Short and Medium-term Effects of Manual Therapy on Latent Myofascial Pain

NCT ID: NCT01709357

Last Updated: 2012-10-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

117 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-09-30

Study Completion Date

2012-03-31

Brief Summary

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The purpose of this study was to investigate the short and medium-term effects of three manual techniques on cervical range of motion and pressure pain sensitivity in subjects with mechanical stress, presenting latent trigger point of upper trapezius muscle.

Detailed Description

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Myofascial pain syndrome is a common non-articular musculoskeletal chronic pain which has not been yet fully understood. It is characterized by myofascial trigger point. This trigger point is clinically classified as active or latent. Some studies have demonstrated the potential relevance of latent trigger point. In fact, its presence may cause muscle activation pattern alterations, increase nociceptive sensitivity and cause sympathetic activity alterations. Nevertheless, the vast majority of individuals, even asymptomatic, have latent trigger point. High prevalence of myofascial trigger points subsists at cervical and scapular regions.

There is few data regarding myofascial trigger point physiopathology. Furthermore, a diversity of therapeutic interventions consisting of trigger point inactivation and interruption of the vicious cycle is suggested in literature. Nevertheless, the effectiveness of these different interventions in trigger points and the duration of the effects are not yet fully clarified.

Conditions

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Latent Myofascial Trigger Point of Upper Trapezius Muscle

Keywords

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manual therapy trigger point range of motion pain threshold pain perception

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Muscle energy technique

In each volunteer, the therapist identified the latent trigger point on the upper trapezius. A questionnaire about general information was performed. And the maximum homolateral side flexion of the trigger point was measured.

On the following week, the blind assessor performed the pre-intervention measurements of pressure pain threshold, pressure pain perception and cervical range of motions.

Next, the therapist performed the muscle energy technique of the upper trapezius muscle.

Then, all measurements, before described, were repeated, by the assessor, after 10 minutes, 24 hours and one week.

Group Type EXPERIMENTAL

Muscle energy technique

Intervention Type OTHER

The therapist, with one hand on the occipital bone and the other on the shoulder, performed passive side flexion, contralateral to the muscle, taking the subject's head until the end-feel. Then, subjects performed an isometric contraction of 25% of their maximum force, for 5 seconds, while the therapist offered manual resistance. Afterwards the subject was let to relax in this position for additional 5 seconds. Side flexion was now increased until a new end-feel point was reached. This sequence was repeated 3 times. At the end, the therapist passively guided the cervical segment to the neutral position.

Ischemic compression technique

In each volunteer, the therapist identified the latent trigger point on the upper trapezius. A questionnaire about general information was performed. And the maximum homolateral side flexion of the trigger point was measured.

On the following week, the blind assessor performed the pre-intervention measurements of pressure pain threshold, pressure pain perception and cervical range of motions.

Next, the therapist performed ischemic compression technique on the latent trigger point.

Then, all measurements, before described, were repeated, by the assessor, after 10 minutes, 24 hours and one week.

Group Type EXPERIMENTAL

Ischemic compression technique

Intervention Type OTHER

The therapist, with a pincer contact, applied gradual pressure on the latent trigger point of the upper trapezius muscle. Subjects had been previously asked to say when pain was "moderate but bearable", a pain value of 7 in a 1 to 1o scale of pain (in which 1 corresponds to "no pain" and 10 do "unbearable pain"). At this point, pressure was maintained until pain levels were reduced to level 3. The therapist increased once more the pressure until the level of pain was 7 again. This procedure was repeated during 90 seconds.

Passive stretching technique

In each volunteer, the therapist identified the latent trigger point on the upper trapezius. A questionnaire about general information was performed. And the maximum homolateral side flexion of the trigger point was measured.

On the following week, the blind assessor performed the pre-intervention measurements of pressure pain threshold, pressure pain perception and cervical range of motions.

Next, the therapist performed the passive stretching of the upper trapezius muscle.

Then, all measurements, before described, were repeated, by the assessor, after 10 minutes, 24 hours and one week.

Group Type EXPERIMENTAL

Passive stretching technique

Intervention Type OTHER

The therapist, with one hand on the occipital bone and the other on the shoulder, performed a contralateral side flexion of the muscle passively until the maximum obtainable amplitude was reached, while subjects were asked to breathe steadily. During the breathing phase the therapist increased the side flexion until the end of the obtainable amplitude, this position was maintained. This procedure was repeated during 30 seconds. Finally the therapist passively guided the cervical segment to the neutral position.

Sham technique

In each volunteer, the therapist identified the latent trigger point on the upper trapezius. A questionnaire about general information was performed. And the maximum homolateral side flexion of the trigger point was measured.

On the following week, the blind assessor performed the pre-intervention measurements of pressure pain threshold, pressure pain perception and cervical range of motions.

Next, for the sham technique, the therapist only contacted with his hands the head and the shoulder of the subject, without executing any movement, for 30 seconds.

Then, all measurements, before described, were repeated, by the assessor, after 10 minutes, 24 hours and one week.

Group Type SHAM_COMPARATOR

Sham technique

Intervention Type OTHER

The therapist was seated at the head of the treatment table, and with one hand on the occipital bone and the other on the shoulder, without executing any movement, for 30 seconds.

No intervention group

In each volunteer, the therapist identified the latent trigger point on the upper trapezius. A questionnaire about general information was performed. And the maximum homolateral side flexion of the trigger point was measured.

On the following week, the blind assessor performed the pre-intervention measurements of pressure pain threshold, pressure pain perception and cervical range of motions.

Next,the subject was lying for 30 seconds, without intervention.

Then, all measurements, before described, were repeated, by the assessor, after 10 minutes, 24 hours and one week.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Muscle energy technique

The therapist, with one hand on the occipital bone and the other on the shoulder, performed passive side flexion, contralateral to the muscle, taking the subject's head until the end-feel. Then, subjects performed an isometric contraction of 25% of their maximum force, for 5 seconds, while the therapist offered manual resistance. Afterwards the subject was let to relax in this position for additional 5 seconds. Side flexion was now increased until a new end-feel point was reached. This sequence was repeated 3 times. At the end, the therapist passively guided the cervical segment to the neutral position.

Intervention Type OTHER

Passive stretching technique

The therapist, with one hand on the occipital bone and the other on the shoulder, performed a contralateral side flexion of the muscle passively until the maximum obtainable amplitude was reached, while subjects were asked to breathe steadily. During the breathing phase the therapist increased the side flexion until the end of the obtainable amplitude, this position was maintained. This procedure was repeated during 30 seconds. Finally the therapist passively guided the cervical segment to the neutral position.

Intervention Type OTHER

Ischemic compression technique

The therapist, with a pincer contact, applied gradual pressure on the latent trigger point of the upper trapezius muscle. Subjects had been previously asked to say when pain was "moderate but bearable", a pain value of 7 in a 1 to 1o scale of pain (in which 1 corresponds to "no pain" and 10 do "unbearable pain"). At this point, pressure was maintained until pain levels were reduced to level 3. The therapist increased once more the pressure until the level of pain was 7 again. This procedure was repeated during 90 seconds.

Intervention Type OTHER

Sham technique

The therapist was seated at the head of the treatment table, and with one hand on the occipital bone and the other on the shoulder, without executing any movement, for 30 seconds.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* volunteers with 18 or more years of age
* with a palpable latent trigger point in the fibbers of the upper trapezius muscle
* with an average time of computer work of at least 2h/day.

Exclusion Criteria

* with a body mass index (BMI) equal or higher than 31 kg/cm2
* with bilateral latent triggers in the fibers of the upper trapezius muscle
* have done any pharmacological therapeutic during any of the 7 days before the study or anti-coagulant therapeutics
* have done any treatment at cervical region during the month before the study
* having cardio-respiratory, neurological, neuro-musculoskeletal, oncologic or systemic pathologies
* having cognitive deficits or psychologic/psychiatric disturbances
* be pregnant
* having a clinical history of cervical, high dorsal, shoulder or cranial surgery or trauma during the prior 12 months.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Escola Superior de Tecnologia da Saúde do Porto

OTHER

Sponsor Role lead

Responsible Party

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Natália Maria Oliveira Campelo

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Natália MO Campelo

Role: PRINCIPAL_INVESTIGATOR

Escola Superior de Tecnologia da Saúde do Porto

Locations

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Escola Superior de Tecnologia da Saúde do Porto

Vila Nova de Gaia, Porto District, Portugal

Site Status

Countries

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Portugal

References

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Simons DG. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008 Jan;89(1):157-9. doi: 10.1016/j.apmr.2007.11.016.

Reference Type BACKGROUND
PMID: 18164347 (View on PubMed)

Fernandez-de-Las-Penas C, Simons D, Cuadrado ML, Pareja J. The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Curr Pain Headache Rep. 2007 Oct;11(5):365-72. doi: 10.1007/s11916-007-0219-z.

Reference Type BACKGROUND
PMID: 17894927 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 14759755 (View on PubMed)

Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep. 2011 Oct;15(5):386-92. doi: 10.1007/s11916-011-0210-6.

Reference Type BACKGROUND
PMID: 21559783 (View on PubMed)

Other Identifiers

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NC-001

Identifier Type: -

Identifier Source: org_study_id