MYOPAIN

A journal of myofascial pain and fibromyalgia

ISSN: 2470-8593 (Print) 2470-8607 (Online) Journal homepage: http://www.tandfonline.com/loi/imup21

The Effect of Combining Myofascial Release with

Ice Application on a Latent Trigger Point in the
Forearm of Young Adults: A Randomized Clinical
Trial

Cristian Gutiérrez-Rojas, Ignacio González, Elías Navarrete, Evelyn Olivares,

José Rojas, Diego Tordecilla & Carlos Bustamante

To cite this article: Cristian Gutiérrez-Rojas, Ignacio González, Elías Navarrete, Evelyn Olivares,
José Rojas, Diego Tordecilla & Carlos Bustamante (2017): The Effect of Combining Myofascial
Release with Ice Application on a Latent Trigger Point in the Forearm of Young Adults: A
Randomized Clinical Trial, MYOPAIN, DOI: 10.1080/24708593.2017.1403526

To link to this article: https://doi.org/10.1080/24708593.2017.1403526

Published online: 20 Nov 2017.

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 MYOPAIN, A Journal of Myofascial Pain and Fibromyalgia, Early Online: 1–8, 2017
! 2017 Informa UK Limited, trading as Taylor & Francis Group.
ISSN: 2470-8593 print / 2470-8607 online
DOI: 10.1080/24708593.2017.1403526

ARTICLE

The Effect of Combining Myofascial Release with Ice Application on

a Latent Trigger Point in the Forearm of Young Adults:
A Randomized Clinical Trial
Downloaded by [UNIVERSITY OF ADELAIDE LIBRARIES] at 07:33 04 December 2017

Cristian Gutiérrez-Rojas, MSc, PT, Ignacio González, PT, Elı́as Navarrete, PT, Evelyn Olivares, PT,
José Rojas, PT, Diego Tordecilla, PT, and Carlos Bustamante, MSc, PT
Laboratorio Rendimiento Fı´sico y Salud, Escuela de Kinesiologı´a, Facultad de Ciencias, Pontificia Universidad Católica de
Valparaı´so, Valparaı´so, Chile

ABSTRACT
Background: Myofascial trigger points (MTrP) are considered to be a common source of pain in people. Due to their
presence in any skeletal muscle in the body, they can be relevant in the genesis of musculoskeletal disorders. Their
preventive management could reduce its potential activation and impact over people’s functioning.
Objectives: The aim was to determine the immediate effect of combining myofascial release (MFR) with ice on a latent
MTrP in the forearm of young adults.
Materials and methods: Using a randomized repeated measures design, 30 young adults with one latent MTrP on the
extensor muscles of the forearm were allocated into three groups; group I received ice massage, group II received MFR
and group III received MFR with ice. The pressure pain threshold (PPT), pressure pain perception (PPP) and strength
of the flexor and extensor muscles of the forearm were evaluated at baseline, immediately after treatment and at 30 min.
Results: An immediate improvement in PPT (p 50.05) and PPP (p 5 0.0005) occurred in group III. Additionally, an
increase in flexor muscle strength (p 5 0.05) is observed 30 min in this group. Group II increased its PPT immediately
(p 5 0.005) and afterwards (p50.05). Group I also changed its PPP immediately (p50.005). No changes in extensor
muscle strength were observed.
Conclusions: The results demonstrate an immediate improvement in pain variables after the application of ice massage,
MFR and MFR with ice in young adults with a latent MTrP.
KEYWORDS: Myofascial release, cryotherapy, trigger point(s), pressure pain threshold, manual therapy

INTRODUCTION painful on stimulation and produce referred pain

(5). Among the factors associated with the develop-
Myofascial trigger points (MTrPs) are considered to
ment of MTrPs a systematic review has pointed out
be a common source of pain in people (1). Due to
the following: trauma, overuse, psychological stress
their presence in any skeletal muscle in the body,
and joint dysfunction (6). MTrPs are classified as
they can be relevant in the genesis of musculoskeletal
active or latent MTrPs, and both types are associated
disorders (2). A systematic review showed that
with dysfunction. Active MTrPs produce a familiar
MTrPs were responsible for pain in 74% of patients
spontaneous pain, a tenderness in the muscle spot, a
with musculoskeletal problems (3) and their preva-
local twitch response when stimulated, and a
lence have shown a range from 21% of the patients
referred pain zone. By contrast, latent MTrPs only
treated in a general clinic to 93% of the patients seen
generate pain when compressed (5,7).
in a specialized center (4).
MTrPs are defined as hypersensitive palpable Various dysfunctions are associated with latent
spots in a taut band of a skeletal muscle that are MTrPs. For instance, an impact on the activation

Correspondence: Cristian Gutiérrez-Rojas, Escuela de Kinesiologı́a, Pontificia Universidad Católica de Valparaı́so, Avenida
Universidad 330, Curauma, Valparaı́so, Chile. Tel: þ56-32-2274044. E-mail: cristian.gutierrez@pucv.cl
Submitted: 5 December 2016; Revisions Accepted 7 November 2017; published online 16 November 2017
 2 C. Gutiérrez-Rojas et al.
patterns of upward scapular rotator muscles has
been detected in subjects with latent MTrPs (8).
Additionally, an accelerated fatigue and increased
resting motor neuron excitability may affect these
muscles (9,10). Even autonomic disorders, similar to
attenuated skin flow response, were observed after
nociceptive stimulation in healthy participants
(11,12). Timely treatment of the latent MTrPs
could prevent their potential activation and impact
on the functioning of the people.
Several treatment approaches have been devel-
oped to eliminate MTrPs. However, active ones (due
their immediate impact) have received more atten-
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tion than latent MTrPs. Treatments can be classified
in invasive (needling therapy) and non-invasive
therapies. Examples of the latter are applications of
physical agents (cryotherapy and electrotherapy),
ischemic compression, proprioceptive neuromuscu-
lar facilitation and myofascial release (MFR).
Ice massage consists of gliding (stroking) move-
ments of an ice cube (or ‘‘popsicle’’) over the skin
(13,14). It is used to deliver cold treatments for
small, evenly shaped areas (15), and it is effective in
cases involving muscle spasm, contusions, and
minor injuries and to numb small areas of the skin
(14). Also, it has been used to reduce pain in patients
with osteoarthritis or neuropathies and during labor
(16). Although ice massage is recommended for
treating MTrPs, Simons (5) notes that no studies
have determined its effectiveness on MTrPs.
MFR has been described as a wide variety of
manual therapy techniques in which pressure is
applied to the muscle and fascia (17,18), with guided
low load and long duration mechanical forces to the
myofascial complex, which is an attempt to reduce
pain and restore functioning (19). It has been used
in many conditions to reduce pain, tightness, and
disability and to improve range of motion and
quality of life (18,19). Although the most common
MFR approach in MTrPs is direct/ischemic com-
pression (20), the release of surrounding tis-
sues is also recommended as a complementary
approach because MTrPs can cause fascia dysfunc-
tion (21,22).
In most studies, multilateral treatment is men-
tioned as an appropriate method for managing
myofascial pain (23). Nevertheless, at present, no
studies have associated MFR with ice application to
treat latent MTrPs. Therefore, the aim of this study
was to determine the immediate effects of combining
MFR with ice application on latent MTrPs in the
forearm of young adults, specifically in pressure pain
threshold (PPT), pressure pain perception (PPP)
and forearm muscle strength. The hypothesis was
that the MFR combined with ice application would
induce mayor changes in the pressure pain thresh-
olds and perception than the other treatments.
MATERIALS AND METHODS
Participants
Thirty volunteer young adult students from the
Pontificia Universidad Católica de Valparaı́so, com-
posed the sample. The number of participants was
calculated using a-priori power analysis (24) based
on a previous study (25) to achieve an 80% power
(for the interaction of group and time over repeated
measures), effect size value of 0.5 and alpha level of
0.05. The study was revised and approved by the
local ethic committee. Participants attended a brief-
ing in which the evaluations and treatments were
explained and informed consents were obtained.
The study included young adults between the ages
of 20 and 25 years with at least one latent MTrP in
the extensor muscles group of the forearm (domin-
ant upper arm). In the case when more than one
latent MTrP was detected, the most symptomatic
was evaluated. Participants sat with their forearms
on an adjustable table (90 elbow flexion with palm
facing down and neutral wrist) for MTrP palpation.
MTrPs were considered latent when there was (1) a
palpable taut band in the muscle, (2) a tender point
in the taut band, (3) a local twitch response elicited
by palpation and (4) pain evoked upon palpation
without patient recognition that it is a familiar
symptom (5). The most painful MTrP was marked
on the skin using a dermographic pen.
Exclusion criteria were as follows: (1) participants
with active MTrP in the forearm, (2) a history of
upper arm pathology within the last six months
(neurologic, rheumatic or orthopedic conditions),
(3) volunteers who were previously treated with
myofascial therapy before the study, or (4) partici-
pants who were using drugs for anti-inflammatory
or analgesic purposes (23).
Design
This study had a repeated measures design in order
to determine the immediate effects of combining
MFR with ice application on latent MTrPs. The
independent variables were related to the treatment
group (I: ice massage, II: MFR, and III: MFR with
ice) and time of assessment (baseline, immediately
after treatment at the 0 min and at 30 min later). The
dependent variable included PPT, PPP and strength
of flexor and extensor muscles of the forearm. The
allocation of the participants to the groups (n ¼ 10
in each group) was performed by a member of the
 Management of latent myofascial trigger points
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FIGURE 1. Treatment applied to the study groups. (A) Ice massage, (B) myofascial release and (C) myofascial release with ice
application. Dotted circle represents treatment area; small arrows represent compression phase of fascial release and large arrows
represent movement direction of fascial release.
research team using a sealed envelope system. As
they arrived, the participants selected one of the
envelopes that were ordered according to a random
sequence of assignment. Treatments were performed
by a qualified physical therapist and the outcome
assessment and statistical analysis were performed by
professionals, all of them were blinded to the study
aim (double blind study).
Treatment protocols
Participants in group I (Figure 1A) received an ice
massage application. Treatment was performed with
the subject in the same position as for the MTrP
assessment (forearm at rest with 90 of elbow
flexion, pronated and wrist in neutral position).
Massage was directly applied to the skin over the
MTrP using circular and stroking motions with an
ice cube (with an approximate r ¼ 2 cm covering a
12 cm2 area without any pressure) for 10 minutes.
The water was not wiped off while the ice
melted (26).
Participants in group II (Figure 1B) received
MFR. Application was performed with the subject in
the same position that was previously described.
MFR was performed using a longitudinal compres-
sion approach. With the thumb, the superficial fascia
of the treated muscles was stretched through the
skin, starting at the humerus (proximal to the lateral
epicondyle) and extending to the extensor retinacu-
lum of the wrist (27,28). The movement was
performed very slowly and pressure was applied as
the tissue was released. The release was performed
for 10 min.
Participants in group III (Figure 1C) received
MFR combined with ice application. Treatment was
performed with the subject in the same position that
was previously described. MFR was performed using
3
a longitudinal compression approach with an ice
cube as a tool. With the ice cube, the superficial
fascia of the treated muscles was stretched through
the skin, starting at the humerus (proximal to the
lateral epicondyle) and extending to the extensor
retinaculum of the wrist (27,28). The movement was
performed (over the taut band and MTrP) very
slowly while applying pressure with the ice cube as
the tissue released. The release was performed for
10 minutes.
Outcome measures
PPT is defined as the weakest compression intensity
at which a person feels discomfort or pain rather
than pressure (1,23). PPT of the latent MTrP was
measured using an algometer (Model 12-1442,
Fabrication Enterprise Inc., USA), a device consist-
ing of a round rubber disk (area, 1 cm2) connected
to a pressure gauge that was pressed vertically on the
MTrP (at a rate of 1 Kg/cm2 per second). Three
measurements were recorded at 30-s intervals, and
the average value was used.
PPP is defined as the pain intensity a person feels
at a determined pressure using an algometer. Pain
intensity was measured using a visual analogue scale.
Pain was evoked with 3.0 kg/cm2 of pressure on the
latent MTrP. A unique measure was recorded.
PPT (ICC 0.72-0.79) (23,29) and PPP (25) are
two reliable and valid form of measuring pain over
MTrPs. Moderate to high interrater and intrarater
reliability has been observed when measuring
MTrPs.
The strength measure was considered as the
maximal voluntary isometric contraction (MVIC)
force of the wrist extensor and flexor muscles in
Newtons (N). The MVIC was measured using a
custom-designed device with a lever, load cell
 4 C. Gutiérrez-Rojas et al.
TABLE 1. Characteristic of the sample.
Group I
Variable Mean  SD
Age (years) 22.3  1.4
Number of MTrPs 1.1  0.3
BMI 23.4  1.4
Physically active (n)
Yes 1 2
No 9 8
Hand dominance (n)
Right 9 9
Left 1 1
MTrPs: myofascial trigger points; BMI: body mass index.
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(ANYLOAD, USA, model 101NH S-Beam, Output
3 mV/V  1%, safe overload 150%) and custom
monitor (for registration) that had an analog low-
pass filter (10 Hz). Participants were tested while
sitting on a chair. The forearm was horizontally
positioned within a cradle (of the device) and
secured in a pronated or supinated position (for
extensor muscles and flexor muscles, respectively).
The height of the device was adjusted so that the arm
was placed at 20  10 shoulder abduction and at 0
shoulder flexion. The elbow was positioned at 90
flexion. The palmar or dorsal face of the metacarpal
bones was in contact with the lever (at 30 flexion or
extension) such that the axis of the wrist was aligned
with the axis of the lever. The contralateral hand
rested on the thigh. Three MVIC of 2–5 s with rest
periods of 30 s or more were recorded and their
maximal value were analyzed.
Statistical analysis
The normal distribution of variables was tested using
the D’Agostino & Pearson normality test. Dependent
variables (PPT, PPP and strength of extensor and
flexor muscles) were analyzed by two-way repeated
measures analysis of variance (two-way RM
ANOVA, with treatment group and time of assess-
ment as factors), which was followed by Bonferroni’s
post hoc analysis (STATA 9.1 software). The results
are expressed as the means  SEMs. Differences were
considered statistically significantly when p50.05.
Effect sizes were calculated using Cohen’s d for
comparative outcomes.
RESULTS
The study had a total of 30 participants (16 females
and 14 males). Each group was conformed as
following: group I (6 females and 4 males), group
Group II Group III p value
Mean  SD Mean  SD
22.3  1.4 22.7  1.1 0.75
1.0  0.0 1.2  0.4 0.34
24.2  0.6 23.8  0.9 0.23
1 0.74
9
10 0.59
0
II and III (5 females and 5 males). Table 1
summarizes the characteristics of the sample.
Table 2 summarizes the means  SEMs for the
dependent variables at time of assessments. No
differences between the groups were detected at
baseline.
For PPT (Figure 2A), there was no significant
interaction (treatment group  time of assessment)
(F (4,54) ¼ 0.99, p ¼ 0.41) or main effect for treat-
ment group (F (2,27) ¼ 0.07, p ¼ 0.93), although a
significant effect of the time of assessment (F
(2,54) ¼ 11.51, p50.0001) was observed. MFR with
ice application (group III) increased pressure pain
threshold (p50.05; d ¼ 0.66) immediately after
application. Similarly, MFR (group II) increased
these thresholds (p50.005; d ¼ 1.01), which per-
sisted after 30 min (p50.05; d ¼ 0.69). Although a
similar trend was observed using ice massage, is not
significant.
Only a significant main effect of the time of
assessment (F (2,54) ¼ 15.95, p50.0001) was
detected for PPP (Figure 2B; interaction of treatment
group x time of assessment (F (4,54) ¼ 0.80,
p ¼ 0.52); treatment group (F (2,27) ¼ 0.73,
p ¼ 0.49)). An immediate reduction of pain occurred
after applying ice massage (group I; p50.005;
d ¼ 0.61) and MFR with ice (group III, p50.0005;
d ¼ 1.20). The effects did not persist 30 min later.
No significant interaction (treatment group x
time of assessment) (F (4,54) ¼ 0.23, p ¼ 0.91) or
main effects for treatment group (F (2,27) ¼ 0.40,
p ¼ 0.67) was observed in flexor muscles strength
(Figure 2C), although there was a significant effect of
the time of assessment (F (2,54) ¼ 5.48, p50.01).
Post hoc comparisons only revealed that flexor
muscles strength increases 30 min after having
applied MFR combined with ice (group III;
p50.05; d ¼ 0.25).
 Management of latent myofascial trigger points 5
TABLE 2. Means  SEM of the dependent variables at baseline and follow-ups.

Time Variables Group I Group II Group III

Baseline PPT 6.53  0.69 6.14  0.44 6.95  0.67
PPP 3.90  0.70 4.60  0.77 4.50  0.52
MVIC F 77.80  8.66 77.20  7.21 66.20  11.26
MVIC E 85.70  7.18 79.50  10.22 85.30  11.48
0 min PPT 7.56  0.70 7.87  0.62 8.27  0.57
PPP 2.60  0.63 3.70  0.65 2.60  0.47
MVIC F 83.00  8,52 81.20  7.05 71.80  10.52
MVIC E 88.00  8.86 93.30  6.99 85.40  10.98
30 min PPT 7.47  0.81 7.57  0.81 7.20  0.62
PPP 3.00  0.63 4.20  0.72 3.50  0.56
MVIC F 84.50  9.35 81.50  7.14 75.40  11.46
MVIC E 85.90  8.68 91.10  7.30 87.40  10.25
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PPT: pressure pain threshold (kg/cm2); PPP: pressure pain perception (VAS); MVIC F: maximal voluntary isometric contraction
of wrist flexor muscles (N); MVIC E: maximal voluntary isometric contraction of wrist extensor muscles (N).

FIGURE 2. Effect of treatment over PPT (A), PPP (B), flexor muscles strength (C) and extensor muscles strength (D) versus the
time of assessment. (PPT: Pressure Pain Threshold; PPP: Pressure Pain Perception; MFR: Myofascial Release; *p50.05;
**p50.005; ***p50.0005).

No significant interaction (treatment group  Finally, there were no significant differences

time of assessment) (F (4,54) ¼ 0.88, p ¼ 0.47) or
main effects for the treatment group (F
(2,27) ¼ 0.01, p ¼ 0.98) and time of assessment (F
(2,54) ¼ 1.40, p ¼ 025) was observed in extensor
muscles strength (Figure 2D). Post hoc analysis
revealed no changes.
between groups both immediately and 30 min later.
DISCUSSION
The results of present study demonstrated signifi-
cant, immediate changes in PPT and PPP after
applying MFR with ice. Additionally, a change in
 6 C. Gutiérrez-Rojas et al.
flexor muscle strength was observed 30 minutes after
this treatment. MFR alone produced an increase of
PPT immediately and afterwards (30 min). PPP also
changed immediately with the use of ice massage. No
changes were observed in extensor muscle strength.
Finally, no differences were detected between groups
at both reassessment times (0 and 30 min).
To the best of our knowledge, this is the first
report in which PPT changed immediately with the
combination of MFR and ice application. It is likely
that this change could be related to a merged effect
that MFR and ice massage alone have over the tissue.
In fact, MFR alone increased immediately and
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afterward this variable, which is comparable to
other study (20). For instance, MFR reduces pain
and functional disability associated with plantar heel
pain (30) and lateral epicondylitis (28). It is
suggested that in normative condition, fascia and
connective tissue move with minimal restrictions
(31). However, the presence of MTrPs can cause
myofascial dysfunction (21) because a taut band puts
fascial structures under permanent tension, which
can alter movement and posture patterns. Thus,
various authors suggest that treatment should focus
not only on MTrPs but also on surrounding tissue
(e.g. fascia, muscles, and connective tissues) (22). It
is thought that MFR lengthens the sarcomeres,
which then reduces energy consumption and releases
noxious substances (1). Another possible explan-
ation stems from the neurophysiological mechan-
isms that are associated with MFR. On the one hand,
it is thought that pressure exerted during MFR
might stimulate some fascial receptors [Golgi tendon
organs and Ruffini and Pacini corpuscles] that could
reduce motor unit activity over MTrPs (17). On the
other hand, MFR might have an analgesic effect that
is mediated by peripheral, spinal, or supraspinal
mechanisms. In the first two, the findings could be
expected due control gate theory (17). In addition,
the finding observed in group III could be related
with the effects of cold. Several studies have
demonstrated that application of cold [in variety of
modalities] reduces tissue temperature (32,33)
and increases the PPT. It is thought that ice
massage may stimulate descending inhibitory
pain pathways (16). Additionally, ice massage
modifies sensory conduction and can have a
hypoalgesic effect (34). One study (35) found that
PPT was increased 10 and 30 minutes after ice
massage. It is important to note that the effect [in
group III] was not lasting and that it was probably
affected by the time and area of application.
Moreover, ice massage alone had a nonsignificant
trend in increasing PPT.
With respect to PPP changes, they are likely
associated with the aforementioned effects of cryo-
therapy. The hypoalgesic effect of ice massage and
MFR with ice could modulate the necessary thresh-
old to elicit a pain respond (16). This finding could
be related to the reduction of sensory nerve
conduction observed after cold applications
(34,36). Furthermore, it has been reported that ice
massage could reduce motor nerve conduction (34).
This effect may impact motor end plates related to
MTrPs, which could modify PPT and PPP observed
in group I and III at reassessment (0 min). MFR
alone produced no change in PPP, which is a
confounded finding because PPT increased with
treatment at both reassessments. This outcome
could support the idea that cold application may
have a mayor influence on this variable compared
with the manual approach.
It is probable that the change observed in flexor
muscle strength after MFR with ice could be related
to diminished extensor muscle activity. Evidence
shows that muscles with MTrPs have increased
motor unit excitability (both at rest and during
antagonist activity) that is associated with reduced
antagonist reciprocal inhibition (37). In this scene,
the application of MFR with ice over the extensor
muscle may reduce this excitability and restore
proper reciprocal inhibition, increasing the strength
of the flexor muscles. Another study (38) noted that
application of a cold-water bath in the forearm
reduces the maximal isometric force of the evaluated
muscles. It is speculated that ice associated with
MFR could also modulate reciprocal inhibition. A
same trend in flexor muscles strength was observed
in the group that received ice massage, but this was
not significant. It is important to notice that latent
MTrPs in the flexor muscles were not evaluated, so
we are not secure that an indirect effect of treatment
occurred in these muscles and if this change has a
clinical importance. Another possibility that could
explain the results observed in flexor muscles
strength is the likely familiarization of the partici-
pants with the isometric strength test (39). However,
extensor muscles strength does not have the same
behavior.
As previously mentioned, no changes were
detected in extensor muscles strength. This seems
to be a controversial subject because some authors
have observed a drop of maximal isometric force
(38,40) while others have found opposite results (41)
when ice application is implicated. In all likelihood,
no effect was detected according to our method of
application for 10 minutes over a small area (group
I) versus a large area (group III). Group II had a
 Management of latent myofascial trigger points
trend of increased force, but it was not significant. A
longer treatment time may be needed to elicit
changes in this variable.
The clinical importance of the therapeutic strate-
gies used in the present study is that all of them have
a favorable effect on pain (threshold and percep-
tion). This effect reaches a clinically relevant change
in PPT, since most of them increase more than
1 kg/cm2. The findings of the current study suggest
that these therapeutic strategies are advisable to treat
latent MTrPs at least in this population. Even
though the changes are at short time, threshold
and perception modifications will allow us to use
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other complementary strategies when patients have
latent MTrPs associated with severe pain or an
irritable condition. Physiotherapists are aware that
optimization of treatment is important when we
must treat all the problems related to patients’
condition (e.g. improvement of ROM, strength
training, pain education, and so on). Importance
that is enhanced due to its low cost of implemen-
tation, its safety and the immediate change asso-
ciated to its application.
Some limitations may restrict the generalization
of the results. The small sample may be responsible
why significant differences between the groups were
not detected. Also, the small sample restricted the
analysis according to the gender. There are evidences
showing that female pressure pain thresholds are
lower than males (42). This issue must be addressed
in future studies. The time used for each treatment
(10 minutes) may have been insufficient to induce
greater effects in the variables. Considering the
nature of the interventions and that the reassess-
ments were performed immediately after treatment
the examiner could not stay blinded. The study only
evaluated the immediate effect of one intervention,
and this could differ with more sessions in clinical
practice. We did not inquire into the level of activity
performed by the participants or whether it was
related to the use of the upper limb. It is important
to consider some evaluation of this variable that may
interfere with the results. Although the participants
were perceived as being psychologically healthy, it is
important to assess this state on an appropriate scale
(e.g. Beck Depression Inventory). Depressive symp-
toms can interfere with the threshold and perception
of pain (43). In future studies, these limitations
should be addressed.
CONCLUSIONS
The results of present study demonstrate an imme-
diate improvement in pressure pain threshold and
7
perception in group III (myofascial release with ice
application). Additionally, an increase in flexor
muscle strength is observed 30 minutes in this
group. Group II (miofascial release) increases its
pain threshold immediately and afterwards (30 min).
Group I (ice massage) also changes pressure pain
perception immediately. No changes are observed in
extensor muscle strength in the groups.
ACKNOWLEDGMENTS
The authors thank Oscar Achiardi T. and Gabriela
Morales T. for their valuable collaboration.
DECLARATION OF INTEREST
The authors declare that there is no conflict of
interest.
This research did not receive any specific grant
from funding agencies in the public, commercial, or
not-for-profit sectors.
ETHICAL APPROVAL
This study was approved by the Ethical Committee
of the Pontificia Universidad Católica de Valparaı́so
and conducted in agreement with the Ethical
Principles for Medical Research Involving Human
Subjects outlined in the Declaration of Helsinki.
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