Comparison of Three Different Myofascial Trigger Point Treatments in Chronic Non-Specific Neck Pain

Official title

Comparison of Three Different Myofascial Trigger Point Treatments on Pain, Range of Motion, Joint Position Sense and Quality of Life in Chronic Non-specific Neck Pain

Overview

The aim of this study was to compare the efficacy of ischaemic compression (IC), positional relaxation (Strain Counterstrain \[SCS\]), and integrated neuromuscular inhibition technique (INIT) applications on pain intensity, pressure pain threshold, range of motion, joint position sense, disability, kinesiophobia, quality of life and patient satisfaction in addition to conventional treatment for chronic non-specific neck pain. It is planned to include 51 patients in the study. The included patients will be divided into 3 groups: Group 1 (HR Group), Group 2 (SCS Group) and Group 3 (INIT Group). All three groups will receive a conventional physiotherapy programme 5 times a week for 4 weeks and the same exercise programme 3 days a week for 4 weeks.

Detailed description

Chronic neck pain is one of the most common musculoskeletal problems in the general population and is the second most common type of pain after low back pain worldwide. Electrophysiological agents, therapeutic exercise and trigger point therapy techniques are frequently used in chronic non-specific neck pain. There is insufficient evidence in the current literature regarding which trigger point therapy technique is more effective. The aim of this study was to compare the efficacy of ischaemic compression (IC), positional relaxation (Strain Counterstrain \[SCS\]), and integrated neuromuscular inhibition technique (INIT) on pain intensity, pressure pain threshold, range of motion, joint position sense, disability, kinesiophobia, quality of life and patient satisfaction in addition to conventional treatment for chronic non-specific neck pain. The study was planned to include 51 patients between the ages of 18-65 years who applied to Gebze Medicalpark Hospital and met the inclusion criteria. The included patients will be randomised and divided into 3 groups: Group 1 (HR Group), Group 2 (SCS Group) and Group 3 (INIT Group). All three groups will receive a conventional physiotherapy programme (TENS, therapeutic ultrasound, hot pack) 5 times a week for 4 weeks and the same exercise programme 3 days a week for 4 weeks. In addition to conventional treatment, Group 1 will receive HR for upper trapezius, levator scapulae, splenius capitus and lower trapezius muscles, Group 2 will receive SCS for upper trapezius, levator scapulae, splenius capitus and lower trapezius muscles and Group 3 will receive INIT for upper trapezius, levator scapulae, splenius capitus and lower trapezius muscles 3 sessions per week for 4 weeks (12 sessions in total). As evaluation criteria, visual analogue scale will be used to evaluate the intensity of pain felt at rest, activity and at night, and algometer will be used to objectively measure pain threshold and tolerance. Cervical range of motion and joint position sense will be assessed using CROM III-Cervical Range of Motion device. Disability level will be assessed using the Neck Disability Scale, fear of movement using the Tampa Kinesiophobia Scale, quality of life using the Short Form-12, and Global Change Scale to assess patient satisfaction. Assessments will be made before starting the treatment programme and after the completion of the 4-week treatment programme.

Interventions

• Other Conventional Therapy
  All three groups will receive a conventional physiotherapy program (TENS, therapeutic ultrasound, hot pack) 5 times a week for 4 weeks and the same exercise program 3 days a week for 4 weeks.
• Other Ischemic Compression Group
  The ischemic compression group will receive ischemic compression therapy for the upper trapezius, levator scapulae, splenius capitis, and lower trapezius muscles.
• Other Strain-Counter Strain
  The strain counterstrain technique will be applied to the upper trapezius, levator scapulae, splenius capitis, and lower trapezius muscles.
• Other Integrated Neuromuscular Inhibition Technique (INIT)
  This group will be subjected to INIT for the upper trapezius, levator scapulae, splenius capitis, and lower trapezius muscles, 3 sessions per week for 4 weeks (12 sessions in total).

Primary outcome measures

• Visual Analogue Scale [Time frame: 4 weeks]
• Algometer [Time frame: 4 weeks]
• Cervical Joint Position Sense [Time frame: 4 weeks]
• Cervical Range of Motion [Time frame: 4 weeks]
• Neck Disability Scale [Time frame: 4 weeks]
• Tampa Kinesiophobia Scale [Time frame: 4 weeks]
• Short Form-12/ SF-12 [Time frame: 4 weeks]
• Global Change Scale [Time frame: 4 weeks]

Eligibility criteria

Inclusion criteria

• The patient is between 18 and 65 years of age,
• The patient presents to the outpatient clinic with a complaint of neck pain that has been persisting for at least 3 months,
• Pain intensity higher than 3.5/10 cm according to the Visual Analogue Scale,
• Active trigger point in at least one of the upper trapezius, levator scapulae, splenius capitus, lower trapezius muscles that may cause neck pain,
• Neck Disability Index total score higher than 15,
• Having the ability to read and write in Turkish was determined as the inclusion criteria.

Exclusion criteria

• Has had a neck, spine or shoulder injury within the last 6 months,
• The patient has neck pain caused by inflammatory, hormonal, neurological disorders or after trauma,
• Positive radicular findings compatible with nerve root compression, history of spinal fracture, spinal tumours and related malignancies, congenital spinal anomalies,
• History of neck, upper thoracic spine and shoulder surgery,
• Scoliosis surgery or a health problem that causes limitation in spinal mobility,
• Diagnosed with any malignant condition, systemic, neurological or rheumatological disease,
• Having a skin disease or hearing-vision problem that may affect the assessment process,
• Uncontrolled hypertension, uncontrolled diabetes mellitus, meniere's disease and vertigo,
• Physiotherapy sessions for neck pain in the last month,
• Pregnancy,
• Use of any analgesic or psychotropic agent was determined as exclusion criteria.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Biruni University — Istanbul

Publications

• Dardzinski JA, Ostrov BE, Hamann LS. Myofascial pain unresponsive to standard treatment: successful use of a strain and counterstrain technique with physical therapy. J Clin Rheumatol. 2000 Aug;6(4):169-74. doi: 10.1097/00124743-200008000-00001. PMID 19078466
• Hanten WP, Olson SL, Butts NL, Nowicki AL. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000 Oct;80(10):997-1003. PMID 11002435
• Desai MJ, Bean MC, Heckman TW, Jayaseelan D, Moats N, Nava A. Treatment of myofascial pain. Pain Manag. 2013 Jan;3(1):67-79. doi: 10.2217/pmt.12.78. PMID 24645933
• Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin. 2007 Dec;25(4):841-51, vii-iii. doi: 10.1016/j.anclin.2007.07.003. PMID 18054148
• Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004 Feb;14(1):95-107. doi: 10.1016/j.jelekin.2003.09.018. PMID 14759755
• Stifano G, Colantuono S, Carusi V, La Marra F, Marra A, Granata M. A case of tension-type headache in fibromyalgia. J Headache Pain. 2010 Aug;11(4):367-8. doi: 10.1007/s10194-010-0218-z. Epub 2010 May 9. No abstract available. PMID 20454992

Identifiers

NCT: NCT06814808 · BiruniUni.

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗