Effect of Fascial Distortion Model versus Kinetic Chain Activation Technique in young adults with trapezitis: A randomized clinical trial

Objectives: This study aims to investigate the effects of myofascial release therapy (MRT) added to standard physical therapy and rehabilitation practices on neck pain, trigger point (TP) numbers, pressure pain threshold (PPT), cervical joint range of motion (ROM), neck disability and quality of life in patients with cervical myofascial pain syndrome (MPS). Patients and methods: This prospective, randomized-controlled trial included a total of 60 patients (8 males, 52 females; mean age: 41.6±12.5 years; range, 20 to 65 years) aged between 18 and 65 years who reported neck pain persisting for over one month and satisfied the Travell and Simons criteria for MPS diagnosis between December 2021 and September 2022. The patients in Group 1 (n=30) underwent a standard physical therapy program. Patients in Group 2 (n=30) additionally underwent MRT three days a week. Before and on Day 15 after treatment, patients' pain was evaluated by Visual Analog Scale (VAS), TP numbers by palpation, PPTs by pressure algometer, cervical ROM by goniometer, disability by Neck Disability Index (NDI), quality of life by Nottingham Health Profile (NHP). Results: The VAS scores, TP numbers, PPTs, cervical ROM values, NDI, and NHP scores exhibited a significant improvement posttreatment compared to pretreatment in both groups (p<0.001). Considering the changes after treatment, in Group 2, the changes of VAS-movement, VAS-rest, TP numbers, PPTs, cervical ROMs, NDI, NHP scores were significantly higher than Group 1 (p≤0.05 for all). Conclusion: In patients with neck pain due to cervical MPS, MRT provides positive effects on pain, TP numbers, PPT measurements, cervical ROM, neck disability, and quality of life. The MRT appears to be an effective treatment for cervical MPS as it is non-invasive, easy to apply, inexpensive, and has a low side effect profile.

Effects of Diacutaneous Fibrolysis on Pain and Mobility in Chronic Neck Pain: A Randomized Sham-Controlled Trial.

Sedentary lifestyle, age-related degenerative changes or traumatic injuries leads to cervical spine structural mal-alignment, which results in neck pain and other symptoms. Various therapeutic exercises and manual techniques have been proven to be beneficial in terms of managing these symptoms. This study aimed to determine the combined effects of cervical mobilization and post-isometric relaxation (PIR) technique on managing neck pain, cervical side flexion range of motion, and functional limitation in participants with mechanical neck pain linked with myofascial trigger points. This study followed a 2-arm, parallel-group, pretest-posttest randomized comparative design. Thirty participants with mechanical neck pain associated with myofascial trigger points aged 30.87 ± 4.45 years were randomly allocated to Groups 1 and 2. Group 1 received conventional intervention, PIR, and cervical mobilization techniques while Group 2 received conventional intervention and PIR technique only. Neck pain, muscle tenderness, cervical range of motion, and functional limitations were assessed using a visual analog scale, pressure pain threshold (PPT), goniometer, and neck disability index (NDI) questionnaire, respectively at baseline on day 1 and post-intervention on day 7, 14, and 21. Wilcoxon signed-rank test and the Mann-Whitney U test evaluated within-group and between-group analyses, respectively. Statistical significance was established at a 95% confidence interval, indicated by P < .05. Significant differences (95% confidence interval [CI], P < .05) were observed within each group for all the outcomes scores when compared to the baselines across multiple time points. Significant variations were observed between the groups when comparing visual analog scale and NDI scores at weeks 1, 2, and 3 post-interventions. In contrast, insignificant differences (95% CI, P > .05) were observed for side flexion range of motion and PPT compared at weeks 1, 2, and 3 post-interventions except for PPT at week 3 post-intervention (95% CI, P < .05). Additionally, Cohen d test revealed the superiority of group 1 over group 2 in reducing pain and functional limitations and improving cervical side flexion range of motion and PPT. The combination of cervical mobilization and Post-isometric relaxation techniques was discovered to effectively alleviate neck pain and enhance functional abilities when contrasted with the application of post-isometric relaxation alone in patients with mechanical neck pain linked with myofascial trigger points.

To investigate potential relationships of clinical (age, function, side of pain, years with pain), physical (cervical range of motion, pinch grip force), psychological (depression), and neurophysiological (pressure and thermal pain thresholds) outcomes and hand pain intensity in carpal tunnel syndrome (CTS). Two hundred and forty-four (n=224) women with CTS were recruited. Demographic data, duration of the symptoms, function and severity of the disease, pain intensity, depression, cervical range of motion, pinch tip grip force, heat/cold pain thresholds (HPT/CPT), and pressure pain thresholds (PPT) were collected. Correlation and regression analysis were performed to determine the association among those variables and to determine the proportions of explained variance in hand pain intensity. Significant negative correlations existed between the intensity of pain and PPTs over the radial nerve, C5/C6 zygapophyseal joint, carpal tunnel and tibialis anterior muscle, HPT over the carpal tunnel, cervical extension and lateral-flexion, and thumb-middle, fourth, and little finger pinch tip forces. Significant positive correlations between the intensity of hand pain with function and depression were also observed. Stepwise regression analyses revealed that function, thumb-middle finger pinch, thumb-little finger pinch, depression, PPT radial nerve, PPT carpal tunnel, and HPT carpal tunnel were significant predictors of intensity of hand pain (R²=0.364; R² adjusted=0.343; F=16.87; P<0.001). This study showed that 36.5% of the variance of pain intensity was associated to clinical (function), neurophysiological (localized PPT and HPT), psychological (depression), and physical (finger pinch tip force) outcomes in women with chronic CTS.

Background and Purpose: Strain counterstrain (SCS), also known as positional release, is an indirect osteopathic manipulative technique to relieve musculoskeletal pain and dysfunction such as myofascial trigger points. SCS begins by identifying specific tender points related to musculoskeletal pain and dysfunction, and then the practitioner positions the patient in the position-of-comfort which is typically obtained by shortening tissues around tender points for 90 seconds. The purpose of this study was to investigate the immediate and lasting effects of SCS technique on trigger points or tender points. Methods: Three databases (Pubmed, ScienceDirect, and Google Scholar) were searched and articles were included if met the following criteria: (1) subjects were randomly assigned to one of treatment groups; (2) subjects with identified trigger points or tender points; (3) the intervention group received either SCS technique alone or SCS technique combined with other treatment which was the same as control group; (4) the control group received no treatment, sham treatment, or other treatment which not contained SCS technique; (5) outcome measures contained visual analog scale (VAS) of pain intensity or pressure pain threshold (PPT) of trigger points or tender points. Results: A total of ten studies were included and analyzed. Immediately after single or multiple sessions of treatment, there was significant improvement of both VAS (standardized mean difference [SMD] = -1.85, p ＜ 0.0001) and PPT (SMD = 1.08, p ＜ 0.0001) in the intervention group compared with the control group. Moreover, 1-4 weeks after the end of multiple sessions of treatment, there was significant improvement of VAS (SMD = -0.56, p = 0.02) but no significant improvement of PPT (SMD = 0.97, p = 0.08) in the intervention group compared with the control group. Conclusion: This meta-analysis indicated that there were both immediate and lasting effects of SCS technique on significantly decreasing VAS and there was immediate effect of SCS technique on significantly increasing PPT. Clinical Relevance: This meta-analysis suggests that SCS technique can decrease pain intensity and sensitivity of trigger points or tender points.

BACKGROUND AND OBJECTIVES: There is a data gap regarding cold pain and pressure pain in healthy young individuals. The present study aimed to compare cold pain threshold and intensity and pressure threshold in young men and women with different fat percentages. METHODS: The study included 30 men and 42 women aged between 18 and 25 years, divided into two groups: normal - body mass index ≤24.9 and overweight - ≥25. Fat percentage was estimated by tetrapolar bioimpedance, pain-pressure threshold by pressure algometer, cold pain threshold was timed, and the intensity measured by the visual analog scale. RESULTS: The intensity of pain caused by cold showed no significant difference between groups, as well as the cold pain threshold and the initial and final pain threshold. The same behavior happened within the men and women groups. When comparing the difference between genders, pressure pain and cold pain thresholds had significant differences. Pain intensity did not differ between genders. CONCLUSION: Fat percentage did not affect the response time of cold pain and pressure pain thresholds and pain intensity in young adults. When considering gender, although the cold pain threshold in men was higher than in women, pain intensity was similar.

Randomized clinical trial. To compare the effects of cervical versus thoracic thrust manipulation in patients with bilateral chronic mechanical neck pain on pressure pain sensitivity, neck pain, and cervical range of motion (CROM). Evidence suggests that spinal interventions can stimulate descending inhibitory pain pathways. To our knowledge, no study has investigated the neurophysiological effects of thoracic thrust manipulation in individuals with bilateral chronic mechanical neck pain, including widespread changes on pressure sensitivity. Ninety patients (51% female) were randomly assigned to 1 of 3 groups: cervical thrust manipulation on the right, cervical thrust manipulation on the left, or thoracic thrust manipulation. Pressure pain thresholds (PPTs) over the C5-6 zygapophyseal joint, lateral epicondyle, and tibialis anterior muscle, neck pain (11-point numeric pain rating scale), and cervical spine range of motion (CROM) were collected at baseline and 10 minutes after the intervention by an assessor blinded to the treatment allocation of the patients. Mixed-model analyses of covariance were used to examine the effects of the treatment on each outcome variable, with group as the between-subjects variable, time and side as the within-subject variables, and gender as the covariate. The primary analysis was the group-by-time interaction. No significant interactions were found with the mixed-model analyses of covariance for PPT level (C5-6, P>.210; lateral epicondyle, P>.186; tibialis anterior muscle, P>.268), neck pain intensity (P = .923), or CROM (flexion, P = .700; extension, P = .387; lateral flexion, P>.672; rotation, P>.192) as dependent variables. All groups exhibited similar changes in PPT, neck pain, and CROM (all, P<.001). Gender did not influence the main effects or the interaction effects in the analyses of the outcomes (P>.10). The results of the current randomized clinical trial suggest that cervical and thoracic thrust manipulation induce similar changes in PPT, neck pain intensity, and CROM in individuals with bilateral chronic mechanical neck pain. However, changes in PPT and CROM were small and did not surpass their respective minimal detectable change values. Further, because we did not include a control group, we cannot rule out a placebo effect of the thrust interventions on the outcomes. Therapy, level 1b.J Orthop Sports Phys Ther 2012;42(9):806-814, Epub 18 June 2012. doi:10.2519/jospt.2012.4151.

Background: Forward head posture is associated with the upper trapezius myofascial trigger points and cause pain, restricted range of motion, and referred pain in the arm. The positional release technique is likely to focus on evaluating the efficacy of this manual therapy approach. Objective: To determine the effects of positional release technique for myofascial trigger points of the upper trapezius with forward head posture Method: A randomized control trial study was conducted in the Physiotherapy Department of THQ Hospital Wazirabad, Pakistan, from February 2021 to June 2021 with a sample size of n=32 male participants. Participants were recruited with pain intensity of at least 3 points on the Visual Analogue Scale at baseline, at least one active TrP in the upper trapezius that was diagnosed using the method described by Travel and Simon, and computer users who spend at least 6 hours per day in a sitting posture and are between the ages of 18 and 45. All subjects were randomly and equally allocated into the Positional Release Therapy (PRT) group and a conventional Physical Therapy group. A total 12 treatment sessions were given with 3 days a week for consecutive 4 weeks. The data was collected at the baseline and after the 12th session. The outcome measures for trigger point sensitivity were pain pressure threshold (PPT), visual analogue scale (VAS), active contra lateral flexion (ACLF), cranio-vertebral angle (CVA), and neck disability index (NDI). Data analysis was done through SPSS version-27. Results: The mean age of 34.3±6.57 years. The positional release therapy post-intervention results showed more significant improvement (p≤0.05) in all outcomes PPT, VAS, ACLF, CVA, and NDI between the groups with large effect size. Conclusion: Positional release therapy (PRT) is superior to conventional therapy in decreasing pain intensity and threshold with disability in patients of upper trapezius trigger points Keywords: cranio-vertebral angle; forward head posture; neck disability index; pain pressure threshold; positional release therapy; trigger points; upper trapezius; visual analogue scale.

The prevalence of neck pain is on the increase. A sedentary life style, poor ergonomics in the workplace and in daily life, and stress all contribute to neck overload. The aim of this study was to assess the efficacy of a single session of a Fascial Distortion Model (FDM) intervention combined with foam rolling in patients with cervical spine overload. The study enrolled 90 patients, who were randomized to an FDM group, a foam rolling group (who exercised with a Duoball against a wall) and a control group, of 30 patients each. Mobility was measured with a digital inclinometer, pain intensity was assessed with a VAS scale and (upper and middle) trapezius tone was evaluated by sEMG. These measurements were carried out twice in each group and analysed in Matlab and Statistica 13. Both groups subjected to a therapeutic intervention (FDM and foam rolling) reported a significant reduction in neck pain intensity and improved cervical spine mobility (p&lt;0.01). The control group did not demonstrate changes in mobility or pain intensity. The resting trapezius tone did not change in any of the groups. Conclusions, 1. A single session of FDM therapy can effectively reduce and eliminate cervical spine pain, which may be of use in work-site rehabilitation. 2. Single sessions of FDM and foam rolling can effectively improve neck mobility in patients with cervical spine overload. 3. There is a rationale for conducting further prospective randomized studies of larger samples to assess the duration of the beneficial effects of both therapies and determine an optimum session frequency.

This study investigated the effect of low-level laser therapy (LLLT) on the masticatory performance (MP), pressure pain threshold (PPT), and pain intensity in patients with myofascial pain. Twenty-one subjects, with myofascial pain according to Research Diagnostic Criteria/temporomandibular dysfunction, were divided into laser group (n = 12) and placebo group (n = 9) to receive laser therapy (active or placebo) two times per week for 4 weeks. The measured variables were: (1) MP by analysis of the geometric mean diameter (GMD) of the chewed particles using Optocal test material, (2) PPT by a pressure algometer, and (3) pain intensity by the visual analog scale (VAS). Measurements of MP and PPT were obtained at three time points: baseline, at the end of treatment with low-level laser and 30 days after (follow-up). VAS was measured at the same times as above and weekly throughout the laser therapy. The Friedman test was used at a significance level of 5% for data analysis. The study was approved by the Ethics Committee of the Federal University of Sergipe (CAAE: 0025.0.107.000-10). A reduction in the GMD of crushed particles (p < 0.01) and an increase in PPT (p < 0.05) were seen only in the laser group when comparing the baseline and end-of-treatment values. Both groups showed a decrease in pain intensity at the end of treatment. LLLT promoted an improvement in MP and PPT of the masticatory muscles.

To investigate the effect of a structured exercise training program on pain, functional status, physical function and quality of life (QoL) in string and woodwind players with nonspecific cervical pain. This study had a prospective cohort design and conducted on 40 musicians (26 male, 14 female) aged between 18 and 65years with persistent nonspecific neck pain in the previous 3months. Forty musicians were assigned to either violin (n = 20, median age; 26.5year, height; 1.67m, body mass; 65kg, BMI; 23.04kg/m2) or ney group (n = 20, median age; 27.5year, height; 1.81m, body mass; 75kg, BMI; 23.35kg/m2) and followed the same structured exercise program (3days/per week for 8weeks). The primary outcome was neck pain intensity and assessed on a visual analog scale (VAS). Secondary outcomes; cervical range of motion (ROM) was measured using a goniometer, the jaw-to-sternum and jaw-to-wall distances were used for the assessment of cervical mobility, neck, shoulder and back muscles strength were assessed with a hand-held dynamometer, the Northwick Park Neck Pain and Short Form 36 (SF-36) questionnaires were also used. Normality of data distribution was checked using the Kolmogorov-Smirnov test. For evaluating the training effectiveness on outcome measures, Mann-Whitney U and Wilcoxon test were used compare pre-test and post-test values with/within groups, respectively. The primary outcome (pain intensity) was lowered %33 in both groups. However, the mean change was found similar (median mean changes; -2 for both groups) (p > 0.05). The secondary outcomes; cervical mobility, cervical flexion ROM, disability and muscle strength of the left middle trapezius, left hand grip, anterior and middle parts of the right deltoid, and cervical flexors also significantly improved in both groups (p < 0.05). Only the mean changes of right serratus anterior, middle trapezius and cervical flexor muscles were higher in violin group than ney group (p < 0.05). There was no significant difference in the cervical extension, right rotation, left rotation, right lateral flexion and left lateral flexion after the treatment in both groups (p > 0.05). There was no significant difference between the groups after the exercise program in terms of pain, mobility, range of motion and SF-36 subdomains (p > 0.05). Specific exercise program had similar positive effects on pain, cervical mobility, cervical fexion ROM and disability in string and woodwind players. Although several muscles showed similar improvements in strength, some muscle groups recovered differently. Physical needs specific to the instrument and performance should be taken into account when prescribing exercises to musicians having the same problem, but playing different instruments.

Nonspecific neck pain is associated with chronic pain, disability, reduced cervical mobility, postural control disorders and impaired proprioceptive control. The aim of this study was to compare the effectiveness of two therapeutic exercise programs (i.e. cervical proprioception and cervical mobility) in reducing pain and disability in individuals with nonspecific neck pain. We further aimed to compare the effectiveness of the two treatments in improving pressure pain threshold, cervical range of motion and head repositioning accuracy. This study was designed as a randomized controlled trial. This study took place in a private rehabilitation clinic. Forty-two participants diagnosed with nonspecific neck pain, aged 18-65 years, were randomized to a cervical mobility group (N.=22) or a proprioception group (N.=20). The cervical mobility group combined a passive treatment and active mobility exercises, whereas the Proprioception group combined a passive treatment and proprioceptive exercises. Pain intensity, disability, pressure pain threshold, range of motion, and head repositioning accuracy were assessed at baseline and after 10 sessions. Pain intensity and disability significantly improved for both interventions (p<0.01), but such improvement was greater for pain intensity in the proprioception group than in the cervical mobility group (P<0.01). Pressure pain threshold, range of motion and head repositioning accuracy improved only in the proprioception group (P<0.01). A program based on cervical proprioception exercises demonstrated to improve pain, disability, pressure pain threshold, range of motion and head repositioning accuracy in patients with nonspecific neck pain. However, a program based on cervical mobility exercises only showed to improve pain intensity and disability, while such improvement was not clinically relevant. The proprioceptive exercise program may be considered as the treatment of choice in patients with nonspecific neck pain.

Objective To evaluate the test-retest and inter-rater reliability of the hand-held pressure algometer as a measuring instrument of pressure pain threshold(PPT).Method A total of 37 healthy subjects were recruited for reliability test.Three raters measured the PPT at 12 body sites of the subjects.Each rater conducted three trials on each site.In the validity test,10 patients with active trigger points in the upper trapezius were recruited and measured by one rater using the pressure algometer for PPT,the visual analogue scale(VAS)was also used to evaluate the pain intensity induced by the trigger point.The intraclass correlation coefficient and Spearman correlation coefficient were calculated to reflect the reliability and validity.Results The test-retest and inter-rater reliabilities were both high(ICC＞0.95),with the measurements by one rater were more reliable than measurements by multiple raters.The inter-rater reliability of PPT measurement obtained by using the mean value of 3 trials was higher than any of the 3 trials alone.The PPT values of the trigger points were higher than those of the normal points,and there was a significantly negative correlation between the PPT values of the trigger points and the VAS scores.Conclusion The intra-and inter-rater PPT measurements in healthy subjects obtained with the hand-held pressure algometer were highly reliable.The algometer was valid for quantifying myofascial trigger point sensitivity. Key words: Pressure pain threshold; Algometer; Reliability; Validity

Immediate effect of activator trigger point therapy and myofascial band therapy on non-specific neck pain in patients with upper trapezius trigger points compared to sham ultrasound: A randomised controlled trial

Tratamiento de síndrome de impingement subacromial mediante punción seca profunda: estudio de caso