Multi-modal Assessment of Myofascial Trigger Point Response to Osteopathic Manipulation in the Anterior Forearm

Work-related muscle disorders are a main cause of missed work, globally, and arecostly for public health systems. However, development of musculoskeletal tissue diagnostics is lagging compared to other tissues and organs. Myofascial trigger points (MTP) are unique muscle tissue phenomenon that are challenging to address due to a lack of objective assessment methodology. This study seeks to meet this need by devising a non-invasive, objective methodology for evaluating musculoskeletal tissue following intervention or physical provocation, specific to the anterior forearm region. In Aim 1, current literature on MTP pathophysiology informs a multi-modal assessment approach, including: 1) pain pressure threshold (PPT), 2) power Doppler (PD) ultrasound, 3) strain elastography (SE), and 4) surface electromyography (sEMG). In Aim 2, controlled ultrasound image acquisition and standardization techniques are developed for imaging muscle tissue with PD (Aim 2a) and SE (Aim 2b) . These techniques improved differentiability of vascularity and compliance estimation after physical provocation or intervention. In Aim 3, the multi-modal approach is implemented in a human pilot study (n=34) investigating MTP response to osteopathic manipulative treatment, compared to rest and light exercise. Positive trends and significant changes are detected after OMT and rest. PPT significantly increased after OMT (p = 0.021). Tissue compliance significantly increase after rest (p ≪ 0.0001) and after OMT( p = 0.002). Principal component analysis finds 9 of 13 outcome measures to be salient features of MTP treatment effect. The data suggests high and low responders, yielding insights for improved patient screening and study design for future work. With further optimization and development, this method may be applied to a broad array of clinical scenarios for musculoskeletal tissue evaluation directed towards amelioration of neuromuscular symptoms.