The Comparison of PIR and GT in Mechanical Neck Pain
Condition: Mechanical Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      The aim of this research is to compare the effects of post isometric relaxation and graston
      technique in mechanical neck pain. Post isometric relaxation and graston effects on pain ,
      cervical range of motion and function. A randomized controlled trial was done at Max health
      hospital G-8 markaz Islamabad . The sample size was 20. The Participants were divided into
      two groups,10 participants in group A (post iso metric relaxation) and 10 in group B (Graston
      technique ) . The study duration was 6 months. Sampling technique applied was purposive
      sampling technique Randomized through sealed enveloped method . Only 18 to 50 years
      participants with mechanical neck pain were included in the study . Outcome measure Tools
      used in this study were Numerical pain rating scale (NPRS) ,inclinometer for cervical ROM,
      Algometer for pain pressure threshold and Neck disability index for assessing functional
      disability . Data analyzed through SPSS version 20.
    

Detailed description: 
      Among all Musculoskeletal disorders occuring in general population ,the neck pain is one of
      the most common disorder. It's prevalence ranges from 14.2% to 71% in the general population
      and more prevalent in adult women With the adult age of 15-74 years it's mean point
      prevalence becomes 7.6%. The child's et al concluded that the life time prevalence of neck
      pain is 22-70% Among computer workers it has been observed higher incidence , the studies
      predicted one year incidence of neck pain from 10.4% to 21.3%. Neck pain is defined as "the
      pain anywhere within the region bounded superiorly by superior nuchal line, inferiorly by an
      imaginary line through the tip of first thoracic spinous process and laterally by sagittal
      plane tangential to the lateral borders of the neck"..

      Postural and mechanical based symptoms occurs in Mechanical neck pain that are under the
      influence of many factors that's why difficult to understand.The evidence of studies suggests
      prolonged adapted posture and repetitive movements falls under the category of biomechanical
      factors that introduce neck pain whereas according to psychosocial stress associated with
      neck pain , in which over activity of trapezius muscle motor units monitored , due to
      increased mental and physical demand of work . That Results in Muscle spasm and pain ,
      majorly caused by long time exposure to these stressors which can lead to functional
      disability , reduces activity level , anxiety , depression overall influence the quality of
      life of individual.

      Evidence supported by studies that , in subjects with mechanical neck pain may have trigger
      points in cervical muscles that include upper trapezius , levator scapulae and
      sternocleidomastoid muscles . When palpated elicited referred pain pattern , so responsible
      for major provoked symptoms of Mechanical neck pain. In the cervical region the upper
      trapezius , levator scapulae , scalene and sternocleidomastoid muscles are tend to be more
      tight and painful thus their lengthening is more prioritized. Along with the upper trapezius
      is considered as the most commonly involved muscle. The trigger points are defined as the
      taut bands of skeletal muscle tissues in hypersensitive areas that generates pain on
      palpation and shows tenderness on touch. In individual with Mechanical neck pain , the pain
      processes may involve muscular trigger points. According to shah et al it has been shown that
      Mechanical Neck Pain is associated with sensitization mechanisms, the algogenic substances
      and chemical mediators (potassium , serotonin, bradykinin ,histamine , prostaglandins and
      leukotrienes) that involved in tissue damage can also lead to peripheral transduction are
      present in higher level in active trigger points than latent trigger points.

      Literature Review :A Systemic review or Meta-analysis in 2017 by including 7 studies after
      screening 1169 articles to determine the impact of manual therapy and exercise therapy as
      combined treatment or delivered alone for the treatment of neck pain patients. They concluded
      that combined treatment were no more effective for improving outcomes.

      In 2018 done a metaanalysis conducted to determine the effects of thoracic manipulation on
      pain and disability in patients of chronic mechanical neck pain . The results describes that
      thrust manipulation was highly effective than non thrust manipulation for reducing pain and
      disability associated with mechanical neck pain patients In 2019 a systemic review of 47
      randomized controlled trails studies conducted about treatment of chronic non specific neck
      pain majorly focused on efficacy , effectiveness and safety of manipulation , mobilization
      and multi-modal approaches.They also predicted that multi-modal approach may have more impact
      in decreasing pain and increasing function in patients with non specific neck pain.

      The study Results suggested that Adding Post isometric relaxation technique to the
      conventional physical therapy treatment program of chronic Mechanical Neck Pain was more
      effective in reducing pain and functional disability and increasing cervical ROM than the
      traditional treatment program alone.

      A study in 2016 suggested that for Muscle energy technique reduces the pain and functional
      disability higher than stretching technique.

      A study suggested that for reducing pain and increasing Range of motion Muscle energy
      technique was better than static stretching in treating patients with mechanical neck pain.

      According to an Randomized controlled trail study that compared the efficacy of spinal
      manipulative therapy and Graston technique for the treatment of non specific thoracic
      pain.There is no significant difference in outcome at any point for pain or disability when
      comparing Spinal manipulative Therapy , Graston Technique.

      According to an RCT , the Post Isometric Relaxation was highly beneficial for improving
      cervical ROM and reducing pain , associated disability in non specific neck pain patients
      then isometric exercises.

      According to comparative study in 2017, results suggested increase in neck mobility and
      reduction in pain , but concluded that Muscle energy technique was more beneficial than
      positional release technique in patient's with non-specific neck pain.

      In 2016 According to a study in patients with chronic mechanical neck pain .The outcome
      measure tools was Visual Analogue Scale for pain intensity , universal goniometer used to
      measure rotation and lateral flexion of neck muscles while function was determined by Neck
      Disability Index scale. Results showed improvement in both Proprioceptive Neuromuscular
      facilitation and Muscle Energy Technique .
    

Intervention name(s): Graston technique; post isometric relaxation
Intervention type(s): Device; Other
Intervention description(s): Experimental group included Graston technique :The protocol consist of Longitudinal stroking parallel to muscle fiber for 1min , spin over trigger points for 1 min using knob of instrument and fanning for 2 min.; Post Isometric Relaxation, 5 rep , 20% isometric contraction 10 sec , 20 sec of stretch hold beyond resistance barrier
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Post isometric relaxation; Graston technique; Mechanical neck pain