Influence of adding strain-counterstrain to standard therapy on axioscapular muscles amplitude and fatigue in mechanical neck pain: a single-blind, randomized trial

Yasmin S El-Khateeb, Amira G Mahmoud, Mai H Mohamed, Alshaymaa S Abd El-Azeim, Yasmin S El-Khateeb, Amira G Mahmoud, Mai H Mohamed, Alshaymaa S Abd El-Azeim

Abstract

Background: Strain-counterstrain technique (SCS) or positional release therapy is strongly recommended for patients with mechanical neck pain (MNP) because this method has excellent benefits, but the clinical significance of this method is unclear.

Aim: The aim of this study was to investigate the influence of adding the SCS technique to standard therapy on pain, pressure pain threshold, disability according to Neck Disability Index (NDI), and electrophysiological characteristics (amplitude and fatigue) of the upper part of trapezius in the axioscapular muscles of patients with mechanical neck pain.

Design: Single-blind, randomized clinical trial.

Setting: Outpatient clinic.

Population: Sixty patients (19-38 years old) with mechanical neck pain participated in this study and were recruited from the outpatient clinic at the faculty of physical therapy after a referral from an orthopedist.

Methods: Patients were randomly assigned by opaque sealed envelope to two treatment groups: group A received SCS, standard therapy in form of active range of motion, stretching exercises, and postural correction exercises (PCES), whereas group B, received standard therapy only; therapeutic sessions were performed three times/week for 4 weeks. The visual analogue scale, pressure pain threshold, NDI, upper trapezius median frequency, and root mean square were used to evaluate the patients' pretreatment and post-treatment status.

Results: Multiple pairwise comparisons within each group revealed statistically significant differences in all outcome variables with favor to the SCS group.

Conclusions: The Strain-counterstrain technique combined with traditional standard therapy is an effective method more than traditional standard therapy alone for the management of patients with MNP.

Clinical rehabilitation impact: The present study has implications, especially for clinical decision-making about therapy of choice in MNP to reduce pain, improve function as measured through SCS technique and its impact on normal lifestyle, and to highlight the need for active intervention.

Conflict of interest statement

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—Assessment of pressure pain threshold.
Figure 2
Figure 2
—Assessment of maximum voluntary isometric contraction.
Figure 3
Figure 3
—Strain-counterstrain position.
Figure 4
Figure 4
—Flow chart.

References

    1. Falla D, O’Leary S, Farina D, Jull G. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. Clin J Pain 2012;28:628–34. 10.1097/AJP.0b013e31823e9378
    1. Cagnie B, Danneels L, Van Tiggelen D, De Loose V, Cambier D. Individual and work related risk factors for neck pain among office workers: a cross sectional study. Eur Spine J 2007;16:679–86. 10.1007/s00586-006-0269-7
    1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J 2006;15:834–48. 10.1007/s00586-004-0864-4
    1. Heintz MM, Hegedus EJ. Multimodal management of mechanical neck pain using a treatment based classification system. J Manual Manip Ther 2008;16:217–24. 10.1179/106698108790818260
    1. Hush JM, Maher CG, Refshauge KM. Risk factors for neck pain in office workers: a prospective study. BMC Musculoskelet Disord 2006;7:81. 10.1186/1471-2474-7-81
    1. Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskeletal Rehabil 2017;30:1149–69. 10.3233/BMR-169615
    1. Lluch E, Nijs J, De Kooning M, Van Dyck D, Vanderstraeten R, Struyf F, et al. Prevalence, Incidence, Localization, and Pathophysiology of Myofascial Trigger Points in Patients With Spinal Pain: A Systematic Literature Review. J Manipulative Physiol Ther 2015;38:587–600. 10.1016/j.jmpt.2015.08.004
    1. Okhovatian F, Mehdikhani R, Naimi SS. Comparison between the immediate effect of manual pressure release and strain/counter strain techniques on latent trigger point of upper trapezius muscle. Clin Chiropr 2012;15:55–61. 10.1016/j.clch.2012.04.003
    1. Kumar S, Prasad N. Cervical EMG profile differences between patients of neck pain and control. Disabil Rehabil 2010;32:2078–87. 10.3109/09638288.2010.481029
    1. Zakharova-Luneva E, Jull G, Johnston V, O’Leary S. Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction. J Manipulative Physiol Ther 2012;35:346–53. 10.1016/j.jmpt.2012.04.011
    1. Falla D, Jull G, Hodges PW. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res 2004;157:43–8. 10.1007/s00221-003-1814-9
    1. Enwemeka CS, Bonet IM, Ingle JA, Prudhithumrong S, Ogbahon FE, Gbenedio NA. Postural correction in persons with neck pain (I. A survey of neck positions recommended by physical therapists). J Orthop Sports Phys Ther 1986;8:235–9. 10.2519/jospt.1986.8.5.235
    1. Bernetti A, Agostini F, de Sire A, Mangone M, Tognolo L, Di Cesare A, et al. Neuropathic Pain and Rehabilitation: A Systematic Review of International Guidelines. Diagnostics (Basel) 2021;11:74. 10.3390/diagnostics11010074
    1. Hong CZ. Treatment of myofascial pain syndrome. Curr Pain Headache Rep 2006;10:345–9. 10.1007/s11916-006-0058-3
    1. McLean L. The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region. J Electromyogr Kinesiol 2005;15:527–35. 10.1016/j.jelekin.2005.06.003
    1. Johnson SM, Kurtz ME. Osteopathic manipulative treatment techniques preferred by contemporary osteopathic physicians. J Am Osteopath Assoc 2003;103:219–24.
    1. Dardzinski JA, Ostrov BE, Hamann LS. Myofascial pain unresponsive to standard treatment: successful use of a strain and counterstrain technique with physical therapy. J Clin Rheumatol 2000;6:169–74. 10.1097/00124743-200008000-00001
    1. Wong CK, Schauer-Alvarez C. Effect of strain/counterstrain on pain and strength in hip musculature. J Manual Manip Ther 2004;12:215–23. 10.1179/106698104790825185
    1. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332. 10.1136/bmj.c332
    1. Gary FB, Hodgson L. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. J Bodyw Mov Ther 2005;9:248–55. 10.1016/j.jbmt.2005.02.002
    1. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008;31:165–9. 10.1097/MRR.0b013e3282fc0f93
    1. Walton DM, Levesque L, Payne M, Schick J. Clinical pressure pain threshold testing in neck pain: comparing protocols, responsiveness, and association with psychological variables. Phys Ther 2014;94:827–37. 10.2522/ptj.20130369
    1. Graven-Nielsen T, Vaegter HB, Finocchietti S, Handberg G, Arendt-Nielsen L. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: a reliability study. Pain 2015;156:2193–202. 10.1097/j.pain.0000000000000294
    1. Fischer AA. Algometry in Diagnosis of Musculoskeletal Pain and Evaluation of Treatment Outcome: an Update. J Musculoskeletal Pain 1998;6:5–32. 10.1300/J094v06n01_02
    1. Shaheen AA, Omar MT, Vernon H. Cross-cultural adaptation, reliability, and validity of the Arabic version of neck disability index in patients with neck pain. Spine 2013;38:E609–15. 10.1097/BRS.0b013e31828b2d09
    1. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther 2009;39:400–17. 10.2519/jospt.2009.2930
    1. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991;14:409–15.
    1. Szeto GP, Straker LM, O’Sullivan PB. Examining the low, high and range measures of muscle activity amplitudes in symptomatic and asymptomatic computer users performing typing and mousing tasks. Eur J Appl Physiol 2009;106:243–51. 10.1007/s00421-009-1019-4
    1. Nicoletti C, Spengler CM, Läubli T. Physical workload, trapezius muscle activity, and neck pain in nurses’ night and day shifts: a physiological evaluation. Appl Ergon 2014;45:741–6. 10.1016/j.apergo.2013.09.016
    1. Meseguer AA, Fernández-de-las-Peñas C. Navarro- Poza JL, Rodríguez -Blanco C, Boscá Gandia JJ. Immediate effects of the strain/counter strain technique in local pain evoked by tender points in the upper trapezius muscle. Clin Chiropr 2006;9:112–8. 10.1016/j.clch.2006.06.003
    1. Pearson ND, Walmsley RP. Trial into the effects of repeated neck retractions in normal subjects. Spine 1995;20:1245–50, discussion 1251. 10.1097/00007632-199506000-00006
    1. Salo P, Ylönen-Käyrä N, Häkkinen A, Kautiainen H, Mälkiä E, Ylinen J. Effects of long-term home-based exercise on health-related quality of life in patients with chronic neck pain: a randomized study with a 1-year follow-up. Disabil Rehabil 2012;34:1971–7. 10.3109/09638288.2012.665128
    1. Kumar GY, Sneha P, Sivajyothi N. Effectiveness of Muscle energy technique, Ischaemic compression and Strain counterstrain on Upper Trapezius Trigger Points: A comparative study. Int J Phys Edu Sports Health. 2015;1:22–6.
    1. Prashant PN, Anand H, Subhash MK. Comparison of muscle energy technique and positional release therapy in acute low back pain. Indian J Physiother Occup Ther 2010;4:32–6.
    1. Albert AM, Jose LN. Immediate effects of the strain counterstrain in local pain evoked by tender points in upper trapezius muscle. Clin Chiroprac 2006:9:112-8. 10.1016/j.clch.2006.06.003
    1. Chaitow L. Muscle energy. Edinburgh, UK: Churchill Livingstone; 2001.
    1. Lambert M, Hitchcock R, Lavallee K, Hayford E, Morazzini R, Wallace A, et al. The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review. Phys Ther Rev 2017;22:76–85. 10.1080/10833196.2017.1304184
    1. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc 2016;60:200–11.
    1. D’Ambrogio KJ, Roth GB. Positional Release Therapy. St Louis, MO: Mosby; 1997.
    1. Lewis H, Flynn SE. Randomized controlled trial of physiotherapy compared with advice for low back pain. BMJ 2001;329:708–11.
    1. Markovic G. Acute effects of instrument assisted soft tissue mobilization vs. foam rolling on knee and hip range of motion in soccer players. J Bodyw Mov Ther 2015;19:690–6. 10.1016/j.jbmt.2015.04.010
    1. Weiselfish S. Manual Therapy for the Orthopedic and Neurologic Patient Emphasizing Strain and Counterstrain Technique. Hartford, CT: Regional Physical Therapy (self-published); 1993.
    1. Bailey M, Dick L. Nociceptive considerations in treating with counterstrain. J Am Osteopath Assoc 1992;92:334–41, 337–41. 10.1515/jom-1992-920314
    1. Wilson E, Payton O, Donegan-Shoaf L, Dec K. Muscle energy technique in patients with acute low back pain: a pilot clinical trial. J Orthop Sports Phys Ther 2003;33:502–12. 10.2519/jospt.2003.33.9.502
    1. Korr IM. Proprioceptors and somatic dysfunction. J Am Osteopath Assoc 1975;74:638–50.
    1. Jones LH. Strain-counterstrain. Indianapolis, IN: Jones Strain-Counterstrain Inc; 1995.
    1. Morningstar M. Cervical curve restoration and forward head posture reduction for the treatment of mechanical thoracic pain using the pettibon corrective and rehabilitative procedures. J Chiropr Med 2002;1:113–5. 10.1016/S0899-3467(07)60013-5
    1. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ 2017;358:j3221. 10.1136/bmj.j3221
    1. Abdulwahab SS, Sabbahi M. Neck retractions, cervical root decompression, and radicular pain. J Orthop Sports Phys Ther 2000;30:4–9, discussion 10–2. 10.2519/jospt.2000.30.1.4
    1. Simons DG. Clinical and etiological update of myofascial pain from trigger points. J Musculoskeletal Pain 2004;4:93–121. 10.1300/J094v04n01_07
    1. Huguenin LK. Myofascial trigger points: the current evidence. Phys Ther Sport 2004;5:2–12. 10.1016/j.ptsp.2003.11.002

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