Type of Article:  Original Research

Volume 5; Issue 6 (December 2017)

Page No.: 2527-2533

DOI: https://dx.doi.org/10.16965/ijpr.2017.243


Yasser R. Lasheen, Ghada Ismail Mohamed *.

Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt.

Corresponding Author: Ghada Ismail Mohamed, PhD, PT, Lecturer of Physical Therapy Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt. E-Mail: drdody2007@outlook.com


Background: Myofascial trigger points(MTrPs) are perceived by numerous clinicians to be one of the most prevalent cause of pain and dysfunction in musculoskeletal system.

Purpose: of this study was to examine the effect of shock wave therapy versus low level laser (LLLT) in treatment of myofascial trigger points (MTrPs) of rotator cuff muscle dysfunction. Materials and Methods: Thirty patients from both genders were randomly distributed into two groups (fifteen patients for each group). They were all diagnosed as unilateral shoulder pain and suffering from myofascial trigger points in rotator cuff muscle. The first group(A) with a mean age of 34.67(± 5.95) years subjected to LLLT( Gallium-Arsenide I.R laser of 904 nm wave length with 3J / point for 90 sec pulse) in addition to ischaemic pressure for 12 sessions, 3 session a week. While the second group(B) with a mean age of 34.07 (± 4.51) got shock wave treatment (6000shocks, 2000 shock/ session, 4 session separated by one week, energy flux density 0.38 mJ/mm2, 1.6 barand10HZ) in addition to ischemic pressure for 12 sessions, 3 sessions a week. Pre and post treatment evaluations were recorded with respect to measuring pain intensity level, pressure pain threshold of myofascial trigger points and range of motion (ROM) of shoulder flexion and abduction.

Results: Patients of both groups showed statistical significant improvement in all the measured variables. Between groups difference the shock wave group (B) showed a statistical significant improvement in decreasing pain intensity level, increasing pressure pain threshold and improving shoulder range of motion than LLLT group (A) (p value<0.05).

Conclusion: Both shock wave and LLLT had a significant effect on decreasing shoulder pain intensity level, increasing pressure pain threshold and increasing in shoulder flexion and abduction (ROM). However, the shockwave therapy was more effective than LLLT in treatment of myofascial trigger points of rotator cuff muscle dysfunction.

Key words: Low level laser,  Myofascial trigger points, Rotator cuff muscle dysfunction, and Shock wave therapy.


  1. Ethnel L and Aurie Downes. Reliability of Clinical Pressure Pain Algometric Measurement Obtained on Consecutive Days. Phys. Therapy. 1998;78(2):160-169.
  2. Paul-dauphin A, Guillemin F, Virion J & Briancon S. Bias and Precision in Visual Analogue Scales : A Randomized Controlled Trial.Am J Epidemiol. 1999;150(10)1117-27.
  3. Hazel M.Clarkson. MUSCULOSKELETAL ASSESSMENT Joint Motion and Muscle Testing. . 3 rd edition. Edited by Lupash. Philadelphia and Baltimore; 2013; 531–532.
  4. Gatterman ML& Mcdowell BL.Chapter 6- Management of Muscle Injury and Myofsacial Pain Syndrome. Whiplash:A Patient- Centered Approach to Mnagement. 2012:85-118. Elsevier Inc.
  5. Mcevoy & Dommerholt J. Chapter 16- Myofacial Trigger Point of The Shoulder, Physical Therapy of Shoulder.5th ed. 2012: 351-379. Elsevier Inc
  6. Thorsen H, AN Gam, BH Svensson, M J ,MK Jensen & I Piculell. Low Level Laser Therapy for Myofascial Pain in The Neck and Shoulder Girdle. A double-blind, cross-over study. Scand J. Rheumatol. 1992; 21(3): 139.
  7. Chen C, Hu C, Weng P, Huang Y, Chiang C, Chen C & Tsuang, Y. Extracorporeal shockwave therapy improves short-term functional outcomes of shoulder adhesive capsulitis. Journal of Shoulder and Elbow Surgery.2014; 23(12):1843–1851
  8. Perez M, Weiner R & G J. Extracorporeal shockwave therapy for plantar fasciitis. Clin Podiatr Med Surg. 2003;20:323–334.
  9. Ji- Hyun Lee, Sangyoung Lee, Seokjoo Choi,Yoon-Hee Choi and Kwansub Lee. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis.J Phys Ther Sci. 2017;29(3):536-538.
  10. Plaisier PW, van der Hul RL, Terpstra OT, Bruining HA. Current role of extracorporeal shockwave therapy in surgery. Br J Surg. 1994;81(2):174–181.
  11. Wang C, Huang H, & Pai C. Shock Wave Enhanced Neovascularization at the Tendon-Bone Junction : An Experiment in Dogs. The Journal of Foot and Ankle Surgery. 2002;41(1):16–22.
  12. Babak Vahdatpour, Parisa Taheri, Abolghasem Zare Zade and Saeed Moradian.Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder.Int J Prev Med.2014;5(7):875-881.
  13. Harniman E, Carette S, Kennedy C & Beaton D. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists. 2004;17(2), 132–151.
  14. El Shiwi A M F, Balbaa A A. , Hussein A H, etal. (2010). Shock wave therapy versus therapeutic exercises in treatment of shoulder impingement syndrome. Faculty of Physical Therapy Cairo University.
  15. Srbely J Z, Dickey J P, Lowerison M, Edwards M., Nolet P S, & Wong L L . Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. 2008;139(2): 260–266.
  16. Pribicevic M & Pollard H. Rotator cuff impingement. Manipulative and Physiological Theraputics. 2005;27(9): 580–590.
  17. Sergienko S & Kalichman L. Myofascial origin of shoulder pain: A literature review. Journal of Bodywork and Movement Therapies. 2015; 19(1):91-101.
  18. Simons DG, Travell JG. Travell and Simons’ myo- fascial pain and dysfunction: the trigger point manual . 2nd Baltimore: Williams & Wilkins;1999.
  19. Mcevoy J, & Dommerholt J. Chapter 16 – Myofascial Trigger Points of the Shoulder. Physical Therapy of the Shoulder .5th ed.; 2012.pp: 351–379.
  20. Hidalgo-Lozano A F, ´ndez-de-las-Pen ˜as C, Alonso-Blanco C , Ge HY, Nielsen A & Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Brain Res. 2010; 202:915-925.
  21. Baloglu I., Lok V.: Shockwave therapy for plantar fasciitis. In: Coombs R., Schaden W., Zhou SS): Musculoskeletal shockwave Therapy. Greenwich Medical Media, London, 2000, pp. 51–52.
  22. Rompe JD, Hope C, Kullmer K, Heine J B R. Analgesic effect of extracorporeal shock-wave therapyon chronic tennis elbow. J Bone Joint Surg Br. 1996; 78(2):233-7.
  23. Bauermeister W. The diagnosis and treatment of myofascial trigger points using shockwaves. July. In Abstracts from the Sixth World Congress on Myofascial Pain and Fibromyalgia,, 2004:18–22.
  24. Lucas K R, Polus B I, & Rich P a. Latent myofascial trigger points: their effects on muscle activation and movement efficiency. Journal of Bodywork and Movement Therapies.2004; 8(3): 160–166.
  25. Ilbuldu E, Cakmak A, Disci R, et al. Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome,. Photomed Laser Surg, 2004;22(4):306-11.
  26. Simunovic Z & Trobonjaca T. Treatment of medial and lateral epicondylitis—tennis and golfer’s elbow— with low level laser therapy: a multicenter double blind, placebo-controlled clinical study on 324 patients,. J Clin Laser Med Surg. 1998;16(3):145–
  27. LD Rickards. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. Int J Osteopath Med.2006;9(4):120–136.
  28. Yamany A A, & Salim S E. Efficacy of Low Level Laser Therapy for Treatment Myofascial Trigger Points of Shoulder Pain. 2011;12(6): 758–764.
  29. Fabio Antonaci. Pressure Algometry in Healthy Subjects: Inter-examiner Variability. Scand J Rehabilitation Medicine. 1998;30(1):3-8.
  30. Kim Y, Lee H & Kong, C. Which method is more effective in treatment of calcific tendinitis in the shoulder ? Prospective randomized comparison between ultrasound-guided needling and extracorporeal shock wave therapy. Journal of Shoulder and Elbow Surgery. 2014;23(11):1640–1646.