# Balneotherapy and Manual Therapy of Key Myofascial Trigger Points as Therapeutic Integration for COPD Associated with Myofascial Pain Syndrome: A Case Series

## TL;DR

A new therapy combining balneotherapy and manual treatment improved symptoms in COPD patients with myofascial pain.

## Contribution

A detailed and codified therapeutic protocol (BPM-ITC) for COPD+MPS was developed and tested.

## Key findings

- Patients showed clinically relevant improvements in dyspnea, pain, and bio-physical health.
- Statistical analysis confirmed significant positive effects of the BPM-ITC protocol.
- The therapy included manual therapy, crenotherapy, and water-based motor re-education.

## Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common condition that can cause dyspnea, pain, and biomechanical-postural alterations, especially when overlapping with Myofascial Pain Syndrome (MPS). Balneological rehabilitation medicine can help manage COPD and MPS, but it lacks homogeneity and detailed descriptions of effective therapeutic protocols. Therefore, we conducted a case series to preliminarily evaluate the clinical effects of a detailed and codified approach, called Bio-Physico-Metric Integrated Thermal Care (BPM-ITC), for COPD+MPS. Methods: 10 patients were observed while undergoing 20 sessions of BPM-ITC in 4 weeks. Patients were assessed before and after the protocol using the Medical Research Council (MRC) dyspnea scale, Numeric Pain Rating Scale (NPRS), and the Bio-Postural Questionnaire (BPQ) for bio-physical health status. Treatments included manual therapy of key myofascial trigger points combined with crenotherapy, steam inhalations, mud therapy, vascular path, and water-based motor re-education. Results: At the end of the protocol, clinically relevant improvements were observed in almost all parameters considered in single observed cases; overall statistical analysis of the data highlighted significant positive effects in concomitance with the BPM-ITC protocol. Conclusions: The BPM-ITC protocol was followed by significant clinical improvements in the observed cases, suggesting its potential as a complementary approach for COPD+MPS. Further studies on this topic are recommended.