Muscle Energy Techniques and Trigger Point Therapy in Asymptomatic Persons With Latent Trigger Point
Condition: Asymptomatic Condition
MeSH terms: Disease; Asymptomatic Diseases
Study type: Interventional

Summary: 
      The main objective of this study is to evaluate the effectiveness of therapy which will be a
      combination of Muscle Energy Technique (MET) and Trigger Point Therapy (TPT), performed
      bilaterally on the upper trapezius muscle in the group of asymptomatic persons with latent
      trigger point. The study will show whether one-time therapy has an impact on: mobility of the
      cervical spine, biophysical parameters (muscle tone, stiffness and elasticity) of soft
      tissues and pressure pain threshold of upper trapezius muscle. An additional goal will be to
      compare the effectiveness of the three treatments used: combination of MET with TPT, single
      MET and single TPT.

      Research hypotheses:

        -  The combination of MET with TPT will increase the angular ranges of basic cervical spine
           movements immediately after the therapy and these effects will persist the second day
           after the intervention.

        -  The combination of MET with TPT will increase the elasticity and reduce muscle tone and
           stiffness in the area of the upper trapezius immediately after the therapy, and these
           effects will persist the second day after the intervention.

        -  The combination of MET with TPT will increase the pressure pain threshold of upper
           trapezius muscle immediately after the therapy, and this effect will persist the second
           day after the intervention.

        -  The combination of MET with TPT will be more effective than single MET and single TPT
           methods.

      Muscle Energy Techniques (MET) can be defined as a group of soft tissue manipulation methods.
      They are a multi-task techniques that can be performed to improve the function of the
      musculoskeletal system and reduce pain. METs are used by clinicians who treat various
      myofascial and joint dysfunctions as well as a form of prevention and protection of the
      musculoskeletal system.

      Trigger point therapy (TPT) uses manual techniques such as ischemic compression (IC),
      positional release (PR), dry needling and soft tissue manipulations [TP1]. Their main purpose
      is to reduce or eliminate the symptoms generated by myofascial trigger points (TrPs), which
      are defined as severely irritated areas within the hypertonic muscle fiber band or the fascia
      itself. Latent TrPs are described as those that do not generate symptoms on their own.
      However, they can cause refered pain at the time of provocation, i.e. pressure at the place
      of their occurrence.

      In the scientific literature there are no reports on the assessment of the combination of MET
      with TPT
    

Detailed description: 
      The randomized study will focus on assessing the effectiveness of 3 different
      physiotherapeutic interventions. The physiotherapist with 10 years of professional experience
      will be responsible for performing all diagnostic procedures and therapeutic interventions.

      Diagnosis of latent trigger point will be performed on subjects in the supine position. The
      therapist using a pincer grip will perform palpation in the area of the entire upper
      trapezius muscle. Testing for the presence of trigger point can be considered positive when
      it is noted: 1) the presence of a detectable strained band in the muscle, 2) the presence of
      an excessively sensitive area in the strained muscle band, 3) the response of local vibration
      caused by compression of the strained band, 4) occurrence of characteristic transferred
      symptoms (pain radiating to the posterior-lateral side of the neck, and/or mastoid process of
      the temporal bone, and/or the temporal bone area, and/or the angle of the jaw) as a result of
      compression of the hypersensitive muscle band. The test will be performed on both sides of
      this muscle.

      The following measurement methods are planned to be used:

        1. Electrogoniometry of the cervical spine. A Penny & Giles strain tensometric
           electrogoniometer will be used. Using this device, the angular values of cervical spine
           movements will be examined. The SG150 two-plane sensor and the Q110 single-plane sensor
           will be used. The lower edge of the upper sensor will be attached around the occipital
           tuberosity, while the upper edge of the lower sensor on the C7 spinous process. The
           examined person will be in a sitting position. Double-sided tape from Biometrics will be
           used to stick the electrogoniometer sensors. For the measurements of each movement, the
           subject will perform 3 repetitions. Then the mean value will be calculated, which will
           be the result.

        2. Myotonometry. In order to examine the biophysical parameters of soft tissues a MyotonPRO
           will be used.

           Measurements will be made on the upper part of the trapezius muscle at the point located
           in the middle of the segment between the C7 spinous process and the shoulder angle of
           the acromion. During measurements, the subject will be lying down.

        3. Pressure pain threshold (PPT). The Wagner Instruments Algometer will be used to assess
           the subjective parameter - pressure pain threshold of first discomfort. The place of
           measurement will be the point located on the upper trapezius muscle in the middle of the
           segment between the C7 spinous process and the shoulder angle of the acromion. The
           subject will be lying down on his back. Pressure from the algometer sensor will be
           applied from above and perpendicular to the examined muscle. Three measurements will be
           taken alternately for both sides of the upper trapezius. The mean value will be
           calculated, which will be the results for the right and left sides of the examined
           muscle.

      The order of measurements will be: 1) myotometry, 2) pressure pain threshold test, 3)
      cervical spine electrogoniometry.

      Participation in the study will be voluntary, free and fully anonymous. The participant will
      be able to opt out of the study at any stage. All planned therapeutic and measurement methods
      are non-invasive and safe. They do not threaten the health and life of the respondents.
    

Intervention name(s): Muscle Energy Technique (MET); Trigger Point Therapy (TPT); Muscle Energy Technique (MET) combined with Trigger Point Therapy (TPT)
Intervention type(s): Other; Other; Other
Intervention description(s): The Contract-Relax Agonist-Contract (CRAC) technique will be used, which belongs to the broad MET group. The participant will be in the supine position. The therapist will set the cervical segment in the lateral flexion until a slight soft tissue tension is felt. The technique will consist of two stages. In the first phase (contraction phase), the upper trapezius will be activated against the therapist's resistance (shoulder girdle elevation) - 10 seconds. Then the person undergoing the procedure breathes in and out deeply. Then 10 seconds of antagonist group contraction (shoulder girdle depression) will be performed. Next, the therapist will passively move the participant's shoulder girdle towards the depression. Then the second phase will follow (stretching phase), during which the participant will passively lie in the back position for 30 seconds. Both phases will make up the therapeutic cycle. Each participant will have 5 cycles on each side of the upper trapezius.; The technique of Positional Release (PR) will be used, which is one of the broadly understood Trigger Point Therapy. It will consist in compressing the trigger point with a simultaneous shortening of muscle attachments (slight lateral flexion towards the relaxed muscle). The muscle on both sides will be treated. The pressure exerted by the therapist's pincer grip will be acceptable to the patient. The duration of the technique will be 2 minutes for each muscle. While performing this technique, the participant will passively lie on his back.; For this type of intervention, TPT will first be performed on both sides of the upper trapezius muscle, followed by MET, which will also be performed bilaterally. The detailed method of performing the applied therapeutic techniques for the combined procedure will be identical as in the case of isolated (single) methods.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The first stage will involve recruitment. 60 people will be gathered based on the qualifying and disqualifying criteria. This group of participants will be randomized. Each participant will draw a number that will determine the assignment to a specific group (MET plus TPT group, single MET or single TPT group). Preliminary measurements will be collected before the intervention. Each participant will have a specific intervention depending on which research group they belong to. The therapist will be responsible for performing the given therapeutic technique. Immediately after the intervention and on the second day, data will be collected by the researcher. The person conducting the function of coordinator will supervise the proper conduct of the scientific research. The collected data will be analyzed by the outcomes assessor.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: muscle energy techniques; trigger point therapy; range of motion; soft tissue properties; pressure pain threshold; combination of therapeutic methods