Myofascial Trigger Points: From Metabolic Failure to Recovery

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Research Article | Vol 6 | Issue 1 |  January-June 2026 | page: 22-26 | Blanca Piñeyro Garza

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.195

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 19 Apr 2026, Review Date: 28 May 2026, Accepted Date: April 2026 & Published: 30 June 2026

Author: Blanca Piñeyro Garza [1]

[1] Sportphysis Clinic, Monterrey, Mexico.
.

Address of Correspondence
Dr. Blanca Piñeyro Garza,
Sportphysis Clinic, Monterrey, Mexico.
E-mail: drabpineyro@gmail.com

Abstract

Background: Conventional treatment of myofascial pain has historically focused on symptom mitigation (pain relief), which may explain the high recurrence rates observed in clinical practice. Myofascial trigger points (MTrPs) represent a structural metabolic dysfunction characterized by a state of tissue hypoxia, localized “rigor mortis”, and fascial restriction.
Methods: This article aims to integrate the energy crisis model with molecular findings of tissue acidosis and ischemia, proposing a sequential non-invasive treatment triad consisting of radial pressure waves/focused shockwaves/radial pressure waves application (preparation/intervention/drainage).
Discussion: The chronological evolution of the MTrP concept is reviewed, from the integrated energy crisis hypothesis proposed by Travell and Simons to the molecular confirmation of Jay Shah’s “biochemical soup” and cytoskeletal blockade model. Shockwave therapy is introduced as a cellular “mechanical defibrillator” capable of restoring ATP synthesis and sarcomere homeostasis within a tensegrity-based framework. Treatment outcomes are further assessed using pressure algometry as an objective measure of functional recovery.
Conclusion: The BIOLOGICAL RESET protocol redefines the therapeutic approach, shifting from passive analgesic management toward active biological engineering, achieving clinical success through pure mechanotransduction.
Keywords: Myofascial pain syndrome, Trigger points, Shock waves, Radial pressure waves

References

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How to Cite this article: Piñeyro B | Myofascial trigger points: From metabolic failure to recovery | Journal of Regenerative Science | Jan-Jun 2026; 6(1): 22-26.

 

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Visualization Analysis of Research Progress and Trends in Coronary Heart Disease Cardiac Rehabilitation Based on Bibliometrics

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Research Article | Vol 6 | Issue 1 |  January-June 2026 | page: 14-21 | Na Chen

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.193

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 25 Mar 2026, Review Date: 02 April 2026, Accepted Date: May 2026 & Published: 30 June 2026

Author: Na Chen [1]

[1] Department of Internal Medicine, Peking University Hospital, Beijing, China
.

Address of Correspondence
Dr. Na Chen,
Department of Internal Medicine, Peking University Hospital, Beijing, China.
E-mail: CN09558@pku.edu.cn

Abstract

Purpose: Coronary heart disease (CHD) remains a leading cause of global mortality, and cardiac rehabilitation (CR) is a core component of secondary prevention to improve patient outcomes. This study employed bibliometric methods to visually analyze the research status, hotspots, and evolutionary trends in CHD CR over the past 26 years, providing references for future research directions.
Methods: Using the Web of Science Core Collection as the data source, we searched for literature on CHD CR with the query: TS = ([“Coronary Heart Disease” OR “CHD”] AND (“Cardiac Rehabilitation” OR “CR”]) covering the period from 1999 to August 2025. After excluding non-English studies, conference proceedings, retracted publications, and book chapters, 1,885 valid articles were included. Bibliometric analysis was performed using VOSviewer and CiteSpace to explore publication trends, contributions of countries, institutions, authors, and journals, as well as keyword co-occurrence, clustering, and burst dynamics.
Results: A total of 1,885 articles were published by 8,492 authors from 2,767 institutions across 82 countries, in 531 journals, with 53,513 citations from 11,695 sources. The annual publication volume showed a steady upward trend, increasing from ≤60 articles in the early 2000s to over 100 articles annually after 2017. The top three countries in terms of publication quantity were the USA (484 articles), the United Kingdom (293 articles), and China (277 articles); Canada had the highest average citation frequency (72.1 citations/article). The most productive institutions were the University of Sydney (62 articles) and the University of Queensland (45 articles). The leading authors were Lavie, Carl J. (36 articles) and Taylor, Rod S. (27 articles, with an average citation frequency of 173.9). The journal with the most publications was Journal of Cardiopulmonary Rehabilitation and Prevention (113 articles), while HEART had the highest average citation frequency (82.1). High-frequency keywords included “coronary heart disease” (1,208 times), “cardiac rehabilitation” (1,106 times), and “secondary prevention” (443 times); keywords with high centrality were “coronary heart disease” (0.13) and “quality of life” (0.10). Keyword clustering identified six research hotspots: myocardial infarction, congenital heart disease, physical activity, risk factors, health, and quality of life. Recent burst keywords (2020–2025) included “percutaneous coronary intervention”, “systematic review”, “mobile health”, and “European Society”.
Conclusion: CHD CR research has shown continuous growth, with the USA and European countries leading in academic influence. Current research focuses on exercise-based rehabilitation, secondary prevention, and quality of life improvement; future directions may emphasize personalized rehabilitation programs, digital health applications, and long-term efficacy of rehabilitation after percutaneous coronary intervention.
Keywords: Coronary heart disease, Cardiac rehabilitation, Bibliometrics, VOSviewer, CiteSpace

References

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4. Dibben GO, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease: A meta-analysis. Eur Heart J 2023;44:452-69.
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17. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021;11:CD001800.
18. Grace SL, Taylor RS, Gaalema DE, Redfern J, Kotseva K, Ghisi G. Cardiac rehabilitation: A global perspective on where we have come and where we must go. JACC Adv 2023;2:100412.
19. Redfern J, Gallagher R, O’Neil A, Grace SL, Bauman A, Jennings G, et al. Historical context of cardiac rehabilitation: Learning from the past to move to the future. Front Cardiovasc Med 2022;9:842567.
20. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: Systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682-92.
21. Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011;7:CD001800.
22. Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: An American Heart Association scientific statement from the council on clinical cardiology (subcommittee on exercise, cardiac rehabilitation, and prevention) and the council on nutrition, physical activity, and metabolism (subcommittee on physical activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005;111:369-76.
23. Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: Secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005;143:659-72.
24. Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation 2007;116:1653-62.

 

How to Cite this article: Chen N | Visualization Analysis of Research  Progress and Trends in Coronary Heart Disease Cardiac Rehabilitation Based on Bibliometrics | Journal of Regenerative Science | Jun-Jun 2026; 6(1): 14-21.

 

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Sequential Regenerative Activation of Cavernosal Tissue using Low-intensity Extracorporeal Shockwave Therapy and Systemic Exosome Administration in Neurogenic Erectile Dysfunction

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Original Article | Vol 6 | Issue 1 |  January-June 2026 | page: 9-13 | César Eisner

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.191

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 28 Mar 2026, Review Date: 02 Apr 2026, Accepted Date: April 2026 & Published: 30 June 2026

Author: César Eisner [1]

[1] Shockwave Argentina, Ciudad Autónoma de Buenos Aires, Argentina.

Address of Correspondence
Dr. César Eisner,
Shockwave Argentina, Ciudad Autónoma de Buenos Aires, Argentina.
E-mail: shockwaveargentina@gmail.com

Abstract

Introduction: Neurogenic erectile dysfunction (NED) results from injury to the cavernous nerves and is characterized by impaired nitrergic signaling, tissue hypoxia, endothelial dysfunction, and progressive fibrotic remodeling of the corpora cavernosa. Current treatments primarily address symptoms rather than underlying regenerative mechanisms.
Objective: The objective of the study is to propose a mechanistically guided regenerative therapeutic model combining low-intensity extracorporeal shockwave therapy (Li-ESWT) with systemic administration of mesenchymal stem cell-derived exosomes to promote neural repair and restore the cavernosal neurovascular microenvironment.
Materials and Methods: A conceptual therapeutic protocol is described based on the biological interaction between shockwave-induced mechanotransduction and chemotactic recruitment of regenerative extracellular vesicles through activation of the stromal-derived factor-1 (SDF-1)/C-X-C chemokine receptor type 4 (CXCR4) axis.
Results: Li-ESWT induces transient upregulation of angiogenic and chemotactic mediators including vascular endothelial growth factor, endothelial nitric oxide synthase, and SDF-1, generating a temporary regenerative microenvironment. Systemically administered exosomes expressing CXCR4 receptors may preferentially migrate toward tissues with increased SDF-1 expression, facilitating targeted delivery of regenerative signaling molecules capable of promoting neural regeneration, angiogenesis, and antifibrotic modulation.
Conclusion: Sequential activation of tissue mechanotransduction followed by systemic exosome administration may represent a biologically guided regenerative strategy for NED. This approach constitutes the conceptual basis for the PROSIN protocol, a multimodal regenerative therapy designed to restore penile neurovascular function.
Keywords: Neurogenic erectile dysfunction, Extracorporeal shockwave therapy, Exosomes, Regenerative medicine, Stromal-derived factor-1 C-X-C chemokine receptor type 4 axis, Cavernous nerve regeneration

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How to Cite this article: Eisner C | Sequential Regenerative Activation of Cavernosal Tissue using Lowintensity Extracorporeal Shockwave Therapy and Systemic Exosome Administration in Neurogenic Erectile Dysfunction. | Journal of Regenerative Science | Jan-Jun 2026; 6(1): 09-13.

 

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Pain: What Do Doctors Need to Know?

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Medical Education | Vol 6 | Issue 1 |  January-June 2026 | page: 6-8 | Ricardo Kobayashi, Carolina Besser Cozac Kobayashi, Lin Tchia Yeng, Manoel Jacobsen Teixeira

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.189

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 06 Feb 2026, Review Date: 19 Mar 2026, Accepted Date: April 2026 & Published: 30 June 2026

Author: Ricardo Kobayashi [1], Carolina Besser Cozac Kobayashi [1], Lin Tchia Yeng [1], Manoel Jacobsen Teixeira [1]

[1] Department of Neurology, Pain Center, University of Neurology, São Paulo, Brazil.
.

Address of Correspondence
Dr. Ricardo Kobayashi,
Department of Neurology, Pain Center, University of São Paulo, São Paulo, Brazil.
E-mail: koba@globo.com

Abstract

Pain is one of the leading causes of medical consultations and emergency department visits, making its accurate assessment and management essential components of quality healthcare. Pain can be classified according to duration, intensity, and pathophysiology, including nociceptive, neuropathic, nociplastic, and mixed mechanisms. Chronic pain represents a major public health challenge because of its high prevalence and its impact on physical and psychological functioning. A comprehensive evaluation based on medical history, physical examination, and appropriate use of complementary studies is crucial for establishing an accurate diagnosis and guiding treatment. Mechanical and inflammatory pain patterns, comorbidities, mood disorders, and functional impairment should be considered during assessment. Multimodal pain management addresses the multifactorial nature of pain through pharmacological and non-pharmacological strategies. Pharmacological options include non-opioid analgesics, opioids, nonsteroidal anti-inflammatory drugs, nutraceuticals, muscle relaxants, antidepressants, anticonvulsants, and topical agents, with treatment tailored to the underlying pain mechanism and individual patient characteristics. Opioids should be used cautiously, particularly in chronic pain, with clearly defined functional goals. Non-pharmacological interventions, including physical rehabilitation, exercise, postural education, pain neuroscience education, and mind-body approaches, are fundamental for restoring function and improving quality of life. Effective pain management prioritizes functional recovery and reduction of suffering rather than complete pain elimination, emphasizing individualized, mechanism-based, and multidisciplinary approaches.
Keywords: Musculoskeletal pain, Chronic pain, Mixed pain, Neuropathic pain, Pain management.

References

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17. Finnerup NB. Nonnarcotic methods of pain management. N Engl J Med 2019;380:2440-8.
18. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis. Lancet Neurol 2015;14:162-73.
19. Derry S, Cording M, Wiffen PJ, Law S, Phillips T, Moore RA. Pregabalin for pain in fibromyalgia in adults. Cochrane Database of Syst Rev 2016;2016:CD011790.

 

How to Cite this article: Kobayashi R, Kobayashi CBC, Yeng LT, Teixeira MJ | Pain: What Do Doctors Need to Know?. | Journal of Regenerative Science | Jan-Jun 2026; 6(1): 06-08.

 

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Methodological and Interpretative Limitations in a Case Report of Achilles Tendon Rupture Following Extracorporeal Radial Pressure Wave Therapy

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Bibliographic Analysis | Vol 6 | Issue 1 |  January-June 2026 | page: 3-5 | Daniel Moya, Achim Loske

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.187

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 25 Feb 2026, Review Date: 13 Mar 2026, Accepted Date: April 2026 & Published: 30 June 2026

Author: Daniel Moya [1], Achim Loske [2]

[1] Department of Orthopaedics, Hospital Británico de Buenos Aires, Buenos Aires, Argentina,
[2] Centro de Física Aplicada y Tecnología Avanzada, Universidad Nacional Autónoma de México, Querétaro, México.

Address of Correspondence
Daniel Moya,
Department of Orthopaedics, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar

Abstract

This commentary critically examines a case report attributing Achilles tendon rupture to shock wave therapy. The manuscript presents significant conceptual and methodological flaws, particularly the conflation of extracorporeal shock wave therapy, radial pressure wave therapy, and percussive ultrasound, despite their distinct physical and biological characteristics. The proposed mechanism of cumulative microtrauma lacks supporting evidence and contradicts current mechanotransduction-based models. In addition, insufficient reporting of treatment parameters limits reproducibility. The authors fail to consider well-established risk factors for tendon rupture, relying instead on temporal association, which constitutes a post hoc fallacy. Overall, the conclusions are speculative, unsupported, and not aligned with existing literature.

Keywords: Shock waves, Radial pressure waves, Achilles tendinopathy, Achilles rupture

References

1. Argyropoulou E, Sakellariou E, Karampinas P, Rozis M, Galanis A, Kolovos I, et al. A case report of Achilles tendon distractive rupture after shock wave therapy. J Surg Case Rep 2025;2025:rjaf206.
2. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100:251-63.
3. Loske AM, Moya D. Shock waves and radial pressure waves: Time to put a clear nomenclature into practice. J Regen Sci 2021;1:4-8.
4. Loske AM, Moya D. Errors in shock wave therory can impact clinical outcomes. J Regen Sci 2024;4:35-6.
5. Lin TC, Lin CY, Chou CL, Chiu CM. Achilles tendon tear following shock wave therapy for calcific tendinopathy of the Achilles tendon: A case report. Phys Ther Sport 2012;13:189-92.
6. Stania M, Juras G, Chmielewska D, Polak A, Kucio C, Król P. Extracorporeal shock wave therapy for Achilles tendinopathy. Biomed Res Int 2019;2019:3086910.
7. Novak P, Verdaasdonk R. Radial ESWT update – New observations explain positive treatment results in sports medicine. In: Lohrer H, Nauck T, editors. Shock Wave Therapy in Practice: Shock Waves in Sports Medicine. Heilbronn: Buchverlag; 2017. p. 126-57.
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9. Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (ESWT) on tendon tissue. Muscles Ligaments Tendons J 2012;2:33-7.
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11. Nikolikj-Dimitrova ED, Gjerakaroska-Savevska C, Koevska V, Mitrevska B, Gocevska M, Manoleva M, et al. The effectiveness of radial extracorporeal shock wave therapy for chronic achilles tendinopathy: A case report with 18 months follow-up. Open Access Maced J Med Sci 2018;6:523-7.
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How to Cite this article: Moya D, Loske A. Methodological and Interpretative Limitations in a Case Report of Achilles Tendon Rupture Following Extracorporeal Radial Pressure Wave Therapy.| Journal of Regenerative Science | Jan-Jun 2026; 6(1): 03-05.

 

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“Roma città aperta” (Rome open city)

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Editorial | Vol 6 | Issue 1 |  January-June 2026 | page: 1-2 | Daniel Moya

DOI: https://doi.org/10.13107/jrs.2026.v06.i01.185

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2026; The Author(s).

Submitted Date: 30 May 2026, Review Date: 30 May 2026, Accepted Date: June 2026 & Published: 30 June 2026

Author: Daniel Moya [1]

[1] Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.

Address of Correspondence
Daniel Moya,
Department of Orthopaedics, Hospital Británico de Buenos Aires, Argentina.
E-mail: drdanielmoya@yahoo.com.ar

Editorial

Rome, Open City is a masterpiece of Italian neorealist cinema. Set between 1943 and 1944 during the Nazi occupation, the film sought to denounce and raise awareness of the suffering experienced during that period. Directed by Roberto Rossellini in 1945, it was filmed on location, using the still-devastated city as the backdrop for a dramatic story told with remarkable realism.
The host city of the 2nd International Meeting of the International Federation of Shockwave Treatment presented an entirely different atmosphere. On this occasion, Rome was a city open to encounters, to the exchange of ideas and experiences, and to fellowship and unbiased scientific dialogue.
The venue itself reflected another chapter in the city’s history. The Hospital of Santo Spirito, founded in 727 AD, has recently been restored to its former splendor, recalling the days when it housed more than 300 inpatient beds (Fig. 1).

Figure 1: Detail of the dome of the Santo Spirito Hospital. (Photo courtesy of Dr. Jan Dirk Rompe).

The composition of the Scientific Committee embodied the organizers’ vision. In many cases, it brought together professionals recognized well beyond the field of shockwave therapy, yet possessing extensive expertise in the subject. This represents the strongest safeguard against models in which a small group of “illuminati” remains in power over time and dictates the direction for everyone else. Such an approach prevents the recycling of the same perspectives and avoids fostering self-reinforcing convictions around concepts that have not necessarily been conclusively demonstrated.
Indeed, one lecture had a truly “shocking” impact. Dr. Jan Dirk Rompe (Germany), one of the pioneers of shockwave treatment, demonstrated that despite the favorable clinical outcomes achieved with the procedure in the treatment of Achilles tendinopathy, the scientific evidence remains far from definitive. His presentation sparked considerable interest in developing research projects aimed at addressing this important gap in knowledge.
Participants also enjoyed lectures delivered by renowned experts, including Dr. Nicola Maffulli (United Kingdom), Dr. Sun Wei (China), Dr. Ronald Hamisultane (France), Dr. Josep Pous (Spain), Dr. Ram Chidambaram (India), Dr. Dan Zin (Israel), Dr. Cristina D’Agostino (Italy), Dr. Mani Singh (United States), Dr. Ricardo Kobayashi (Brazil), and many other distinguished professionals from around the world.
The Italian Society for Shockwave Treatment, under the leadership of Drs. Maria Chiara Vulpiani, Sergio Gigliotti, and Paolo Buselli, played an active role in the meeting and conducted a Certification Course that reached full capacity. Describing the scientific contributions of this institution and its members to the field of shockwave treatment would require an article in itself.
Other Italian institutions, including the Academy of Bioregenerative Medicine and Surgery, several universities, and leading researchers, also made substantial contributions.
The event brought together a large group of colleagues from across Latin America, spanning from northern Mexico to the southern tip of Patagonia, who participated actively throughout the meeting.
The meeting received scientific endorsement from the International Society of Orthopedics and Traumatology and was broadcast live on OrthoTV, the world’s leading interactive medical platform.
No account of the meeting would be complete without acknowledging Dr. Alfonso Di Giorno, whose tireless efforts were essential in achieving its success.
This event will undoubtedly be remembered for many reasons, but above all for serving as a catalyst for the advancement of this scientific field. Anticipation is already building for the next meeting, to be held in China in 2028 under the leadership of Dr. Sun Wei. The destination will change, but the spirit that animated this gathering will surely remain the same.

How to Cite this article: Moya D | Roma città aperta” (Rome open city) | Journal of Regenerative Science | Jan-Jun 2026; 6(1): 01-02.

 

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