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      Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points

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          Myofascial pain syndrome, thought to be the main cause of neck pain and shoulder muscle tenderness in the working population, is characterized by myofascial trigger points (MTrPs). This study aimed to examine the immediate and short-term effect of the combination of two therapeutic techniques for improving neck pain and muscle tenderness in male patients with upper trapezius active MTrPs. This study was a pretest-posttest single-blinded randomized controlled trial. Sixty male subjects with mechanical neck pain due to upper trapezius active MTrPs were recruited and randomly allocated into group A, which received muscle energy technique (MET) and ischemic compression technique (ICT) along with conventional intervention; group B, which received all the interventions of group A except ICT; and group C, which received conventional treatment only. Baseline (Pr), immediate postintervention (Po), and 2-week follow-up (Fo) measurements were made for all variables. Pain intensity and pressure pain threshold (PPT) were assessed by a visual analog scale (VAS) and pressure threshold meter, respectively. All the three groups received their defined intervention plans only. Repeated-measures analysis of variance was used to perform intra- and intergroup analyses. Cohen's d test was used to assess the effect size of the applied interventions within the groups. The intergroup analysis revealed significant differences among groups A, B, and C in VAS and PPT at Po (VAS-Po: F = 13.88, p=0.0001; PPT-Po: F = 17.17, p=0.0001) and even after 2 weeks of follow-up (VAS-Fo: F = 222.35, p=0.0001; PPT-Fo: F = 147.70, p=0.0001). Cohen's d revealed a significant treatment effect size within all groups except group C (only significant for VAS-Po–VAS-Pr: mean difference = 1.33, p < 0.05, d = 1.09); however, it showed a maximum effect size in group A for its variables (VAS-Fo–VAS-Pr: mean difference = 5.27, p=0.01, d = 4.04; PPT-Fo–PPT-Pr: mean difference = 2.14, p < 0.01, d = 3.89). Combination therapies (MET plus ICT) showed immediate and short-term (2-week follow-up) improvements in neck pain and muscle tenderness in male patients with upper trapezius active MTrPs.

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          Most cited references 36

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          Pressure algometry in manual therapy.

          SUMMARY. The pressure pain threshold (PPT), i.e. the least stimulus intensity at which a subject perceives pain, was studied in 30 patients with chronic unilateral pain in the shoulder and arm region.Fourteen trigger points were investigated on both sides of the body using pressure algometry. Eight paravertebral points and six points in the shoulder and arm region were evaluated. Each location was examined twice. The patients were tested by one examiner.The intraobserver reliability of PPT measurements was considered to be good. The Intraclass Correlation Coefficients of reliability (ICC), based on two repeated PPT measurements varied between 0.64 and 0.96. The painful side of the body was found to be more sensitive than the non-painful side, although there was not always a significant difference at the 0.05 level. The PPT was found to be higher in males than in females (P < 0.05). Females demonstrated lower PPTs than males at each trigger point. It was established that pressure tenderness varies over individual trigger points. Significant regional differences in PPT values were observed (P < 0.05). PPT values decreased in a cranial direction in the spine and in a caudal direction in the upper limb.Although the authors expected to find segmentally reduced PPT values on the painful side of the body, a generalized reduction of PPT values was present at all peripheral and spinal segmental sites. Some correlations between segmentally related trigger points were found by factor analysis. Copyright 1996 Harcourt Publishers Ltd.
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            Interrater reliability in myofascial trigger point examination

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              Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity.

              To investigate the immediate effect of physical therapeutic modalities on myofascial pain in the upper trapezius muscle. Randomized controlled trial. Institutional practice. One hundred nineteen subjects with palpably active myofascial trigger points (MTrPs). Stage 1 evaluated the immediate effect of ischemic compression, including 2 treatment pressures (P1, pain threshold; P2, averaged pain threshold and tolerance) and 3 durations (T1, 30s; T2, 60s; T3, 90s). Stage 2 evaluated 6 therapeutics combinations, including groups B1 (hot pack plus active range of motion [ROM]), B2 (B1 plus ischemic compression), B3 (B2 plus transcutaneous electric nerve stimulation [TENS]), B4 (B1 plus stretch with spray), B5 (B4 plus TENS), and B6 (B1 plus interferential current and myofascial release). The indexes of changes in pain threshold (IThC), pain tolerance (IToC), visual analog scale (IVC), and ROM (IRC) were evaluated for treatment effect. In stage 1, the IThC, IToC, IVC, and IRC were significantly improved in the groups P1T3, P2T2, and P2T3 compared with the P1T1 and P1T2 treatments (P<.05). In stage 2, groups B3, B5, and B6 showed significant improvement in IThC, ItoC, and IVC compared with the B1 group; groups B4, B5, and B6 showed significant improvement in IRC compared with group B1 (P<.05). Ischemic compression therapy provides alternative treatments using either low pressure (pain threshold) and a long duration (90s) or high pressure (the average of pain threshold and pain tolerance) and short duration (30s) for immediate pain relief and MTrP sensitivity suppression. Results suggest that therapeutic combinations such as hot pack plus active ROM and stretch with spray, hot pack plus active ROM and stretch with spray as well as TENS, and hot pack plus active ROM and interferential current as well as myofascial release technique, are most effective for easing MTrP pain and increasing cervical ROM. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

                Author and article information

                Biomed Res Int
                Biomed Res Int
                BioMed Research International
                10 March 2020
                : 2020
                1Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
                2Department of Building and Real-Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong
                3Department of Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
                Author notes

                Academic Editor: Redha Taiar

                Copyright © 2020 Ahmad H. Alghadir et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funded by: Deanship of Scientific Research, King Saud University
                Award ID: RGP-VPP-209
                Research Article


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