Myofascial Release Therapy and Mechanical Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Mechanical neck pain is a musculoskeletal disorder usually associated with work absenteeism.
      Myofascial release therapy (MRT) is currently under development and has the treatment of
      mechanical neck pain as one of its main focal points. However, there is a paucity of studies
      reporting its effectiveness. For that purpose a randomized single-blind parallel group study
      was designed to compare the effectiveness of MRT with manual therapy (MT) for treating
      occupational mechanical neck pain. The sample (n=59) was randomly assigned to two therapeutic
      intervention programs. Group I patients were treated with MT and Group II patients were
      treated with MRT. Variables studied were intensity of neck pain, cervical disability, quality
      of life (QoL), craniovertebral angle and ranges of cervical motion.
    

Detailed description: 
      A variety of physiotherapy interventions have been used to treat mechanical neck pain (NP),
      but few of them have proven effective. The number of studies on the clinical effectiveness of
      MT techniques, such as myofascial release therapy (MRT), has seen a marked increase. MRT is a
      relatively new therapy with increasing acceptance and implementation in the daily clinical
      work of physiotherapists. However, there is a paucity of studies on biomechanical alterations
      associated with mechanical NP and its treatment with MRT, consequently, the clinical benefits
      of MRT remain unclear.

      The purpose of this study was to assess the clinical efficacy of MRT in occupational
      mechanical NP and to determine if MRT has advantages over another MT protocol not including
      MRT.

      An experimental parallel group study was designed. It was a single-blind (assessor)
      randomized controlled clinical trial. Patients from FREMAP - Mutual Insurance Company for
      Occupational Accidents and Diseases - participated in the study from January 2010 to December
      2010. A total of 71 patients were asked to participate in the initial screening, but 8 did
      not meet inclusion criteria, 2 declined to participate in the study for personal reasons, and
      2 could not participate for other reasons. 59 patients with NP were randomly distributed into
      two groups according to two therapeutic intervention programs. Group I (n=29; 18 females/11
      males; mean age: 38.24 ± 11.35 years-old) was treated with MT and Group II (n=30; 15
      females/15 males; mean age: 38.20 ± 10.70 years-old) was treated with MRT.

      The intervention for both groups consisted of analgesic treatment in accordance with the
      guidelines of the FREMAP Protocol for the treatment of mechanical NP. The analgesic part of
      this protocol includes superficial thermotherapy (infrared lamp) and transcutaneous
      electrical stimulation (TENS). Additionally, Group I was treated with MT and Group II with
      MRT. There were 10 treatment sessions distributed within 4 successive weeks with three
      sessions being applied the first and third weeks and two sessions being applied the second
      and fourth weeks.

      MT was provided by one physiotherapist, while MRT was performed by another physiotherapist,
      both from FREMAP. The sessions were held for nearly 50 minutes, until the completion of the
      intervention as determined by FREMAP.

      Analgesic therapy consisted of the application of superficial thermotherapy by an infrared
      lamp (Infra 2000, Enraf Nonius) and TENS (TENSMED 911, Enraf Nonius). The 250-watts infrared
      lamp was focused at a distance of 50 cm on the cervical area for 15 minutes. TENS application
      employed 80 Hz frequency, 150 µs pulse duration, with 50x50 mm electrodes (Gel-Trode, Enraf
      Nonius) placed on the painful or metamers areas for 20 minutes.

      The additional treatments were applied for both groups for 15 minutes. MT techniques
      included: (i) anterior-posterior and side-shift of the cervical spine; (ii) muscle energy
      technique involving side-bending of cervical spine; (iii) neuromuscular technique for
      restricted C1-C2 rotation; (iv) inhibitive occipital distraction; and (v) cervical
      stretching: post-isometric relaxation for the upper trapezius, scalene and
      sternocleidomastoid muscles.

      The MRT included: (i) cranial base release, adjusting the relation of the rectus capitis
      posterior muscles to the dura mater (Hack et al., 1995); (ii) gross release of the
      sternocleidomastoid muscle; (iii) release of the suprahyoid and infrahyoid muscles; and (iv)
      release of the retrohyoid fascia.
    

Intervention name(s): Manual Therapy; Myofascial Release Therapy; Analgesic therapy
Intervention type(s): Other; Other; Device
Intervention description(s): The manual therapy techniques included: (i) anterior-posterior and side-shift of the cervical spine; (ii) muscle energy technique involving side-bending of cervical spine; (iii) neuromuscular technique for restricted C1-C2 rotation; (iv) inhibitive occipital distraction; and (v) cervical stretching: post-isometric relaxation for the upper trapezius, scalene and sternocleidomastoid muscles.; The myofascial release therapy techniques included: (i) cranial base release, adjusting the relation of the rectus capitis posterior muscles to the dura mater; (ii) gross release of the sternocleidomastoid muscle; (iii) release of the suprahyoid and infrahyoid muscles; and (iv) release of the retrohyoid fascia.; Analgesic therapy consisted of superficial thermotherapy by an infrared lamp (Infra 2000, Enraf Nonius) and TENS (TENSMED 911, Enraf Nonius). The 250-watts infrared lamp was focused at a distance of 50 cm on the cervical area for 15 minutes. TENS employed 80 Hz frequency, 150 µs pulse duration, with 50x50 mm electrodes (Gel-Trode, Enraf Nonius) placed on the painful or metamers areas for 20 minutes.
Other intervention name(s): TENS + IRR
Intervention MeSH terms: Analgesics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neck Pain; Myofascial release; Manual therapy