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

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

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.

Study Overview

• Status: Recruiting
• Conditions: Temporomandibular Disorder; Trigger Point Pain, Myofascial
• Intervention / Treatment: Other: Muscle Energy Technique; Other: Conventional PT

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.

• Study Type: Interventional
• Enrollment (Estimated): 42
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab
    • Rawalpindi, Punjab, Pakistan
      • Recruiting
      • Railway General Hospital
      • Contact: KINZA ANWAR, MS-OMPT; Phone Number: +92-3239735427; Email: kinza.anwar@riphah.edu.pk
      • Contact: Naureena Binte Sayed, MS-OMPT*
      • Sub-Investigator: Naureena Binte Sayed, MS-OMPT*

Participation Criteria

Eligibility Criteria

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

Description

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.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Muscle Energy Technique	Other: 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
Other: Conventional PT; Hot pack Ischemic compression	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

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analog Scale VAS	The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable. A patient marks a point on the line that matches the amount of pain he or she feels.	2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Inch Tape	A measuring tape is a flexible tool used for measuring. It is marked in centimeters and inches.	2 weeks
Jaw Functional Limitation Scale	The JFLS-20 is an organ-specific instrument comprising 3 constructs for assessing functional status of the masticatory system; the 3 scales exhibit properties that are ideal for both research and patient evaluation in patient groups with a range of functional limitations of the jaw.	2 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: KINZA ANWAR, MS-OMPT, RIPHAH INTERNATIONAL UNIVERSITY,ISLAMABAD,PAKISTAN

Study record dates

Study Major Dates

• Study Start (Actual): August 30, 2023
• Primary Completion (Estimated): March 10, 2024
• Study Completion (Estimated): April 28, 2024

Study Registration Dates

• First Submitted: July 25, 2023
• First Submitted That Met QC Criteria: July 25, 2023
• First Posted (Actual): August 2, 2023

Study Record Updates

• Last Update Posted (Actual): September 5, 2023
• Last Update Submitted That Met QC Criteria: August 31, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: trigger points; hamstring; muscles of mastication
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Muscular Diseases; Stomatognathic Diseases; Jaw Diseases; Craniomandibular Disorders; Mandibular Diseases; Myofascial Pain Syndromes; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
• Other Study ID Numbers: REC/01649Naureena Binte Sayed

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