Comparative Effect of Active Release Technique and Myofascial Release in Cervical Myofascial Syndrome

Official title

Comparative Effect of Active Release Technique and Myofascial Release to Improve Asthenopia, Sleep and Stress in Patients With Cervical Myofascial Pain Syndrome

Overview

The aim of this randomized controlled trial is to find the comparative effect of Active Release Technique and Myofascial release, each combined with eye exercises, on asthenopia, sleep quality, stress, pain and functional disability in patients with CMPS. A total of 44 participants will be randomized into two groups, ART + eye exercises and MFR+ eye exercises with interventions provided 3 days per week for 4 weeks. Outcomes will be assessed at baseline, 2 weeks and then after 4 weeks.

Detailed description

A musculoskeletal condition known as myofascial pain is characterized by discomfort in the region of a muscle and the fascia, the connective tissue that surrounds it. In addition to having several trigger sites, the pain may be local or widespread. Trigger points are very sensitive muscle foci that radiate pain to the surrounding area and hurts to touch. In particular, the rhomboids, trapezius, levator scapulae, supraspinatus, and infraspinatus often affected muscles in the cervical area. Acute or chronic pain is possible, and it is most likely brought on by overuse, altered posture, or muscular injury. Cervical myofascial pain is highly prevalent globally. A 2021 study by Kamran Ezzati found that 88.9% of Iranian participants had at least one neck trigger point. Similarly, a 2024 study by Sahib Rehman et al in Pakistan reported high prevalence of Myofascial Trigger Points in cervical radiculopathy patients, with mean scores of MTrPs.

Cervical myofascial pain or neck muscle pain is often caused by poor posture or prolonged use of electronic devices, leading to muscle knots or trigger points. A component of myofascial pain is the emotional stress we carry which contributes to muscle tension (in the form of, increased activation of the "fight or flight" response) releasing stress hormones like cortisol that increase muscle tension. As a health care profession, we know that physical injuries like whiplash cause damage to the structures of the neck and may also alter how certain structures respond post injury (inflammation and stiffness). There are many other conditions, such as degenerative disc disease, osteoarthritis, and fibromyalgia, both predispose the patient to altered spinal posture. As a result, muscle may function differently resulting in myofascial pain Cervical myofascial pain can be managed with orthopedic manual techniques like Active Tissue Release (ATR) and Myofascial Release (MFR). ATR, developed by Dr. Michael Leahy, combines pressure with movement to break down adhesions, improve circulation, and reduce trigger point activity. It helps restore muscle balance and relieve postural strain. MFR, popularized by John F. Barnes, uses gentle sustained pressure to release fascial restrictions, improve blood flow, and reduce nervous system overactivity. Both techniques enhance mobility, reduce pain, and promote better posture and function in the neck.

Combining these interventions with eye exercises targets both neuromuscular and visual dysfunction, offering a holistic approach to improving sleep quality, reducing stress, and alleviating cervical pain. The study addresses a gap in evidence by directly comparing ART and MFR with integrated eye exercises, potentially guiding physiotherapists and clinicians toward the most effective treatment strategy for CMPS.

Interventions

• Other Myofascial Release + Eye exercises
  * MFR applied with forearm/ulnar border of palm, gliding towards neck base/upper scapula, Sustained gentle pressure is maintained, held until a release (softening/yield) of fascial tissue is felt; the pressure is gradually increased as tolerance allows. * 3-4 glides × 90 seconds each, according to tolerance. * Frequency: 3 days/week for 4 weeks. * Followed by the same Eye Exercises as in experimental group
• Other Active Release Technique + Eye exercises
  ART applied to cervical region (upper trapezius, Levator scapula and SCM) deep tension stretch with thumb over the tender areas , repeated 3-5 times. Frequency: 3 days/week for 4 weeks Followed by Eye exercises (3 days/week for 4 weeks) * Trataka (focusing on one point) = 30s/ 3 times * Eye ball movements = 10 reps/ 2sets i. Sideways ii. Up and down iii. Two ways diagonal movement iv. Clockwise and anticlockwise rotational movements * Eye blinking and opening = 10 reps/ 2sets * Palming = 30s/1

Primary outcome measures

• : Neck Disability Index (NDI) [Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)]
• Numeric Pain Rating Scale NPRS [Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)]
• Pittsburgh Sleep Quality Index (PSQI) [Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)]
• ASQ-17 (Asthenopia Survey Questionnaire) [Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)]
• Perceived Stress Scale (PSS) [Time frame: Baseline, 2 weeks and 4 weeks (one-month follow-up)]

Eligibility criteria

Inclusion criteria

• • Both genders

• Age between 18 and 40 years
• Neck pain since last month with NPRS >3
• Cervical Myofascial pain (Presence of one or more trigger point in neck/ shoulder muscles particularly (upper trapezius, SCM and levator)
• PSQI score > 5
• Subjects with ASQ-17 score > 13

Exclusion criteria

• • Subjects with a history of cervical trauma or surgery

• Subjects with a history of substance abuse
• Subjects with use of sleep medications
• Subjects with psychological disturbance (stress, depression or anxiety)
• Visual impairment or ophthalmologic disease other than asthenopia

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

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Railway General Hospital, Rawalpindi — Rawalpindi

Identifiers

NCT: NCT07571655 · Iqra Iftikhar

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗