Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review

Question: Among people with myofascial pain, does exercise reduce the intensity of the pain and disability? Design: Systematic review of randomised and quasi-randomised controlled trials. Participants: People with myofascial pain of any duration. Intervention: Exercise versus minimal or no intervention and exercise versus other intervention. Outcome measures: Pain intensity and disability. Results: Eight studies involving 255 participants were included. Pooled estimates from six studies showed statistically significant effects of exercise when compared with minimal or no intervention (support and encouragement or no treatment) on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise was -1.2 points (95% CI -2.3 to -0.1) on a 0 to 10 scale. Pooled estimates from two studies showed a non-significant effect of exercise when compared with other interventions (electrotherapy or dry needling) on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise instead of other therapies was 0.4 points (95% CI -0.3 to 1.1) on a 0 to 10 scale. Individual studies reported no significant effects of exercise on disability compared with minimal intervention (-0.4, 95% CI -1.3 to 0.5) and other interventions (0.0, 95% CI -0.8 to 0.8) at short-term follow-up. Sensitivity analysis suggested that combining stretching and strengthening achieves greater short-term effects on pain intensity compared with minimal or no intervention (-2.3, 95% CI -4.1 to -0.5). Conclusion: Evidence from a limited number of trials indicates that exercise has positive small-to-moderate effects on pain intensity at short-term follow-up in people with myofascial pain. A combination of stretching and strengthening exercises seems to achieve greater effects. These estimates may change with future high-quality studies. [Mata Diz JB, de Souza JRLM, Leopoldino AAO, Oliveira VC (2016) Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review. Journal of Physiotherapy 63: 17-22]