Effects on Neuromuscular Function After Ischemic Compression in Latent Trigger Points in the Gastrocnemius Muscles: A Randomized Within-Participant Clinical Trial

Published:January 09, 2021DOI:



      The purpose of this study was to evaluate changes in neuromuscular function, pain perception, and basic physical properties in latent myofascial trigger points (TrPs) after a single treatment session of ischemic compression in the gastrocnemius muscle.


      A randomized within-participant clinical trial with a blinded assessor was conducted. Twenty-nine asymptomatic volunteers with latent gastrocnemius-muscle TrPs were bilaterally explored. Each extremity was randomly assigned to the control group (no treatment) or the experimental group (90 seconds of ischemic compression over each TrP). Neuromuscular function of the gastrocnemius muscle was assessed using a MyotonPro. Muscle flexibility was analyzed using the lunge test and the passive ankle range of motion. The strength was determined with a handheld dynamometer (MicroFET2). Pain perception was analyzed with a 0-to-10 numerical pain rating scale and determination of pressure pain thresholds over each latent TrP.


      The results revealed a reduction of 15.8% in pain perception and an increment of pressure tolerance of 9.9% without pain in the treatment group. Changes in muscle flexibility (active and passive) and most parameters for neuromuscular response (rigidity, elasticity, and relaxation) were also observed, but they were not significantly different between groups. The clinical effect sizes were moderate for pain perception (d = 0.69), pressure pain threshold (d = 0.78), muscle tone (d = 0.51), and elasticity (d = 0.54) in favor of the treated extremity. Small clinical effect sizes were observed for muscle physical outcomes.


      The present study shows that the use of a single session of ischemic compression for latent gastrocnemius-muscle TrPs improved some sensory outcomes. The effects on ankle range of motion and neuromuscular responses were inconclusive.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stecco A
        • Gesi M
        • Stecco C
        • Stern R
        Fascial components of the myofascial pain syndrome.
        Curr Pain Headache Rep. 2013; 17: 352
        • Fernández-de-las-Peñas C
        • Dommerholt J
        International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: a Delphi study.
        Pain Med. 2017; 19: 142-150
        • Gerwin R
        Myofascial pain syndrome: Here we are, where must we go?.
        J Musculoskelet Pain. 2010; 18: 329-347
        • Ge H
        • Arendt-Nielsen L
        Latent myofascial trigger points.
        Curr Pain Headache Rep. 2011; 15: 386-392
        • Sanz DR
        • Lobo CC
        • López DL
        • Morales CR
        • Marín CS
        • Corbalán IS
        Interrater reliability in the clinical evaluation of myofascial trigger points in three ankle muscles.
        J Manipulative Physiol Ther. 2016; 39: 623-634
        • Cagnie B
        • Castelein B
        • Pollie F
        • Steelant L
        • Verhoeyen H
        • Cools A
        Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review.
        Am J Phys Med Rehabil. 2015; 94: 573-583
        • Zuil-Escobar JC
        • Martínez-Cepa CB
        • Martín-Urrialde JA
        • Gómez-Conesa A
        The prevalence of latent trigger points in lower limb muscles in asymptomatic subjects.
        PM R. 2016; 8: 1055-1064
        • Grieve R
        • Barnett S
        • Coghill N
        • Cramp F
        The prevalence of latent myofascial trigger points and diagnostic criteria of the triceps surae and upper trapezius: a cross sectional study.
        Physiotherapy. 2013; 99: 278-284
        • San-Antolín M
        • Rodríguez-Sanz D
        • Becerro-de-Bengoa-Vallejo R
        • et al.
        Central sensitization and catastrophism symptoms are associated with chronic myofascial pain in the gastrocnemius of athletes.
        Pain Med. 2020; 21: 1616-1625
        • Rodríguez-Sanz D
        • Becerro-de-Bengoa-Vallejo R
        • Losa-Iglesias ME
        • et al.
        Effects of compressive stockings and standard stockings in skin temperature and pressure pain threshold in runners with functional ankle equinus condition.
        J Clin Med. 2018; 7: 454
        • Benito-de-Pedro M
        • Becerro-de-Bengoa-Vallejo R
        • Losa-Iglesias ME
        • et al.
        Effectiveness between dry needling and ischemic compression in the triceps surae latent myofascial trigger points of triathletes on pressure pain threshold and thermography: a single blinded randomized clinical trial.
        J Clin Med. 2019; 8: 1632
        • Simon M
        • Pérez-Bellmunt A
        • Peillon O
        • Ragazzi P
        Treatment of the myofascial trigger-points of triceps surae: a systematic review.
        Int J Sports Exerc Med. 2019; 5: 116
        • Janecki D
        • Jarocka E
        • Jaskólska A
        • Marusiak J
        • Jaskólski A
        Muscle passive stiffness increases less after the second bout of eccentric exercise compared to the first bout.
        J Sci Med Sport. 2011; 14: 338-343
        • Meerits T
        • Bacchieri S
        • Pääsuke M
        • Ereline J
        • Cicchella A
        • Gapeyeva H
        Acute effect of static and dynamic stretching on tone and elasticity of hamstring muscle and on vertical jump performance in track-and-field athletes.
        Acta Kinesiol Univ Tartu. 2014; 20: 48-59
        • Jiménez-Sánchez C
        • Ortiz-Lucas M
        • Bravo-Esteban E
        • Mayoral-del Moral O
        • Herrero-Gállego P
        • Gómez-Soriano J
        Myotonometry as a measure to detect myofascial trigger points: an inter-rater reliability study.
        Physiol Meas. 2018; 39115004
        • Kisilewicz A
        • Janusiak M
        • Szafraniec R
        • et al.
        Changes in muscle stiffness of the trapezius muscle after application of ischemic compression into myofascial trigger points in professional basketball players.
        J Hum Kinet. 2018; 64: 35-45
        • Davies CT
        • Young K
        Effect of temperature on the contractile properties and muscle power of triceps surae in humans.
        J Appl Physiol Respir Environ Exerc Physiol. 1983; 55: 191-195
        • Bizzini M
        • Mannion AF
        Reliability of a new, hand-held device for assessing skeletal muscle stiffness.
        Clin Biomech (Bristol, Avon). 2003; 18: 459-461
        • Viir R
        • Laiho K
        • Kramarenko J
        • Mikkelsson M
        Repeatability of trapezius muscle tone assessment by a myometric method.
        J Mech Med Biol. 2006; 6: 215-228
        • Ditroilo M
        • Hunter AM
        • Haslam S
        • De Vito G
        The effectiveness of two novel techniques in establishing the mechanical and contractile responses of biceps femoris.
        Physiol Meas. 2011; 32: 1315
        • Chuang L
        • Wu C
        • Lin K
        Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with stroke.
        Arch Phys Med Rehabil. 2012; 93: 532-540
        • Agyapong-Badu S
        • Aird L
        • Bailey L
        • et al.
        Interrater reliability of muscle tone, stiffness and elasticity measurements of rectus femoris and biceps brachii in healthy young and older males.
        Work Pap Health Sci. 2013; 1: 4
        • Davidson MJ
        • Bryant AL
        • Bower WF
        • Frawley HC
        Myotonometry reliably measures muscle stiffness in the thenar and perineal muscles.
        Physiother Can. 2017; 69: 104-112
        • Mullix J
        • Warner M
        • Stokes M
        Testing muscle tone and mechanical properties of rectus femoris and biceps femoris using a novel hand held MyotonPRO device: relative ratios and reliability.
        Work Pap Health Sci. 2012; 1: 1
        • Bailey L
        • Samuel D
        • Warner M
        • Stokes M
        Parameters representing muscle tone, elasticity and stiffness of biceps brachii in healthy older males: symmetry and within-session reliability using the MyotonPRO.
        J Neurol Disord. 2013; 1: 1-7
        • Vanderweeen L
        • Oostendorp R
        • Vaes P
        • Duquet W
        Pressure algometry in manual therapy.
        Man Ther. 1996; 1: 258-265
        • Nussbaum EL
        • Downes L
        Reliability of clinical pressure-pain algometric measurements obtained on consecutive days.
        Phys Ther. 1998; 78: 160-169
        • Jensen MP
        • Turner JA
        • Romano JM
        • Fisher LD
        Comparative reliability and validity of chronic pain intensity measures.
        Pain. 1999; 83: 157-162
        • Kawakami Y
        • Kanehisa H
        • Fukunaga T
        The relationship between passive ankle plantar flexion joint torque and gastrocnemius muscle and Achilles tendon stiffness: implications for flexibility.
        J Orthop Sports Phys Ther. 2008; 38: 269-276
        • Clanton TO
        • Matheny LM
        • Jarvis HC
        • Jeronimus AB
        Return to play in athletes following ankle injuries.
        Sports Health. 2012; 4: 471-474
        • Halperin I
        • Aboodarda SJ
        • Button DC
        • Andersen LL
        • Behm DG
        Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters.
        Int J Sports Phys Ther. 2014; 9: 92-102
        • Bennell KL
        • Talbot RC
        • Wajswelner H
        • Techovanich W
        • Kelly DH
        • Hall AJ
        Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion.
        Aust J Physiother. 1998; 44: 175-180
        • Docherty CL
        • Moore JH
        • Arnold BL
        Effects of strength training on strength development and joint position sense in functionally unstable ankles.
        J Athl Train. 1998; 33: 310-314
        • Mentiplay BF
        • Perraton LG
        • Bower KJ
        • et al.
        Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study.
        PLoS One. 2015; 10e0140822
        • Cohen J
        Statistical Power Analysis for the Behavioral Sciences.
        Routledge, New York, NY2013
        • Morris SB
        • DeShon RP
        Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs.
        Psychol Methods. 2002; 7: 105
        • Hong C
        • Simons DG
        Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points.
        Arch Phys Med Rehabil. 1998; 79: 863-872
        • Shah JP
        • Danoff JV
        • Desai MJ
        • et al.
        Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
        Arch Phys Med Rehabil. 2008; 89: 16-23
        • Hug F
        • Tucker K
        • Gennisson JL
        • Tanter M
        • Nordez A
        Elastography for muscle biomechanics: toward the estimation of individual muscle force.
        Exerc Sport Sci Rev. 2015; 43: 125-133
        • Lorimer AV
        • Hume PA
        Stiffness as a risk factor for Achilles tendon injury in running athletes.
        Sports Med. 2016; 46: 1921-1938
        • Martin RL
        • Chimenti R
        • Cuddeford T
        • et al.
        Achilles pain, stiffness, and muscle power deficits: Midportion Achilles tendinopathy revision 2018—clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association.
        J Orthop Sports Phys Ther. 2018; 48: A1-A38
        • Feng Y
        • Li Y
        • Liu C
        • Zhang Z
        Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO.
        Sci Rep. 2018; 8: 17064
        • Kumagai H
        • Miyamoto-Mikami E
        • Hirata K
        • et al.
        ESR1 rs2234693 polymorphism is associated with muscle injury and muscle stiffness.
        Med Sci Sports Exerc. 2019; 51: 19-26
        • Hanten WP
        • Olson SL
        • Butts NL
        • Nowicki AL
        Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.
        Phys Ther. 2000; 80: 997-1003
        • Fryer G
        • Hodgson L
        The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle.
        J Bodyw Mov Ther. 2005; 9: 248-255
        • Fernández-de-las-Peñas C
        • Alonso-Blanco C
        • Fernández-Carnero J
        • Miangolarra-Page JC
        The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: a pilot study.
        J Bodyw Mov Ther. 2006; 10: 3-9