Objective:To observe any effect of dry needling of myofascial trigger points on substance P and synaptophysin expression in the spinal dorsal horn.Methods:Sixty-four Sprague-Dawley rats were randomly divided into a control group ( n=16) and a model group ( n=48). Myofascial trigger points were induced in the model group by a blunt strike and eccentric running. That group was then randomly divided into a no-treatment group ( n=15), a massage group ( n=16), and a dry needling group (16 rats). The rats in the two treatment groups received 4 weeks of dry needling or Chinese massage. Pressure pain thresholds were recorded before the experiment and after the 4 weeks. The content of substance P and synaptophysin in the spinal dorsal horn were measured using immunoblotting and immunohistochemistry. Results:After the treatment 14 rats (93%) in the model group had trigger points, significantly higher than the 8 rats (50%) in the massage group and the 7 rats (44%) in the dry needling group. After treatment, the average pressure pain thresholds of the no-treatment and massage groups was significantly lower than the control group′s average, while the difference between the dry needling group and the control group was not significant. The average pressure pain threshold had improved significantly in the no-treatment group, the massage group and the dry needling group, and the averages of the massage group and the dry needling group were significantly higher than that of the no-treatment group. The level of substance P was significantly higher in the no-treatment group than in the other three groups and the ratio of substance P to Glyceraldehyde 3-phosphate dehydrogenase (GAPDH)was significantly higher. The substance P: GAPDH ratio of the massage group was significantly higher than that of the control group.Conclusions:Dry needling and massage are effective in relieving myofascial pain, at least in rats. Both can reduce the content of substance P in the spinal dorsal horn.

The similarities and differences between trigger points of myalgia and acupoints were explored. Nodules could be detected by B-ultrasound at trigger points of myalgia, but not acupoints. In clinical symptoms, the referred pain pathway of trigger points of myalgia is similar with the pathway of acupuncture meridian. Therefore, the location of trigger points of myalgia should take referred pain as pathway, which is similar with locating acupoints as meridian. Acupuncture at trigger points of myalgia takes jumping feeling as criterion, while acupuncture at acupoints are mainly based on acid swelling and numbness. From clinical observation to basic experimental research, a lot of pathophysiological evidence is provided for trigger point of myalgia. It is believed that the trigger point of myalgia might be the precise acupoint in modern scientific research, and the meridian is the synthesis of the mechanics of nerve, blood vessel and fascia. Although acupuncture and dry needling are different in theory, but the scientific foundation of TCM and western medicine is coherent.

Objective To study the effects of acupuncture at myofascial trigger points on spastic foot drop and inversion after stroke. Methods From May, 2014 to May, 2016, 50 stroke patients were randomly divided into control group (n=25) and observation group (n=25). Both groups accepted routine rehabilitation, while the observation group accepted acupuncture at myofascial trigger points per day in addi-tion. They were assessed with Visual Analogue Scale (VAS) of pain, modified Ashworth Scale (MAS), range of motion (ROM) of ankle, sim-plified Fugl-Meyer Assessment (FMA) for lower limbs and maximum walking speed (MWS) in ten metres before and six weeks after treat-ment. Results The scores of VAS, MAS, and FMA, the ROM of ankle, and MWS improved after treatment (t>6.845, P<0.001), and im-proved more in the observation group than in the control group (t>5.586, P<0.001). Conclusion Acupuncture at myofascial trigger points can release spasm to reduce foot drop and inversion in patients with stroke.

This article demonstrated the myofascial trigger points theory and the application of related techniques in the clinical prac-tice of sports rehabilitation, such as the treatment of athletes injury pain, rehabilitation of movement function limitation, elimination of sports fatigue and so on. The clinical treatments based on the myofascial trigger points theory are simple, effective, noninvasive, and with short recovery time and low recurrence rate. It provides scientific theoretical and practical foundation for the prevention, diagnosis, treat-ment and rehabilitation for sport injury.

OBJECTIVETo investigate the current practice of myofascial pain syndrome (MPS) including current epidemiology, pathology, diagnosis and treatment.

DATA SOURCESThe data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed, MedSci, Google scholar. The terms "myofasial trigger points" and "myofacial pain syndrome" were used for the literature search.

STUDY SELECTIONOriginal articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points (MTrPs) and MPS were retrieved, reviewed, analyzed and summarized.

RESULTSMyofascial pain syndrome (MPS) is characterized by painful taut band, referred pain, and local response twitch with a prevalence of 85% to 95% of incidence. Several factors link to the etiology of MTrPs, such as the chronic injury and overload of muscles. Other factors, such as certain nutrient and hormone insufficiency, comorbidities, and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain. The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots, relative to some hypotheses of integration, muscle spindle discharges, spinal segment sensitization, ect. MTrPs can be diagnosed and localized based on a few subjective criteria. Several approaches, including both direct and supplementary treatments, can inactivate MTrPs. Direct treatments are categorized into invasive and conservative.

CONCLUSIONThis review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.

BACKGROUND:Core training has been gradual y accepted worldwide.“Core”is only a generalized perception, and how to define the muscles, the difference among the muscles and the mode of the muscle recruitment consist of the important part of research work on core training.
OBJECTIVE:From the aspects of theoretical basis, the development of training methods and measurement of training effectiveness, to elaborate the method issues and new insights on core stability training.
METHODS:PubMed, ScienceDirect and CNKI databases were searched by the keywords of“core training, core exercise, core strength”in the titles and abstract to retrieve relevant articles published from 1979 to 2013.
RESULTS AND CONCLUSION:The neural subsystem was first reported by Panjabi to monitor the various signals from the transducers and direct the active subsystem to provide the needed stability. Neutral zone is regarded as an important clinical indicator relevant to spinal stability. Spinal injury and muscle weakening can result in spinal instability and even low back pain and peripheral pain. Core trainings include Swiss bal , plank exercise, sling exercise and so on. Up to now, research on core training is focusing on its mechanism. Core stability training is not only defined as torso stability training, but also refined to the stability training of each joint.

Objective To observe the activation patterns in surface electromyographs (sEMGs) of the lumbar dorsal and ventral muscles and the gluteus medius during asymmetrical trunk postures and while carrying loads with the trunk rotated.Methods sEMGs were recorded from ten healthy men as they stood with their feet in 5 positions-rotated clockwise 0°,45°,90°,135° and 180° with respect to the initial plane of the torso.With each foot position they stood in 3 postures:upright,in lateral flexion and in lateral extension.Each posture was recorded with and without carrying a load of 20 kg by the right hand.The EMG activities of the rectus abdominis (RA),obliquus externus abdominis (EO),erector spinae (ES),multifidus (LM) and gluteus medius (GM) on both sides were recorded.Trunk displacement was monitored by 8 cameras.The EMG data of each muscle were normalized with readings from a maximal voluntary contraction (MVC) of the muscle.Results With the feet at 0° and no load the muscle activities on both sides were 1％-2％ of the MVC readings.With a 20 kg load the percentage was 3％-13％.With the feet at 45° and no load the activities were greater,except in the RA on the contralateral side.With no load at 90°,135° and 180° the muscle activities were greater,but a few muscles in the two extreme trunk postures showed greater activity only on one side,especially the ES and LM.With a load and rotational torque in the spine,the ventral muscles were less active but the dorsal muscles were significantly more active on both sides.Conclusion Standing with rotation of the spine,the activity of some trunk muscles shows great asymmetry,particularly with asymmetric loading of the arms.This might create a phenomenon of lumbar flashing and it could possibly be one of the pathological bases of acute lumbar sprain.

BACKGROUND:Myofascial trigger points have been widely applied in clinical rehabilitation and tissue pain field in the United States and Europe countries, and they have been recognized as the common cause of clinical musculoskeletal pain, joint function limitation, tissue injuries and muscle fatigue by many physiotherapists abroad. However, in China, many experts stil have some mistaken ideas and limitations to understand the pathological mechanism and to diagnosis and treat myofascial trigger points. OBJECTIVE:From the aspects of the etiology, pathological mechanism, diagnosis and positioning, treatments, to elaborate the method issues and the clinical experience of treatments of myofascial trigger points. METHODS:PubMed, ScienceDirect, EBSCO and CNKI databases were searched by the keywords of “myofascial trigger points, myofascial pain syndrome” in Chinese and English, respectively, in the titles and abstract to retrieve relevant articles published from the time of database construction to August 2014. RESULTS AND CONCLUSION:It is concluded that a child has myofascial trigger points in some skeletal muscles after age of 4 years. The main causes of myofascial trigger points include issue trauma, the wrong posture, bone and joint degeneration, nutrition deficiency, mental stress, chronic infection and so on. The pathological mechanism of myofascial trigger points remains unknown, but what has been widely accepted is the integrated trigger point hypothesis introduced by Simons. And how to find and position myofascial trigger points is the key point to treat this disease successfuly. The application of myofascial trigger points techniques is important for the rehabilitation of clinical tissue pain and the occurrence and spread of bone and joint injuries, myofascitis, muscle pain, muscle fatigue and so on.

Objective To investigate the current practice of myofascial pain syndrome (MPS) including current epidemiology,pathology,diagnosis and treatment.Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed,MedSci,Google scholar.The terms "myofasial trigger points" and "myofacial pain syndrome" were used for the literature search.Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points (MTrPs) and MPS were retrieved,reviewed,analyzed and summarized.Results Myofascial pain syndrome (MPS) is characterized by painful taut band,referred pain,and local response twitch with a prevalence of 85％ to 95％ of incidence.Several factors link to the etiology of MTrPs,such as the chronic injury and overload of muscles.Other factors,such as certain nutrient and hormone insufficiency,comorbidities,and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain.The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots,relative to some hypotheses of integration,muscle spindle discharges,spinal segment sensitization,ect.MTrPs can be diagnosed and localized based on a few subjective criteria.Several approaches,including both direct and supplementary treatments,can inactivate MTrPs.Direct treatments are categorized into invasive and conservative.Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.

Objective To explore the application value of spiral CT angiography in etiological diagnosis of spontaneous intracranial hematoma before surgery. Methods 48 patients with spontaneous intracranial hematoma following surgical indication assessed by CT scan were ascertained etiological diagnosis performed by CT angiography before surgery.Results The causes of intracranial hematoma were cerebral aneurysm(2 patients), arteriocenous malformation (5 patients), hypertension(40 patients), and no image in one patient performed by CT angiography.Conclusion CT angiography has important value in etiological diagnosis of spontaneous intracranial hematoma before surgery.