Yo MP
Yo MP
Yo MP
1
MPT Student, DAV Institute of Physiotherapy and Rehabilitation, Jalandhar, Punjab, India
2
Associate Professor, DAV Institute of Physiotherapy and Rehabilitation,Jalandhar, Punjab, India
3
Assistant Professor, DAV Institute of Physiotherapy and Rehabilitation,Jalandhar, Punjab, India
4
MPT Student, Punjabi University, Patiala, Punjab, India
*
Corresponding author
Michael Kaprail, MPT Student
DAV Institute of Physiotherapy and Rehabilitation, Jalandhar, Punjab, India; E-mail: michael_kaprail@hotmail.com
Article information
Received: November 27th, 2018; Revised: December 13th, 2018; Accepted: December 14th, 2018; Published: January 2nd, 2019
ABSTRACT
Background
Adhesive capsulitis is a condition in which the shoulder becomes painful to move and movement is often restricted. Trigger points
cause weakness and easy fatigue in muscles with 95% of patients, having trigger points in the supraspinatus, infraspinatus, teres
minor and subscapularis and other scapular muscles. Trigger points in the neck also produce radiating pain to other areas.
Objective
To investigate whether physical therapy techniques to inactivate myofascial trigger points can reduce symptoms and improve
shoulder and neck function in daily activities in the population of chronic periarthris shoulder patients.
Materials and Methods
All 10 eligible patients both male and female were informed about the study; consent was taken from the willingly participating
patients. Baseline assessments were done which included a range of motion of neck and shoulder, pain intensity and neck disability
index. Treatment starting with inactivation of the active myofascial trigger points by manual techniques employing compression
technique combined with an intermittent cold application by using ice-cubes followed by myofascial release, friction massage and
stretching the muscle daily for 2 weeks with follow-up on the 14th day was given. Data were collected and statistically analyzed us-
ing unpaired t-test and results were obtained.
Results
This study showed that the values on unpaired t-test were significant and relevant in statistical and data analysis on 5% level of
significance.
Conclusion
There was an increase in neck flexion and neck extension and a decrease in Neck Disability Index (NDI)s and pain on Visual
Analogue Scale (VAS). The myofascial trigger point release is effective in treating neck disability and increasing range of motion.
Keywords
Periarthritis shoulder; Trigger point; Manual technique; Neck disability.
Abbreviations
NDI: Neck Disability Index; VAS: Visual Analogue Scale; MTrPs: Myofascial Trigger Points.
cc Copyright 2019 by Kaprail M. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which
allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited.
nective tissue (adhesions) to develop between the joint’s surfaces, The study will investigate whether physical therapy tech-
the shoulder becomes painful to move, and movement is often niques to inactivate myofascial trigger points (MTrPs) can reduce
completely restricted. It occurs in 2-5% of the general population, symptoms and improve shoulder and neck function in daily activi-
with an incidence rate of 2.4 per 1000 years. Women are affected ties in population of chronic periarthiris shoulder patients.
more frequently, in the fourth or sixth decade of life with a peak
incidence in the age range of 50-55 years. The non-dominant arm MATERIALS AND METHODS
is more likely to be involved.1
All 10 eligible patients both male and female were informed about
The usual diagnosis (and often misdiagnosis) for shoul- the study; consent was taken from the willingly participating pa-
der issues, is arthritis, rotator tear, adhesive capsulitis (frozen tients. Baseline assessments were performed which included a
shoulder), bicipital tendinitis and bursitis. There may be true struc- range of motion of neck and shoulder outcome measures of pain
tural damage to the joint; however, trigger points are very often the intensity on visual analogue scale (VAS) and neck disability index
true cause of the pain. Trigger point will always cause the involved (NDI) were recorded. The study was conducted in a busy Phys-
muscle(s) to be weak and easily fatigued, prohibiting the involved iotherapy Clinic in Ludhiana, Punjab, India. Data were collected
muscles from building mass. It is found that about 95% of pa- on day 0 and day 14 and statistically analyzed and results were ob-
tients, who suffer from shoulder issues, also have trigger points in tained and comparisons were made between day 0 and day 14 on
the supraspinatus, infraspinatus, teres minor and subscapularis (the included patients.
SITS muscles) stabilizers; levator scapulae, rhomboids, pectoralis
minor, trapezius, and serratus anterior.2 Treatment starting with inactivation of the active myofas-
cial trigger points by manual techniques employing compression
Trigger points develop within muscle sarcomeres. Sarco- technique combined with the intermittent cold application by us-
meres are the basic building blocks of muscles consisting of actin ing ice-cubes followed by myofascial release, friction massage and
and myosin myofilaments; muscles move when these myofilaments stretching the muscle daily for 2 weeks with follow-up on 14th day
slide over one another. Trigger points develop when this process was given.
becomes attenuated and the sarcomeres becomes overactive; the
actin and myosin myofilaments stop sliding over one another. RESULTS
As a result, the sarcomere becomes turned to the permanently
‘switched-on’ position leading to a state of contraction which leads This study showed that the values on paired t-test were significant
to muscle hypertonia, weakness, shortening, and fibrosis (muscle and relevant in statistical and data analysis on 5% level of signifi-
stiffness).3 cance. So there is an increase in neck flexion and neck extension
and a decrease in NDIS and pain on VAS.
Methods of treating trigger points include electrotherapy
modalities namely (transcutaneous electrical nerve stimulation, This study shows the effectiveness of a comprehensive
ultrasound, low-level laser therapy, electromyography), local anes- MTrP therapy program in patients with shoulder pain. NDIs ques-
thetics (Botulinum toxin injection, dry needling), manual therapies tionnaire score was smaller than expected on the basis of results
(spray and stretch technique, deep pressure massage, mechanical from other studies. With a smaller mean value, observation of
vibration, ischaemic compression), muscle biopsy, thermotherapy, great differences between baseline and follow-up at 14 is less likely.
manipulative therapies and magnet therapies.4,5 The number of patients who improved in this study as seen on
reduction in VAS and NDIS is a clinically relevant result (Table 1
Treating the trigger point by ischemic compression in- and Figure 1).
volves applying sustained pressure to the trigger point with suf-
ficient force and for long enough to slow down the blood supply
the pressure is gradually applied, maintained, and then gradually re-
Table 1. Average Values of Range of Motion of Cervical Flexion and Extension,
leased. It is held as long as 60 seconds.6 By myofascial release meth- Pain on VAS and NDIS at Day 0 (Pre Treatment) and Day 14 Day (After Treatment)
od, in which both hands are crossed and heels of hands are kept Cervical
transversely across the top of the tissue with some compressive Days Cervical Flexion
Extension
VAS NDIS
force, and force is applied with the heels of palm in the cross direc-
Day 0 32.5 22 7.5 21.2
tion equally for 30 seconds and repeated for 3 times.7 Frictional
massage in parallel direction to fiber orientation for 5-10 minutes Day 14 40 28.5 4.8 17.3
‘frees up’ scar tissue within a trigger point, allowing muscle fibers
to move more normally, increasing blood flow through the tissue
and decreasing nerve sensitivity,8 followed by ice massage with ice
CLINICAL SIGNIFICANCE
Figure 1. Values of Range of Motion of Cervical Flexion and Extension, Pain on VAS and
NDIS at Day 0 (Pre Treatment) and Day 14 Day (After Treatment)
There was an increase in neck flexion and neck extension and de-
crease in NDIS and pain on VAS. Myofascial trigger point release
is effective in treating neck disability and increasing range of mo-
tion.
There is a need for further research with adequate sample size and
comparable with equal distribution may be taken off over suffi-
cient duration to arrive at quality and better results by taking more
variables and more conditions and within the same age group and
sex. The management of MTrPs is not restricted to MTrP inacti-
vation, but it requires correction of perpetuating factors that are
clinically apparent but not yet necessarily scientifically established.
CONFLICTS OF INTEREST
DISCUSSION REFERENCES
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