Exercise,especiallycombinedstretchingandstrengtheningexercise,reducesmyofascialpain:asystematicreview

Myofascial pain is a common musculoskeletal condition characterized by painful trigger points in muscles that affects 6-30% of people seeking care for pain. While various treatments like massage, acupuncture, and electrotherapy are used, their effectiveness is often unclear. Exercise is an attractive treatment option because it's non-invasive, low-cost, and has few side effects, but previous reviews haven't specifically examined exercise alone for primary myofascial pain.

The researchers conducted a systematic review searching five major medical databases for randomized controlled trials that tested exercise alone (stretching, strengthening, or endurance training) in people with myofascial pain. They included studies comparing exercise to minimal/no treatment or to other interventions. They extracted pain intensity scores (converted to a 0-10 scale) and disability measures, then combined results using statistical meta-analysis techniques. Study quality was assessed using the PEDro scale.

Eight studies with 255 total participants were included. When exercise was compared to minimal or no treatment, six studies showed exercise significantly reduced pain intensity by 1.2 points on a 0-10 scale (95% CI -2.3 to -0.1). However, this improvement was just barely statistically significant and may not be clinically meaningful (studies suggest 2 points is needed for clinical significance). When exercise was compared to other treatments like dry needling or electrotherapy, two studies showed no significant difference.

A sensitivity analysis of studies combining stretching and strengthening exercises found a larger pain reduction of 2.3 points, which would be clinically meaningful. Only one study examined disability, finding no significant benefit.

Exercise appears to provide small to moderate benefits for myofascial pain in the short term (within 3 months), but the overall evidence is limited and of very low quality. The most promising approach appears to be combining stretching and strengthening exercises, which may provide clinically meaningful pain relief. Given exercise's safety, low cost, and potential additional health benefits, clinicians may still consider recommending exercise programs for patients with myofascial pain, particularly combined stretching and strengthening routines performed 3-5 times per week for 2-4 weeks. However, more high-quality research is needed to confirm these findings and determine optimal exercise protocols.