Ultrasound elastography to guide compression therapy for gastrocnemius trigger points in runners

Myofascial pain syndrome (MPS) is one of the most common musculoskeletal pain disorders affecting athletes. This is an important clinical issue because MPS has a negative impact on athlete achievement as with sporting injuries. We screened 44 amateur runners who ran ≥ 50 km/week and reported running-related lower-leg pain. Thirty runners with gastrocnemius myofascial trigger points (MTrPs; 21 men, 9 women; mean ages 36 and 33 years) underwent B-mode ultrasonography and strain elastography. Ischemic compression was applied to identified MTrPs, with sonographic reassessment after each cycle and at 24 h. Ankle dorsiflexion range of motion (ROM) was measured with a goniometer; no diagnostic threshold was applied. Among 44 runners screened, gastrocnemius MTrPs were diagnosed in 30 (68%); 14/44 had no MTrPs. In those 30 participants, 103 MTrPs were identified (mean 4.7 per person by palpation; 3.4 by ultrasonography). After the first compression course, 75/103 MTrPs were no longer detectable. 21/103 were visible only on elastography with reduced stiffness, and 7/103 remained both palpable and sonographically visible. At 24-h follow-up, none of the 75 eliminated or 21 elastography-only MTrPs recurred; 5/7 persistent MTrPs were deactivated after a second session. Elastography aided the diagnosis of MTrPs in the gastrocnemius muscle of amateur runners and allowed for more objectified control of MTrPs compression therapy.