Re: myoActivation for the treatment of pain and disability. Author replies

Issue: BCMJ, vol. 61 , No. 5 , June 2019 , Pages 202-203 Letters

My experience with myoActivation was the stimulus for writing the letter to the editor. As a skeptical physician I was impressed that it worked well and I wanted to learn more about the technique. I believe that myoActivation is an innovative methodology that can significantly benefit people living with chronic pain.

In your December 2018 letter to the editor in the BCMJ (regarding Dr Cadesky’s article) [BCMJ 2018;60:480] you stated “It’s all about the patient . . . If change starts with what will benefit the patient and not what is perceived to benefit the system, better health care will ensue. We need flexibility and readiness to change as we try out any system. Indeed, that’s how we practise patient care.” I wholeheartedly agree!

Certainly more studies need to be completed to truly demonstrate myoActivation’s effectiveness; myoActivation does, however, have similarities with other commonly practised myofascial release and needling techniques. One difference with myoActivation is that MSP covers it and it is carried out by physicians trained in the technique. I have included references to studies on myofascial release and other needling techniques below.

A number of studies are ongoing in BC. I felt that including them in my previous letter would turn a letter to the editor into a full article. Studies are being carried out in Prince George (Dr Cameron Grose), at BC Children’s Hospital (Dr Gillian Lauder), and at Vancouver Coastal Health (Barb Eddy, NP). Vancouver Community Pain Service has started a 1-year pilot program for chronic pain patients using myoActivation and other therapies in marginalized populations with mental health and addictions.

In your profile in UBC Medicine (Vol. 2, No. 1, Fall 2005) you say, “It’s all about seeing the patient and making observations.” Making careful clinical observation of abnormal anatomy and dysfunctional movement in chronic pain patients is the focus of myoActivation.

I encourage you to take a closer look at the myoActivation methodology.
—Suzanne Montemuro, MD, CCFP

This letter was submitted in response to “Re: myoActivation for the treatment of pain and disability.”


Dr Koehler and I worked together at the Port Arthur Clinic in Thunder Bay, Ontario, in the 1970s.

Suggested reading

Muscle activation

Arguisuelas MD, Lison JF, Sanchez-Zuriaga D, et al. Effects of myofascial release in nonspecific chronic low back pain: A randomized clinical trial. Spine (Phila Pa 1976) 2017;42:627-634.

Canadian Agency for Drugs and Technologies in Health. Dry needling and injection for musculoskeletal and joint disorders: A review of the clinical effectiveness, cost-effectiveness, and guidelines. Ottawa, ON; CADTH Rapid Response Reports; 8 August 2016. Accessed 14 May 2019.

Cerezo-Téllez E, Lacomba MT, Fuentes-Gallardo I, et al. Dry needling of the trapezius muscle in office workers with neck pain. J Man Manip Ther 2016;24:223-232.

Gattie E, Cleland JA, Snodgrass S, et al. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47:133-149.

Gerber LH, Shah J, Rosenberger W, et al. Dry needling alters trigger points in the upper trapezius muscle and reduces pain in subjects with chronic myofascial pain. PM R 2015;7:711-718.

Hu HT, Gao H, Ma RJ, et al. Is dry needling effective for low back pain?: A systematic review and PRISMA compliant meta-analysis. Medicine (Baltimore) 2018;97:e11225.

Kietrys DM, Palombaro KM, Azzaretto E, et al. Effectiveness of dry needling for upper-quarter myofascial pain: A systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43:620-634.

Liu L, Hauang QM, Liu QG, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: A systematic review and meta-analysis. Arch Phys Med Rehabil 2015;96:944-955.

Liu L, Huang QM, Liu QG, et al. Evidence for dry needling in the management of myofascial trigger points associated with low back pain: A systematic review and meta-analysis. Arch Phys Med Rehabil 2018;99:144-152.e2.

Llamas-Ramos R, Pecos-Martin D, Gallego-Izquierdo T, et al. Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2014;44:852-861.

Mayoral O, Salvat I, Martin MT, et al. Efficacy of myofascial trigger point dry needling in the prevention of pain after total knee arthroplasty: A randomized, double-blinded, placebo-controlled trial. Evid Based Complement Alternat Med 2013;2013:694941.

Pecos-Martín D, Montanez-Aguilera FJ, Gallego-Izquierdo T, et al. Effectiveness of dry needling on the lower trapezius in patients with mechanical neck pain: A randomized controlled trial. Arch Phys Med Rehabil 2015;96:775-781.

Tekin L, Akarsu S, Durmus O, et al. The effect of dry needling in the treatment of myofascial pain syndrome: A randomized double-blinded placebo-controlled trial. Clin Rheumatol 2013;32:309-315.

Scar release

Alster TS, Graham PM. Microneedling: A review and practical guide. Dermatol Surg 2018;44:397-404.

Hou A, Cohen B, Haimovic A, et al. Micro-needling: A comprehensive review. Dermatol Surg 2017;43:321-339.

Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg 1995;21:543-549.

Ramaut L, Hoeksema H, Pirayesh A, et al. Microneedling: Where do we stand now? A systematic review of the literature. J Plast Reconstr Aesthet Surg 2018;71:1-14.

Suzanne Montemuro, MD, CCFP. Re: myoActivation for the treatment of pain and disability. Author replies. BCMJ, Vol. 61, No. 5, June, 2019, Page(s) 202-203 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply