Your myofascial tissues are what enclose and separate the layers of muscle in your body. Chronic myofascial pain is a common pain condition, and its prevalence is growing. Among middle-aged people, myofascial pain affects around 37% of men and 65% of women, but among the elderly, those numbers jump to 85% for the combined gender groups. Because the elderly population is expected to double before 2040, chronic myofascial pain is likely going to be a major challenge for health-care into the future.



Chiropractors have long used spinal adjustments as a means to manage musculoskeletal disorders and pain, including chronic myofascial pain. Many report the benefits among their patients receiving spinal therapy. But how and why does chiropractic work on muscle pain?
Researchers have explored the neurophysiological mechanisms and potential therapeutic applications of spinal therapy in treating and managing myofascial pain. Studies have suggested painful trigger points in the myofascial tissues may contribute to this chronic pain condition.

For a new study, researchers investigated if spinal adjustments could produce immediate pain relief by increasing patients' pressure pain thresholds in myofascial trigger points. They recruited 36 young adults with clinically identifiable myofascial trigger points, randomly assigning each participant to receive spinal adjustment therapy or to the control group receiving sham spinal care. Pressure pain thresholds were measured before treatment and again 1, 5, 10, and 15 minutes after the intervention.

They discovered that adjustments evoked immediate increases in pressure pain thresholds. Compared to the control group, the treatment group experienced decreased pain sensitivity. The researchers concluded that spinal adjustments can reduce myofascial pain in healthy young adults.

This study contributed to a growing body of evidence supporting spinal adjustments as a safe and effective way to manage pain, as well as a greater understanding of the role of trigger points in chronic pain conditions. Studies have shown that spinal adjustments can have immediate biological benefits, can ease jaw pain, and can relieve childhood headache, just to name a few benefits. In addition, a former study found that treatment options specifically focused on trigger points are effective for back pain relief.

Reference
Srbely J, Vernon H, Lee D, Polgar M. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. Journal of Manipulative and Physiological Therapeutics 2013 [Epub before print; currently in press.] Accessed at http://download.journals.elsevierhealth.com/pdfs/journals/0161-4754/PIIS0161475413001073.pdf.

Dysfunction in the sacroiliac joint (SIJ), located in the pelvis, is thought to be a possible cause of sciatica, resulting in back pain that radiates down the leg and below the knee.



Scientists have questioned what the best treatment option is for patients with SIJ-related leg pain. In a recent study, researchers compared three treatment options: physical therapy, chiropractic manual therapy, and intra-articular injections of corticosteroids. Patients included 51 adults with leg pain associated with the sacroiliac joint. Researchers analyzed the effectiveness of each method after 6 weeks of selected treatments, and again after 12 weeks. The results for each patient was categorized as either a success or failure, based on relief or worsening of symptoms and average pain scores.

The study's findings revealed that manual therapy is the superior choice for treating leg pain associated with the SIJ. The success rate for chiropractic manual therapy was 72%, compared to just 20% for physiotherapy and 50% for corticosteroid injections. Researchers also found that neither physical therapy nor injections resulted in significant pain relief, whereas manual therapy resulted in a significant improvement on pain scores.

Due to the success rate and pain reduction of manual therapy, the study authors concluded that chiropractic should be the first treatment of choice in patients with SIJ-related leg pain. They hoped that their findings would be confirmed by further research with a larger sample size.

Additional research has highlighted the efficacy of chiropractic for sciatica, even after surgery has failed.

Reference
Visser L, Woudenberg N, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. European Spine Journal 2013 [online]. doi: 10.1007/s00586-013-2833-2.