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The effect of local heating of trigger points on neck pain and plantar fascia pain

Jerrold Petrofsky, Michael Laymon, Haneul Lee


Background: Myofascial trigger points have been recognized for almost 100 years.  They are commonly manipulated by dry needling or injections.  Heat is associated with relaxation in muscle and increased tissue blood flow. 

Purpose: The purpose of this study was to examine the effect of single heat cells on trigger points to see if there was pain reduction in 2 areas of the body, the neck and plantar fascia.   

Methods: Forty adults in the age range between 20 and 64 participated in this study, and they were divided to 2 different groups according to their pain area; 20 had plantar foot pain due to plantar fasciitis and 20 had nonspecific neck pain for at least 1 month. Half of the subjects of each group were randomly divided into 2 subgroups and given either heat or a sham; 48 hours later subjects crossed over from one treatment to the other during the course of the trial.   For each group (neck or plantar pain), 20 of the subjects were given a single heat patch on the trigger points for the neck or foot as appropriate and the other half a sham cell as a placebo.  The subjects were tested for 4 hours.  At the start, a visual analog pain scale was used and pressure pain threshold was measured with a pressure algometer.  A stop watch was given to the subject and started as either the heat patch or placebo was applied to assess when pain starts relieved.

Results: A significant pain reduction was shown in both heat groups (both neck and plantar pain) (p < 0.01).  The reduction in pain for the neck group was significant in the sham heat condition (p < 0.05) but not in the plantar sham heat group (p = 0.06).  Similarly, pressure pain threshold significantly decreased in both heat groups (p < 0.01) but not in sham heat groups (p > 0.05). For significant pain relief, for the sham groups, over half of the subjects did not press the stop watches at all in the sham groups at the end.   Both heat groups were not significantly different than each other and were significantly less in time than the sham groups (p < 0.01).

Conclusions: There was a small placebo effect in the sham subgroups where some pain relief and ability to tolerate pressure were seen.  But the effect of a heat for the neck and plantar areas of the body was significantly better in the heat groups than the sham groups.

Recommendations: More areas of the body need to be tested and on repeated days to see the effect of local heating of trigger points on chronic pain.


heat; neck; pain; plantar fascia; trigger point

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Abu Taleb, W., Rehan Youssef, A., Saleh, A., 2016. The effectiveness of manual versus algometer pressure release techniques for treating active myofascial trigger points of the upper trapezius. J Bodyw Mov Ther. 20, 863-869.

Adamse, C., Dekker-Van Weering, M. G., van Etten-Jamaludin, F. S., et al., 2017. The effectiveness of exercise-based telemedicine on pain, physical activity and quality of life in the treatment of chronic pain: A systematic review. J Telemed Telecare. 1357633X17716576.

Almalty, A. M., Petrofsky, J. S., Al-Naami, B., et al., 2009. An effective method for skin blood flow measurement using local heat combined with electrical stimulation. J Med Eng Technol. 33, 663-669.

Alonso-Blanco, C., Fernandez-de-las-Penas, C., Morales-Cabezas, M., et al., 2011. Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain. 27, 405-413.

Barene, S., Krustrup, P., Holtermann, A., 2014. Effects of the Workplace Health Promotion Activities Soccer and Zumba on Muscle Pain, Work Ability and Perceived Physical Exertion among Female Hospital Employees. PLoS One. 9, e115059.

Bernhardt, O., Schiffman, E. L., Look, J. O., 2007. Reliability and validity of a new fingertip-shaped pressure algometer for assessing pressure pain thresholds in the temporomandibular joint and masticatory muscles. J Orofac Pain. 21, 29-38.

Black, P., Max, M. B., Desjardins, P., et al., 2002. A randomized, double-blind, placebo-controlled comparison of the analgesic efficacy, onset of action, and tolerability of ibuprofen arginate and ibuprofen in postoperative dental pain. Clin Ther. 24, 1072-1089.

Boyles, R., Fowler, R., Ramsey, D., et al., 2015. Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther. 23, 276-293.

Cole, D. C., Ibrahim, S., Shannon, H. S., 2005. Predictors of work-related repetitive strain injuries in a population cohort. Am J Public Health. 95, 1233-1237.

Cotchett, M. P., Landorf, K. B., Munteanu, S. E., 2010. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res. 3, 18.

Coyte, P. C., Asche, C. V., Croxford, R., et al., 1998. The economic cost of musculoskeletal disorders in Canada. Arthritis Care Res. 11, 315-325.

Crawford, F., 2005. Plantar heel pain and fasciitis. Clin Evid. 1533-1545.

Desjardins, P., Black, P., Papageorge, M., et al., 2002. Ibuprofen arginate provides effective relief from postoperative dental pain with a more rapid onset of action than ibuprofen. Eur J Clin Pharmacol. 58, 387-394.

Diamond, S., Balm, T. K., Freitag, F. G., 2000. Ibuprofen plus caffeine in the treatment of tension-type headache. Clin Pharmacol Ther. 68, 312-319.

Digiovanni, B. F., Nawoczenski, D. A., Malay, D. P., et al., 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 88, 1775-1781.

Dunn, J. E., Link, C. L., Felson, D. T., et al., 2004. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol. 159, 491-498.

Eftekharsadat, B., Babaei-Ghazani, A., Zeinolabedinzadeh, V., 2016. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Med J Islam Repub Iran. 30, 401.

Fishbain, D. A., Lewis, J. E., Gao, J., 2013. Is there significant correlation between self-reported low back pain visual analogue scores and low back pain scores determined by pressure pain induction matching? Pain Pract. 13, 358-363.

Flor, H., 2003. Cortical reorganisation and chronic pain: implications for rehabilitation. J Rehabil Med. 66-72.

Gallagher, E. J., Bijur, P. E., Latimer, C., et al., 2002. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 20, 287-290.

Garra, G., Singer, A. J., Leno, R., et al., 2010. Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Acad Emerg Med. 17, 484-489.

Gattie, E., Cleland, J. A., Snodgrass, S., 2017. The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 47, 133-149.

Ge, H. Y., Arendt-Nielsen, L., 2011. Latent myofascial trigger points. Curr Pain Headache Rep. 15, 386-392.

Ge, H. Y., Fernandez-de-Las-Penas, C., Yue, S. W., 2011. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 6, 13.

Ge, H. Y., Vangsgaard, S., Omland, O., et al., 2014. Mechanistic experimental pain assessment in computer users with and without chronic musculoskeletal pain. BMC Musculoskelet Disord. 15, 412.

Goff, J. D., Crawford, R., 2011. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 84, 676-682.

Hansen, I. R., Sogaard, K., Christensen, R., et al., 2011. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: design of a randomised controlled trial. BMC Musculoskelet Disord. 12, 274.

Hsieh, C. Y., Hong, C. Z., Adams, A. H., et al., 2000. Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles. Arch Phys Med Rehabil. 81, 258-264.

Hyland, M. R., Webber-Gaffney, A., Cohen, L., et al., 2006. Randomized controlled trial of calcaneal taping, sham taping, and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther. 36, 364-371.

Kinser, A. M., Sands, W. A., Stone, M. H., 2009. Reliability and validity of a pressure algometer. J Strength Cond Res. 23, 312-314.

Kjaergaard, G. H., Laursen, J. O., 2000. [Osteonecrosis of a knee joint in a young man with IDDM]. Ugeskr Laeger. 162, 4663-4664.

Kumar, V., Millar, T., Murphy, P. N., et al., 2013. The treatment of intractable plantar fasciitis with platelet-rich plasma injection. Foot (Edinb). 23, 74-77.

Laymon, M., Petrofsky, J., McKivigan, J., et al., 2015. Effect of heat, cold, and pressure on the transverse carpal ligament and median nerve: a pilot study. Med Sci Monit. 21, 446-451.

Liu, L., Huang, Q. M., Liu, Q. G., et al., 2017. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated with Low Back Pain: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil.

Liu, L., Huang, Q. M., Liu, Q. G., et al., 2015. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 96, 944-955.

Liu, R., Kurihara, C., Tsai, H. T., et al., 2016. Classification and Treatment of Chronic Neck Pain: A Longitudinal Cohort Study. Reg Anesth Pain Med.

Long, M. H., Bogossian, F. E., Johnston, V., 2013. The prevalence of work-related neck, shoulder, and upper back musculoskeletal disorders among midwives, nurses, and physicians: a systematic review. Workplace Health Saf. 61, 223-229; quiz 230.

Long, M. H., Johnston, V., Bogossian, F., 2012. Work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians: A systematic review of risk factors and functional consequences. Appl Ergon. 43, 455-467.

Mannerkorpi, K., Henriksson, C., 2007. Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol. 21, 513-534.

Mayer, J. M., Ralph, L., Look, M., et al., 2005. Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. Spine J. 5, 395-403.

McCaskey, M. A., Schuster-Amft, C., Wirth, B., et al., 2014. Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review. BMC Musculoskelet Disord. 15, 382.

Mehlisch, D. R., Ardia, A., Pallotta, T., 2002. A controlled comparative study of ibuprofen arginate versus conventional ibuprofen in the treatment of postoperative dental pain. J Clin Pharmacol. 42, 904-911.

Molloy, L. A., 2012. Managing chronic plantar fasciitis: when conservative strategies fail. JAAPA. 25, 48, 50, 52-43.

Moraes do Carmo, C. C., Fonseca de Almeida Melao, L. I., Valle de Lemos Weber, M. F., et al., 2008. Anatomical features of plantar aponeurosis: cadaveric study using ultrasonography and magnetic resonance imaging. Skeletal Radiol. 37, 929-935.

Nadler, S. F., Steiner, D. J., Erasala, G. N., et al., 2002. Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain. Spine (Phila Pa 1976). 27, 1012-1017.

Negrini, S., Imperio, G., Villafane, J. H., et al., 2013. Systematic reviews of physical and rehabilitation medicine Cochrane contents. Part 1. Disabilities due to spinal disorders and pain syndromes in adults. Eur J Phys Rehabil Med. 49, 597-609.

Ong, J., Claydon, L. S., 2014. The effect of dry needling for myofascial trigger points in the neck and shoulders: a systematic review and meta-analysis. J Bodyw Mov Ther. 18, 390-398.

Petrofsky, J., Alshahmmari, F., Yim, J. E., et al., 2011. The interrealtionship between locally applied heat, ageing and skin blood flow on heat transfer into and from the skin. J Med Eng Technol. 35, 262-274.

Petrofsky, J., Bains, G., Prowse, M., et al., 2009. Dry heat, moist heat and body fat: are heating modalities really effective in people who are overweight? J Med Eng Technol. 33, 361-369.

Petrofsky, J., Batt, J., Bollinger, J. N., et al., 2011a. Comparison of Different Heat Modalities for Treating Delayed-Onset Muscle Soreness in People with Diabetes. Diabetes Technol Ther.

Petrofsky, J., Batt, J., Bollinger, J. N., et al., 2011b. Comparison of different heat modalities for treating delayed-onset muscle soreness in people with diabetes. Diabetes Technol Ther. 13, 645-655.

Petrofsky, J., Berk, L., Alshammari, F., et al., 2012. The effect of moist air on skin blood flow and temperature in subjects with and without diabetes. Diabetes Technol Ther. 14, 105-116.

Petrofsky, J., Berk, L., Bains, G., et al., 2013. Moist heat or dry heat for delayed onset muscle soreness. J Clin Med Res. 5, 416-425.

Petrofsky, J., Berk, L., Bains, G., et al., 2016. The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Clin J Sport Med.

Petrofsky, J., Goraksh, N., Alshammari, F., et al., 2011. The ability of the skin to absorb heat; the effect of repeated exposure and age. Med Sci Monit. 17, CR1-8.

Petrofsky, J., Paluso, D., Anderson, D., et al., 2011. The contribution of skin blood flow in warming the skin after the application of local heat; the duality of the Pennes heat equation. Med Eng Phys. 33, 325-329.

Petrofsky, J. S., 2010. A device to measure heat flow through the skin in people with diabetes. Diabetes Technol Ther. 12, 737-743.

Petrofsky, J. S., Bains, G., Raju, C., et al., 2009. The effect of the moisture content of a local heat source on the blood flow response of the skin. Arch Dermatol Res. 301, 581-585.

Petrofsky, J. S., Lawson, D., Suh, H. J., et al., 2007. The influence of local versus global heat on the healing of chronic wounds in patients with diabetes. Diabetes Technol Ther. 9, 535-544.

Petrofsky, J. S., Laymon, M., 2009. Heat transfer to deep tissue: the effect of body fat and heating modality. J Med Eng Technol. 33, 337-348.

Petrofsky, J. S., Laymon, M., Berk, L., et al., 2016. Effect of ThermaCare HeatWraps and Icy Hot Cream/Patches on Skin and Quadriceps Muscle Temperature and Blood Flow. J Chiropr Med. 15, 9-18.

Petrofsky, J. S., Laymon, M. S., Alshammari, F. S., et al., 2016. Use of Low Level of Continuous Heat as an Adjunct to Physical Therapy Improves Knee Pain Recovery and the Compliance for Home Exercise in Patients With Chronic Knee Pain: A Randomized Controlled Trial. J Strength Cond Res. 30, 3107-3115.

Petrofsky, J. S., Lohman, E., Suh, HJ., Garcia, J., Anders, A., Sutterfield, C., Grabicki, J, & Khandge, C., 2006. Determination of the conductive heat exchange of the skin in relation to environmental temperature. J Appl. Res Clin Exp Ther. . 6, 157-169.

Rashid, M., Kristofferzon, M. L., Nilsson, A., et al., 2017. Factors associated with return to work among people on work absence due to long-term neck or back pain: a narrative systematic review. BMJ Open. 7, e014939.

Riddle, D. L., Schappert, S. M., 2004. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 25, 303-310.

Sahin, N., Karahan, A. Y., Devrimsel, G., et al., 2017. Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain. J Phys Ther Sci. 29, 891-895.

Stark, J., Petrofsky, J., Berk, L., et al., 2014. Continuous low-level heatwrap therapy relieves low back pain and reduces muscle stiffness. Phys Sportsmed. 42, 39-48.

Stoop, R., Clijsen, R., Leoni, D., et al., 2017. Evolution of the methodological quality of controlled clinical trials for myofascial trigger point treatments for the period 1978-2015: A systematic review. Musculoskelet Sci Pract. 30, 1-9.

Weiner, D. K., 2006. Pain and aging: a call to those with the power of inquiry, the skills to teach, and the desire to heal. Pain Med. 7, 57-59.

Willems, E., Knigge, U., Jorgensen, H., et al., 2000. Effect of blockade of postsynaptic H1 or H2 receptors or activation of presynaptic H3 receptors on catecholamine-induced stimulation of ACTH and prolactin secretion. Eur J Endocrinol. 142, 637-641.

Wirth, B., Amstalden, M., Perk, M., et al., 2014. Respiratory dysfunction in patients with chronic neck pain - influence of thoracic spine and chest mobility. Man Ther. 19, 440-444.

Young, C., 2012. In the clinic. Plantar fasciitis. Ann Intern Med. 156, ITC1-1, ITC1-2, ITC1-3, ITC1-4, ITC1-5, ITC1-6, ITC1-7, ITC1-8, ITC1-9, ITC1-10, ITC11-11, ITC11-12, ITC11-13, ITC11-14, ITC11-15; quiz ITC11-16.


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