Muscle Energy Technique on Hamstring Muscle for Trigger Points of Muscle of Mastication

NCT ID: NCT05971953

Last Updated: 2023-09-05

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 42 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-08-30
• Study Completion Date: 2024-04-28

Brief Summary

The aim of this randomized controlled trial is to find the effect of muscle energy technique for trigger points of muscle of mastication for reducing pain , improving mouth opening and jaw functional limitations.

Detailed Description

The primary muscles of mastication (chewing food) are the temporalis, medial pterygoid, lateral pterygoid, and masseter muscles. The masticatory muscles are divided into elevator and depressor groups. The collective term 'hamstrings' refers to four muscles- semimembranosus (SM), semitendinosus (ST), biceps femoris long head (BFlh) and biceps femoris short head (BFsh). The hamstring muscles are the major flexors of the knee and also aid hip extension. Trigger point is classically defined as a hyperirritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Latent trigger points located in the muscles can interfere with muscular movement patterns, cause cramps, and reduce muscle strength. Active MTrPs can be associated with a reduced range of motion through muscle dysfunction and muscle weakness, causing orefacial pain, MTrPs in the masticatory muscles may restrict active maximum mouth opening (MMO).

It is possible that stretching the hamstring muscles may activate the dorsal periaqueductal grey area of the midbrain [PAG], and activate descending inhibitory control pathways. It is known that descending projections from the PAG to the medulla have collateral branches that terminate in various areas including the upper cervical spinal cord. Convergence of the nociceptive afferents from the receptive fields of cervical roots C1-C3 and those of the trigeminal nerve, which include the masseter muscle, occurs in the nucleus caudalis. If hamstring muscle stretching is capable of activating the PAG, then decreased sensitivity should affect a greater number of muscles, including the remaining masticatory muscles.

Muscle energy technique (MET) is a manual technique developed by osteopaths that is now used in many different manual therapy professions. It is claimed to be effective for a variety of purposes, including lengthening a shortened or contractured muscle, strengthening muscles, as a lymphatic or venous pump to aid the drainage of fluid or blood, and increasing the range of motion (ROM) of a restricted joint. MET may influence pain mechanisms and promote hypoalgesia.

Conditions

Trigger Point Pain, Myofascial; Temporomandibular Disorder

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Muscle Energy Technique

Muscle Energy Technique

Group Type: ACTIVE_COMPARATOR

Muscle Energy Technique

Intervention Type: OTHER

They would be receiving treatment as follow:

The patient is instructed to gently attempt to push down on the practitioner's shoulder with the leg against the practitioner's resistance( 75% of his and her available strength). After the relaxation, the muscle is lengthened more aggressively beyond the barrier and held for up to 15 seconds. Frequency: 10 reps for 4 times/week for 2 consecutive weeks. Intensity: moderate intensity (pain free) Time: 20 mins

Conventional PT

Hot pack Ischemic compression

Group Type: OTHER

Conventional PT

Intervention Type: OTHER

They would be receiving conventional treatment as follow:

including hot pack for 10 mins ischemic compression for 60 seconds .Frequency: 5 reps with 60 sec hold for 4 times/week for 2 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 10 mins

Interventions

Muscle Energy Technique

They would be receiving treatment as follow:

The patient is instructed to gently attempt to push down on the practitioner's shoulder with the leg against the practitioner's resistance( 75% of his and her available strength). After the relaxation, the muscle is lengthened more aggressively beyond the barrier and held for up to 15 seconds. Frequency: 10 reps for 4 times/week for 2 consecutive weeks. Intensity: moderate intensity (pain free) Time: 20 mins

Intervention Type: OTHER

Conventional PT

They would be receiving conventional treatment as follow:

including hot pack for 10 mins ischemic compression for 60 seconds .Frequency: 5 reps with 60 sec hold for 4 times/week for 2 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 10 mins

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Age group 25 to 50 years..

2. Diagnosis of trps using the diagnostic criteria:

• Presence of palpable taut band in a skeletal muscle.
• Presence of hypersensitive tendor spot in a taut band
• Spontaneous response of the typical referred pain pattern.
• A local twitch response provided by snapping palpation of taut band.
• Reproduction of the typical referred pain pattern of Trp in response to compression.

3. Reduced mouth opening < 40nm

Exclusion Criteria

• Diagnosis of fibromyalgia.
• History of whiplash injury
• History of any surgery in the cranio cervical region
• Having under gone any myofacial pain therapy
• No lower extremity or low back pathology.

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

KINZA ANWAR, MS-OMPT

Role: PRINCIPAL_INVESTIGATOR

RIPHAH INTERNATIONAL UNIVERSITY,ISLAMABAD,PAKISTAN

Locations

Railway General Hospital

Rawalpindi, Punjab Province, Pakistan

Site Status: RECRUITING

Countries

Pakistan

Central Contacts

KINZA ANWAR, MS-OMPT

Role: CONTACT

kinza.anwar@riphah.edu.pk

+92-3239735427

Facility Contacts

KINZA ANWAR, MS-OMPT

Role: primary

kinza.anwar@riphah.edu.pk

+92-3239735427

Naureena Binte Sayed, MS-OMPT*

Role: backup

Other Identifiers

REC/01649Naureena Binte Sayed

Identifier Type: -

Identifier Source: org_study_id