medius. Moreover, 84 of the 100 had a unilateral shortening of the iliopsoas muscle. This study does not include a follow up. The re-establishment of symmetry during the visit was verified. The fact that the study was implemented by one physician leaves it open to bias. The results have a tentative character calling for further research.

Conclusion: The studies covering reversible pelvic obliquity are still lacking though the condition appears to be quite common among patients suffering from musculoskeletal pain. MTrPs may be considered a major source in producing pain in patients having functional scoliosis. There seems to be a strong correlation between functional scoliosis and occurrence of MTrPs. Functional scoliosis imposes persistent muscle strain that perpetuates TrPs in the paraspinal and associated musculature. Correcting the pelvic obliquity causing LLD and functional scoliosis can contribute to treatment of myofascial pain. Dry needling is widely considered a manageable option in the treatment of MTrPs.