Effectofaerobicexerciseinthetreatmentofmyofascialpain:asystematicreview

Myofascial pain syndrome (MPS) is a widespread chronic pain problem, with estimates suggesting it affects about 85% of patients in pain clinics and 9% of those in general internal medicine settings. The condition is marked by myofascial trigger points—tight, irritable bands in skeletal muscle that cause localized and referred pain. While stretching and strengthening exercises are commonly used treatments, less is known about whether aerobic exercise specifically helps people with myofascial pain. Aerobic exercise might help by increasing blood flow and oxygen to trigger points, reducing inflammation, and raising pain thresholds through effects on the central nervous system.

Given that aerobic exercise is accessible, noninvasive, and low-cost, understanding its role in myofascial pain management could expand treatment options for patients.

The researchers conducted a systematic review to find and evaluate studies testing aerobic exercise for myofascial pain. They searched four major medical databases—MEDLINE, Embase, Cochrane CENTRAL, and Web of Science—from each database's start through November 2016. They looked for randomized controlled trials and quasi-randomized trials that compared aerobic exercise (minimum 4 weeks) to no exercise or non-exercise treatments in adults with confirmed myofascial trigger points. Outcomes of interest included pain intensity, pain pressure thresholds, number of trigger points, medication use, function, and range of motion.

Two reviewers independently screened titles, abstracts, and full texts. They planned to pool results statistically if multiple studies were found, using mean differences and standardized mean differences with 95% confidence intervals.

Of 1,331 articles initially identified after removing duplicates, only 23 warranted full-text review. Just one study met all inclusion criteria—a randomized controlled trial by Cantarero-Villanueva et al. (2012) involving 66 breast cancer survivors with myofascial trigger points and neck/shoulder-axillary pain. Participants were randomized to either an 8-week water exercise program (three times weekly, one-hour sessions in a warm pool) or a control group.

The exercise sessions included 10 minutes of warm-up, 35 minutes of low-intensity endurance and core training, and 15 minutes of cool-down with stretching and relaxation.

The study found that participants in the water exercise group had significantly lower pain intensity scores on the visual analogue scale for both neck pain and shoulder/axillary pain compared to controls after the intervention. For neck pain, the mean difference was -30 (95% CI: -25 to -35). For shoulder/axillary pain, the mean difference was -31 (95% CI: -25 to -37). Pain pressure thresholds increased significantly in the cervical spine area of the water exercise group, with a mean difference of 20.3 (95% CI: 34.1 to 6.5) at the C5-6 zygapophyseal joint on the affected side.

The number of active trigger points decreased significantly in most affected muscles in the exercise group compared to controls, including the upper trapezius (18 to 5 versus 18 to 19), infraspinatus (10 to 3 versus 16 to 16), scalene (24 to 6 versus 18 to 17), and pectoralis major (25 to 10 versus 21 to 27). The study had low risk of bias according to the Downs and Black checklist, though there was some uncertainty about blinding of investigators to group assignment.

The evidence base for aerobic exercise in myofascial pain is extremely limited—only one suitable study was found despite a comprehensive search. However, that single study provides promising initial evidence that water-based aerobic exercise may reduce pain intensity, increase pain pressure thresholds in the cervical spine, and decrease the number of active trigger points in breast cancer survivors with myofascial pain. Clinicians might consider recommending aerobic exercise, particularly water-based programs, as part of a multimodal approach to myofascial pain management. The combination of aerobic exercise with strengthening and stretching exercises could be especially beneficial, as these interventions may work through complementary mechanisms—aerobic exercise potentially reducing generalized pain and trigger point formation, while strengthening exercises support affected muscles and improve pain tolerance.

Patients with myofascial pain who are looking for non-pharmacological, low-impact options may find water exercise particularly appealing. However, much more research is needed, including studies in broader populations beyond breast cancer survivors, direct comparisons of aerobic versus strengthening exercise, and investigation of optimal exercise dosing and delivery formats.