Muscle Energy Technique Versus Strain Counterstrain for Upper Trapezius Myofascial Pain Syndrome

Muscle Energy Technique Versus Strain Counterstrain in Treatment of Upper Trapezius Myofascial Pain Syndrome: A Double-Blinded Randomized Controlled Trial

This study will be conducted to examine the superiority of effectiveness between muscle energy technique combined with physical therapy, strain counterstrain combined with physical therapy, and physical therapy alone in terms of pain intensity, pain pressure threshold, cervical lateral flexion and rotation range of motion, and neck function for patients with upper trapezius myofascial trigger points.

Study Overview

• Status: Recruiting
• Conditions: Physical Therapy
• Intervention / Treatment: Procedure: Muscle energy technique combined with the physical therapy program.; Procedure: Strain counterstrain technique combined with the physical therapy program; Procedure: The physical therapy program

Detailed Description

Myofascial pain syndrome represents a common, overlooked, and under-diagnosed disorder that have very critical negative effects on people's lives. In addition, it overloads the societies and causes several burdens on healthcare systems. However, this disorder is usually dismissed by many clinicians keeping the patients in pain for long periods. The central feature of myofascial pain syndrome is the myofascial trigger points that when managed properly, the painful symptoms disappear. Muscle energy technique and strain counterstrain immediate effects were compared in a recent comparative study for patients with upper trapezius myofascial trigger points in terms of pain intensity, pain pressure threshold, and neck mobility. The results showed that there were improvements of both techniques with no significant differences between them. Regarding the evidence of the two techniques; muscle energy technique and strain counterstrain in the management of patients with upper trapezius myofascial trigger points, there is lack of high-quality evidence investigating the effectiveness and safety of both techniques for this population and there is a need for well-developed randomized controlled trial to take a step in the pyramid of levels of evidence for the use and applicability of them. After reviewing the available literature, it was found that there is no study directly combined both techniques with physical therapy protocol in a randomized clinical trial for patients with upper trapezius myofascial trigger points; this will enable us to compare the effects of them in a controlled design to examine and find out the differences between the three treatment protocols.

• Study Type: Interventional
• Enrollment (Estimated): 54
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Haytham Morsi, M.Sc.; Phone Number: +201013657738; Email: 10722019485962@pg.cu.edu.eg

Study Locations

• Egypt
  • Kafr Ash Shaykh, Egypt
    • Recruiting
    • The Outpatient Clinics, Faculty of Physical Therapy Kafrelsheikh University
    • Contact: Ibrahim Morsi, PhD; Phone Number: 01554552868

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

Patients will be included in the study if they fulfil the following criteria:

1. They have active myofascial trigger points in the upper trapezius muscle bilaterally according to the established criteria for myofascial trigger points examination.
2. They have neck pain less than three months.
3. Their age ranges from 18 to 40 years old. Exclusion Criteria

Patients will be excluded from the study if they fulfil the following criteria:

1. Patients with chronic pain syndrome.
2. Patients having myofascial trigger points in other neck muscles.
3. Patients having a history of an injury or surgery or instability or deformity including both; cervical spine and shoulder.
4. Patients diagnosed with a neurological disorder including altered sensation, migraine, cervical spondylosis, radiculopathy, or myelopathy, and tumour.
5. Patients with a systemic disease including rheumatoid arthritis, Reiter's syndrome, diabetes, fibromyalgia syndrome, and severe medical or psychiatric disorders.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A; Experimental group 1.	Procedure: Muscle energy technique combined with the physical therapy program.; A manual therapy technique
Experimental: Group B; Experimental group 2.	Procedure: Strain counterstrain technique combined with the physical therapy program; A manual therapy technique
Experimental: Group C; Experimental group 3.	Procedure: The physical therapy program; Electrotherapy and exercise.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in pain intensity.	Measurement of pain intensity using the visual analogue scale.	Change from Baseline pain intensity at one month.
Change in the right side pain pressure threshold.	Measurement of right side pain pressure threshold using the pressure algometer.	Change from Baseline right side pain pressure threshold at one month.
Change in the left side pain pressure threshold.	Measurement of left side pain pressure threshold using the pressure algometer.	Change from Baseline left side pain pressure threshold at one month.
Change in cervical flexion range of motion.	Measurement of cervical flexion range of motion using the cervical range of motion device.	Change from Baseline cervical flexion range of motion at one month.
Change in cervical extension range of motion.	Measurement of cervical extension range of motion using the cervical range of motion device.	Change from Baseline cervical extension range of motion at one month.
Change in cervical right lateral flexion range of motion.	Measurement of cervical right lateral flexion range of motion using the cervical range of motion device.	Change from Baseline cervical right lateral flexion range of motion at one month.
Change in cervical left lateral flexion range of motion.	Measurement of cervical left lateral flexion range of motion using the cervical range of motion device.	Change from Baseline cervical left lateral flexion range of motion at one month.
Change in cervical right rotation range of motion.	Measurement of cervical right rotation range of motion using the cervical range of motion device.	Change from Baseline cervical right rotation range of motion at one month.
Change in cervical left rotation range of motion.	Measurement of cervical left rotation range of motion using the cervical range of motion device.	Change from Baseline cervical left rotation range of motion at one month.
Change in neck function.	Measurement of neck function using the neck disability index-Arabic version.	Change from Baseline neck function at one month.

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Bassem El Nahass, PhD, Professor of Orthopaedic Physical Therapy, Faculty of Physical Therapy, Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): May 7, 2023
• Primary Completion (Estimated): May 7, 2024
• Study Completion (Estimated): December 31, 2024

Study Registration Dates

• First Submitted: June 21, 2023
• First Submitted That Met QC Criteria: June 21, 2023
• First Posted (Actual): June 29, 2023

Study Record Updates

• Last Update Posted (Actual): June 29, 2023
• Last Update Submitted That Met QC Criteria: June 21, 2023
• Last Verified: June 1, 2023

More Information

Terms related to this study

• Keywords: Muscle energy technique, strain counterstrain, trapezius.
• Additional Relevant MeSH Terms: Nervous System Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Muscular Diseases; Neuromuscular Diseases; Fibromyalgia; Myofascial Pain Syndromes
• Other Study ID Numbers: P.T. 2023-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No