Canine Myofascial Kinetic Lines: A Descriptive Dissection Study Including Related Function and Locomotion and Comparison of the Human and Equine Myofascial Kinetic Lines

Aim: This dissection study was conducted to verify if the Myofascial kinetic lines, outlined in detail in humans and recently documented in horses, were present in dogs. These dynamic lines present rows of interconnected muscles, myofascia and other fascia structures, which influence the biomechanics of the spine and limbs. Methods: Forty-two dogs of different breeds and genders were dissected, imaged, and videoed. Results: Similar kinetic lines were verified in the dog, as described in humans and horses, and additionally, three new branches of the lines were discovered. The kinetic lines described were three superficial lines: Dorsal, Ventral, and Lateral, which all started in the hindlimb and ended in the temporal and occipital regions. These lines act respectively in spinal extension, flexion, and lateral flexion. Three profound lines, which started in the tail and ended in the head. The Deep Dorsal Line followed the transversospinal myofascia. The Deep Ventral Line showed an additional start deep in the medial hind limb, continued in the hypaxial myofascia, and enveloped all the viscera. Also, the Deep Lateral Line started in the hindlimb but parted along the trunk in the deep lateral myofascial structures. Two helical lines crossed the midline two or three times and served to rotate the spine. The Functional Line established a sling from the axilla to the contralateral stifle and presented a new ipsilateral branch. The Spiral Line connected the head and the ipsilateral tarsus and additionally presented a new straight branch. The four front limb lines describe their motion: the Front Limb Protraction and Retraction, Adduction, and Abduction Lines. Conclusion: The canine lines mirrored the equine and human lines with exceptions due to differences in anatomy, foot posture, lumbosacral flexibility, and their biomechanical constitution as predator versus prey animals. Additionally, three new canine branches were verified and described.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

Myofascial pain syndrome(MPS)is characterized by myofascial trigger points and fascial constrictions.At present,domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS.Due to the lack of specific laboratory indicators and imaging evidence,there is no unified diagnostic criteria for MPS,making it easy to confuse with other diseases.The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS.This article reviews relevant domestic and foreign literature on the definition,epidemiology,pathogenesis,clinical manifestation,diagnostic criteria and treatments of MPS.The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors,including pain physicians to manage patients with MPS.

Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome

BACKGROUND Active myofascial trigger points(TrPs)often occur in the upper region of the upper trapezius(UT)muscle.These TrPs can be a significant source of neck,shoulder,and upper back pain and headaches.These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning,work-related productivity,and general quality of life.AIM To investigate the effects of instrument assisted soft tissue mobilization(IASTM)vs extracorporeal shock wave therapy(ESWT)on the TrPs of the UT muscle.METHODS A randomized,single-blind,comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo.Forty patients(28 females and 12 males),aged between 20-years-old and 40-years-old,with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups(A and B).Group A received IASTM,while group B received ESWT.Each group was treated twice weekly for 2 weeks.Both groups received muscle energy technique for the UT muscle.Patients were evaluated twice(pre-and posttreatment)for pain intensity using the visual analogue scale and for pain pressure threshold(PPT)using a pressure algometer.RESULTS Comparing the pre-and post-treatment mean values for all variables for group A,there were significant differences in pain intensity for TrP1 and TrP2(P=0.0001)and PPT for TrP1(P=0.0002)and TrP2(P=0.0001).Also,for group B,there were significant differences between the pre-and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2(P=0.0001).There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1(P=0.9)and TrP2(P=0.76)and PPT for TrP1(P=0.09)and for TrP2(P=0.91).CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs.There is no significant difference between either treatment method.

Clinical efficacy of electromagnetic field therapy combined with traditional Chinese pain-reducing paste in myofascial pain syndrome

BACKGROUND Pulsed electromagnetic field(PEMF)therapy is widely used to treat myofascial pain syndrome(MPS).Damp-clearing and pain-reducing paste(DPP)comprises medical herbs and has been a traditional method of reducing myofascial pain in China for a long time,and it is usually administered with heating.However,the synergistic effect of PEMF therapy on heating-DPP in patients with MPS is unclear.AIM To investigate the synergistic effect of PEMF therapy plus heating-DPP in lumbar MPS.METHODS This double-blind,randomized,placebo-controlled trial was conducted on 120 patients with lumbar MPS who were randomly divided into an experimental group(EG,n=60)and a control group(CG,n=60).Patients in both groups were treated with heating-DPP combined with PEMF therapy;however,the electromagnetic function of the therapeutic apparatus used in the CG was disabled.Each treatment lasted for 20 min and was applied five times a week for two weeks.The short-form McGill Pain Questionnaire was applied at five time points:pretest,end of the first and second weeks of treatment,and end of the first and fourth week after completing treatment.Visual analog scale(VAS),present pain intensity index(PPI),and pain rating index(PRI;total,affective pain,and sensory pain scores)scores were then analyzed.RESULTS Compared with the CG,the VAS,PPI and PRI scores(total,affective pain and sensory pain scores)in the EG were significantly lower after treatment and during follow-up.CONCLUSION PEMF therapy combined with heating-DPP showed better efficacy than heating-DPP alone in reducing the overall intensity of pain and sensory and affective pain.

Similarities and differences between the trigger point of myofascial pain and the traditional meridian points

In recent years,the treatment of myofascial pain trigger point is a relatively popular technology,many people regard it as"Ashi point"in meridian theory,but compared with the traditional meridian theory,the description of myofascial pain trigger point is more intuitive and easier to master.This paper expounds the similarities and differences between myofascial pain trigger point and traditional meridian theory from the aspects of theory,basic research and clinical application,in order to provide a specific idea for the scientific interpretation of meridian phenomenon in traditional Chinese medicine.

Myofascial Foot Pain Following Uneventful Epidural Analgesia for Labor and Delivery

Following an uneventful delivery under epidural analgesia, a 17 year old female patient was referred to the Pain Clinic because of numbness and pain of the left big toe for 2 and a half Months. An Orthopedic consultation had ruled out foot injury and concluded that the pain was radicular and secondary to nerve damage from the epidural analgesia. A Pain Clinic evaluation made the diagnosis of myofascial pain which was successfully treated with trigger pint block using normal saline.

Surgical Treatment of Ankylosis of Temporomandibular Joint with Temporalis Myofascial Flap

Objective. To study the effects of temporalis myofasdal flap (TMF) transferred to treat the long ankylosis of temporomandibular joint (TMJ). Methods : Seventeen cases with ankylosed condytes received arlhroplasty. The degrees of mouth opening pre- and post-operation were e-vahiated, and the spaces of joints in the X-ray films were also measured. The evaluation of the results of the surgical treatment was based on the TMJ functions. Results .Following up 0. 5-3. 0 years, in 12 of 17 cases the degree of mouth opening improved up to 27 mm. The doctors and the patients were both satisfied with the results. Conclusion:The use of TMF in artkroplasty of temporomandibular joint is a good approach in the treatment of TMJ.

Deep Myofascial Kinetic Lines in Horses, Comparative Dissection Studies Derived from Humans

Seven superficial myofascial kinetic lines have been described earlier in horses in a comparative dissection study to the human lines. The lines act as an anatomical basis for understanding locomotion, stabilization, and posture. Further dissections verified three profound equine lines comparable to those described in humans and a fourth line not described previously. Forty-four horses of different breed and gender were dissected, imaged and video recorded. The horses were euthanized due to reasons not related to this study. A Deep Ventral Line (DVL) very similar to that in the human was verified in these studies. The line spans from the insertion of the profound flexor tendon in the hindlimb to the base of the cranium and oral part of the cavities of the head. It includes the profound, hypaxial myofascial structures, the ventral coccygeal muscles, the psoas muscles, the diaphragm, the longus colli/capitis muscles and the ventral capital muscles. The inner lining of the pelvic, abdominal and thoracic cavities with all the organs, vessels and nerves are also included. The line is closely connected to the autonomic nervous system by the vagus nerve, the pelvic nerves, the sympathetic trunk and several of the prevertebral nerves and ganglia. The new line identified in this study, is a Deep Dorsal Line (DDL), which starts in the dorsal tail muscles. It comprises myofascial structures of the spinocostotransversal system from the tail to the head including the nuchal ligament. It connects to the dura mater and has a major role in controlling the motion and stabilization of the Columna vertebralis. Both the DDL and the DVL include the coccygeal myofascia and periosteum of the skull. Due to differences in biped and quadruped anatomy the Front Limb Adduction Line (FADL) and the Front Limb Abduction Line (FABL) differ from the human lines. The lines are identified as slings in the brachial and antebrachial regions. The FABL includes structures for abduction and internal rotation connecting to the Front Limb Retraction Line (FLRL), and the FADL structures of adduction and external rotation in close proximity to the Front Limb Protraction Line (FLPL). The front limb lines support the movement of the front limb around the “thoraco-scapula pivot joint” medially at the level of the upper third of the scapula. The DVL identified in this study is similar to the human DFL whereas the front limb lines differ somewhat from the deep human arm lines due to differences in bi- and quadruped anatomy and biomechanics. We have identified and described this new equine DDL. The lines altogether explain a profound body balance and confirm the three-dimensional equine fascial network, which is of great clinical and biomechanical importance.

Simultaneous Occurrence of Myofascial Pain Referred to Tooth and Endodontic Lesions in Patient with Toothache: A Case Report

Toothache is almost always caused by odontogenic toothache, but diagnosis is more difficult in the case of nonodontogenic toothache. We report a case of simultaneous occurrence of odontogenic and nonodontogenic toothache. This manuscript presents a case report for a 35-year-old woman who visited our Orofacial and Head Pain Clinic with the chief complaint of continuous dull pain in left maxillary molar teeth region. It was concluded to be a case of simultaneous odontogenic toothache and nonodontogenic toothache. It was successfully treated by an endodontist and an orofacial pain specialist. The endodontist performed root canal treatment against odontogenic toothache caused by apical periodontitis using a dental operating microscope. The presence of a trigger point (TP) resulting in tooth pain was inferred. A trigger point injection (TPI) was administered by orofacial pain specialist, and toothache relief was confirmed. Myofascial pain was diagnosed definitively. After confirming that the toothache had resolved at multiple TPIs, a crown prosthesis was placed. Following the application of crown prosthesis, we were concerned but did not find recurrence of toothache from myofascial pain due to increased occlusal force. This case suggests that there is no single cause of chronic pain and that multiple causes must be considered for diagnosis, suggesting the need for treatment by multiple specialists.

Relationship Between Symptom Distress,Functional Status and Quality of Life in Patients with Low Back Myofascial Pain Syndrome

Objective:To explore the relationship between symptomatic functional status and quality of life of patients with low back myofascial pain syndrome(MPS).Methods:From July 2021 to June 2022,106 patients with low back myofascial pain syndrome in the Affiliated Hospital of Hebei University were selected as the research subjects.A total of 106 MPS patients were investigated with general information questionnaire,Memory Symptom Assessment Scale(MSAS),Oswestry Disability Index(ODI)and Short Form Questionnaire(SF-36).The relationship between quality of life and symptom distress and dysfunction was observed and analyzed based on symptom distress and dysfunction scores,SF-36 scores,and so on.Results:The total score of MSAS was 1.79±0.91.The overall symptom distress of the patients was moderate.The ODI score was 18.46±5.95.The functional disability of the patients was classified as moderately impaired.The MSAS-PHYS,MSAS-PSYCH,MSAS-GDI three scale scores were 2.14±0.75,1.69±0.88,1.55±0.46,respectively,and the variability of the three scales is relatively large;the dimension scores were significantly lower than those of the conventional scoring models,and P<0.05,indicating a statistical difference;the scores of each dimension of the patient’s quality of life were compared with the scores of symptom distress and functional status.The higher the symptom distress score,the lower the quality of life,with P<0.05,indicating a statistical difference;the higher the score of each dimension of functional status,the better the quality of life,showing a positive correlation,and P<0.05,indicating a statistical difference.Conclusion:MPS patients face a number of physical and psychological symptoms,and their functional status is limited.Nursing staff should implement health education and intervention measures according to the actual situation of the patients,so as to improve the quality of their lives.

Therapeutic Effects of 35 kDa Hyaluronan Injection at Trigger Points in the Treatment of Myofascial Pain Syndrome

Objectives: This study aimed to evaluate the prolonged therapeutic effects of a 35 kDa molecular weight hyaluronan fragment (HA35) in alleviating pain associated with myofascial pain syndrome (MPS). Hyaluronan interacts with various receptors in the human body, including CD44, LYVE-1, RHAMM, and TLR2, and is well-known for its analgesic effects when used in intra-articular or ultrasound-guided nerve trunk injections. Studies have shown that hyaluronidase cleaves high molecular weight HA to generate HA35, a low molecular weight fragment with enhanced tissue permeability, capable of binding to HA receptors on cell surfaces to produce broad-spectrum analgesic effects. Methods: Ten patients diagnosed with MPS were treated and assessed in this study. HA35 was administered through injection at a dosage of 100 mg daily for 15 days. Patients evaluated their MPS, overall pain levels, and treatment satisfaction using the Numerical Pain Rating Scale (NPRS), the Global Pain Scale (GPS), and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Follow-up evaluations were performed three months post-treatment to assess the duration of therapeutic effects. Results: Significant improvements were observed in NPRS, GPS, and TSQM scores both during and after the treatment period (P Conclusions: HA35 provides effective and sustained relief from pain associated with MPS, demonstrating a prolonged therapeutic benefit.

Sinew-bone three-needle therapy and myofascial power zones following the fourteen meridian-sinew

＂Sinew-bone three-needle therapy＂ was introduced in the paper. The innovation of needle instrument was micro Sinew-bone needles and big Sinew-bone needles; the Innovation of acupuncture techniques were fascia rotating separation, fascia plucked separation, fascia cutting separation, fascia fan separation, flying flicking therapy, and fascia knocking and pricking. The six myofascial power zones i.e three yang hand meridian, three yin hand meridian, three yang foot meridian, three yin foot meridian, conception vessel and governor vessel were put forward. The meridian-sinew flow and move, connecting at the peks of bones where the bones protrude, the sinews connect, movement and stillness harmoniously shift here. Bones have leaks on the sides, there are blood vessels and nerves. Joints peak and protrude, and three points meet. Fascia and muscles meet in a balanced triangle. Meridiansinew knot and form nodes, when soft tissue is damaged there is pain here. Needling manipulation can loose and break this apart, the sinew connection is the key. Treatment method was invented and the location and treatment points using the three needles were summarized.

Understanding of myofascial trigger points

Objective To investigate the current practice of myofascial pain syndrome （MPS） including current epidemiology, pathology, diagnosis and treatment. Data sources The data analyzed in this review were mainly from relevant articles without restriction on the publication date reported in PubMed, MedSci, Google scholar. The terms ＂myofasial trigger points＂ and ＂myofacial pain syndrome＂ were used for the literature search. Study selection Original articles with no limitation of research design and critical reviews containing data relevant to myofascial trigger points （MTrPs） and MPS were retrieved, reviewed, analyzed and summarized. Results Myofascial pain syndrome （MPS） is characterized by painful taut band, referred pain, and local response twitch with a prevalence of 85% to 95% of incidence. Several factors link to the etiology of MTrPs, such as the chronic injury and overload of muscles. Other factors, such as certain nutrient and hormone insufficiency, comorbidities, and muscle imbalance may also maintain the MTrP in an active status and induce recurrent pain. The current pathology is that an extra leakage acetylcholine at the neuromuscular junction induces persistent contracture knots, relative to some hypotheses of integration, muscle spindle discharges, spinal segment sensitization, ect. MTrPs can be diagnosed and localized based on a few subjective criteria. Several approaches, including both direct and supplementary treatments, can inactivate MTrPs. Direct treatments are categorized into invasive and conservative. Conclusion This review provides a clear understanding of MTrP pain and introduces the most useful treatment approaches in China.

Effect of miniscalpel-needle on relieving the pain of myofascial pain syndrome: a systematic review

OBJECTIVE: To evaluate the effect and safety of miniscalpel-needle(MSN) on reducing the pain of myofascial pain syndrome(MPS).METHODS: We reviewed the available literatures inception up to February 2014 using Pubmed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure Database, Chinese Biomedical Database and Wanfang Database.RESULTS: Eight randomized controlled trials were finally identified. The main controls involved acupuncture, medications, injection, massage and cupping. We found that all of the studies agreed on the potential benefit of MSN as a strategy for MPS and the superiority compared to the controls, however,randomized methods applied in most of the trials could be criticized for their high or unclear risk of bias. Further research is also needed to clarify questions around the appropriate frequency and number of treatment sessions of MSN.CONCLUSION: This review shows that MSN might have the effect on MPS, even though there were some limitations in the studies included in the review. Studies with robust methodology are warranted to further test its pain-relieving effect on MPS.

Effect of bloodletting therapy at local myofascial trigger points and acupuncture at Jiaji(EX-B 2) points on upper back myofascial pain syndrome: a randomized controlled trial

OBJECTIVE： To observe the clinical efficacy of bloodletting therapy and acupuncture at Jiaji points for treating upper back myofascial pain syndrome （MPS）, and compare this with lidocaine block therapy. METHODS： A total of 66 were randomly assigned upper back MPS patients to either the treatment group or the control group in a 1 ： 1 ratio. The treatment group （n = 33） were treated with bloodletting therapy at local myofascial trigger points and acupuncture at Jiaji （EX-B 2） points; one treatment course consisted of five, single 20-min-treatments with a 2-day break between each treatment. The control group （n = 33） were treated with a lidocaine block at trigger points; one treatment course consisted of five sessions of lidocaine block therapy with a 2-day break between each session. The simplified McGill Scale （SF-MPQ） and tenderness threshold determination were used to assess pain before and after a course of treatment. RESULTS： After the third and fifth treatment, the SF-MPQ values were significantly decreased （P 〈 0.01） and the tenderness thresholds were significantly increased （P 〈 0.01） in both groups compared with before treatment. There were no significant differences in pain assessments between the two groups after three and five treatments （P 〉 0.05）. There were five cases with minor adverse reactions reported in the control patients, while no adverse reactions were reported in the treatment group. CONCLUSION： Bloodletting therapy at local myo- fascial trigger points and acupuncture at Jiaji points was effective in treating upper back MPS. Clinically, bloodletting and acupuncture therapy had the same efficacy as the lidocaine block therapy, with fewer adverse reactions.

Effect and cerebral mechanism of moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation and myofascial pain syndrome by resting-state functionality magnetic resonance imaging:protocol for an observational study

We want to explore the analgesic brain effect of the moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation(LDH)and myofascial pain syndrome(MPS).In an assessor-blinded observational study,we will include 15 LDH and 15 MPS.They will accept same treatment of heat-sensitive moxibustion at Yaoyangguan(GV3).The resting-state functionality magnetic resonance imaging image data of brain activities before and after treatment will be analyzed by mean fractional amplitude of low-frequency fluctuation,regional homogeneity analysis and brain functional connection.We select seed of first sensory cortex,second sensory cortex,insula cortex,periaqueductal gray and anterior cingulate cortex as the regions of interest to analyse the relationship between brain functional connectivity of pain-related networks and clinical data.Our study could disclose key brain targets and central response characteristics of the analgesic brain effect and the brain functional connection of heat-sensitive moxibustion.

Effectiveness of dry needling on reducing pain intensity in patients with myofascial pain syndrome： a Meta-analysis

OBJECTIVE: To summarize the literature about the effectiveness of dry needling(DN) on relieving pain and increasing range of motion(ROM) in individuals with myofascial pain syndrome(MPS).METHODS: Papers published from January 2000 to January 2013 were identified through an electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus, Physiotherapy Evidence Database(PEDro) and Spanish Superior Council of Scientific Research(CSIC). The studies included were randomized controlled trials written in English and/or Spanish about the effectiveness of DN on pain and ROM in individuals with MPS.RESULTS: Out of 19 clinical trials that were potentially relevant, a total of 10 were included in the Meta-analysis. Regarding pain intensity reduction when measured before and immediately after the intervention, DN achieved improvement compared with the placebo treatment [d =-0.49; 95% CI(-3.21, 0.42)] and with the control group [d =-9.13;95% CI(- 14.70,- 3.56)]. However, other treatments achieved better results on the same variable compared with DN, considering the measurements for pre-treatment and immediately after [d = 2.54;95% CI(-0.40, 5.48)], as well as the pre-treatment and after 3-4 weeks [d = 4.23; 95% CI(0.78, 7.68)].DN showed a significantly increased ROM when measured before the intervention and immediately after, in comparison with the placebo [d = 2.00;95% CI(1.60, 2.41)]. However, other treatments achieved a significant better result regarding ROM when it was measured before the intervention and immediately after, as compared with DN [d =-1.42;95% CI(-1.84,-0.99)].CONCLUSION: DN was less effective on decreasing pain comparing to the placebo group. Other treatments were more effective than DN on reducing pain after 3-4 weeks. However, on increasing ROM,DN was more effective comparing to that of placebo group, but less than other treatments.

Clinical Study on Treatment of Myofascial Pain Syndrome with Ashi Points

Objective： To investigate the clinical efficacy of Ashi points in the treatment of myofascial pain syndrome. Method： A hundred and fifty cases were randomized into a treatment group and a control group by the order of visit. The cases in the treatment group were treated with ＂Stuck Needle＂ method in Ashi points plus tuina manipulations. The cases in the control group were treated with external local application of Votalin. The cases in both groups were treated once a day and 10 times made up one course. Results： Among 90 cases in the treatment group, 18 got clinical recovery, 34 got marked effect, 34 got certain effect, the marked effective rate was 57.8% and the total effective rate was 94.4%; while among 60 cases in the control group, 1 got clinical recovery, 18 got marked effect, 15 got certain effect, the marked effective rate was 31.7% and the total effective rate was 73.3%. Statistical management showed P〈0.01, indicating a significantly better effect in the treatment group. In addition, ＂Stuck Needle＂ method in Ashi points plus tuina manipulations can effectively improve local pain, tenderness, muscle spasm and motion range of joints, and can obtain significantly better effect for muscle spasm and motion range of joints. Conclusion： This therapy is safe, reliable and effective, and therefore worth spreading for clinical application.

Clinical Study on Extracorporeal Shock Wave Therapy plus Electroacupuncture for Myofascial Pain Syndrome

Objective: To observe the clinical effect of extracorporeal shock wave plus electroacupuncture(EA) on myofascial pain syndrome(MPS) and to investigate its treatment mechanism. Methods: Ninety cases who met the inclusion criteria were randomly allocated into an EA group, an extracorporeal shock wave therapy(ESWT) group and a combined therapy group, 30 in each group. EA was employed in the EA group, extracorporeal shock wave therapy in the ESWT group and EA plus extracorporeal shock wave therapy in the combined therapy group. The VAS, tenderness threshold and therapeutic efficacy were evaluated after three months of treatment. Results: After 2 weeks, 4 weeks and 3 months of treatment, the VAS scores in all three groups were significantly reduced and the tenderness threshold significantly elevated. The recovery rate and total effective rate were 23.3% and 83.3% respectively in the EA group, versus 40.0% and 90.0% in the ESWT group and 63.3% and 96.7% in the combined therapy group, showing statistical differences(P<0.05). Conclusion: EA combined with EWST works remarkably well for MPS.

Study on the relationship between relieving energy crisis in myofascial trigger points with An-Pressing manipulation and AMPK/PGC-1α pathway activation

Objective To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points(MTrPs)by observing the effects of An-Pressing manipulation on adenosine triphosphate(ATP),adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK)/peroxisome proliferator-activated receptorγcoactivator 1α(PGC-1α)pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats.Methods Forty-eight male Sprague-Dawley rats were randomly divided into a blank group,a model group,a lidocaine group,and an An-Pressing manipulation group,with 12 rats in each group.The model group,lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method.After modeling,the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation,once every other day;the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs,once every 6 d.The blank group and the model group were fed normally without intervention.After the intervention,local muscle tissue was taken to detect the content of ATP and the expression of AMPK,phosphorylated AMPK(phospho-AMPK),PGC-1α,and glucose transporter 4(GluT4),and the ultrastructure of mitochondria was observed under an electron microscope.Results Compared with the blank group,the ATP content in the model group was decreased(P<0.05),the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were decreased(P<0.05);under the electron microscope,the number of mitochondria decreased,and they were deformed,small in volume,and had deformed cristae.Compared with the model group,the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased(P<0.05),and the protein expression levels of phospho-AMPK,PGC-1α,and GluT4 and the ratio of phospho-AMPK to AMPK were increased(P<0.05);under the electron microscope,the number of mitochondria increased,the shape and size of the mitochondria were basically normal,and the cristae could be seen.Compared with the lidocaine group,phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased(P<0.05);under the electron microscope,the numbers of mitochondria were similar,and the shape and size of the mitochondria were basically normal without swelling,and the cristae could be observed.Conclusion An-Pressing manipulation can increase the ATP content in MTrPs tissue,improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK;its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.