Effect of manual pressure combined with reciprocal inhibition therapy on pain, pain threshold, and maximal force of the gastrocnemius muscle

Introduction. Localised pain can disrupt posture, stability, breathing patterns, and motor performance, often resulting in instability and compensatory mechanisms in other areas, which increases the risk of injury and delays recovery. Consequently, pain management is a fundamental aspect of physiotherapy. Isometric contraction of antagonist muscles induces relaxation of the gastrocnemius via reciprocal inhibition mediated by the gamma loop system, which reduces the H-reflex and muscle stiffness (Siddiqui et al., 2022). Meanwhile, manual pressure alleviates pain by modulating descending pain pathways (Arribas-Romano et al., 2023) and is already a widely utilised clinical method. The combination of these two therapeutic techniques aligns with neuromuscular system pain modulation principles, potentially promoting active functional movement with reduced pain. Additionally, it may help retrain the motornociception relationship in the brain, resulting in decreased muscle stiffness and pain relief. Aim. This study aims to investigate the effects of manual pressure applied to a trigger point on the muscle, combined with reciprocal inhibition through isometric contraction of antagonist muscles, on pain perception, pain threshold, and the maximal force of the gastrocnemius muscle. The findings are expected to provide insights into a novel approach for musculoskeletal pain management and intervention. [...].