Positional Release Technique for Myofascial Trigger Points of the Upper Trapezius
Condition: Trigger Point Pain, Myofascial
MeSH terms: Myofascial Pain Syndromes
Study type: Interventional

Summary: 
      The aim of this research is to find the effects of Positional Release Technique (PRT) on
      pain, range of motion and neck disability index in patients with myofascial trigger points
      (MTRPs) of the upper trapezius with forward head posture (FHP). A Randomized control trial is
      conducted at Tehsil Head Quater (THQ) Civil hospital Wazirabad. The sample size is calculated
      through open epi tool is 32. The subjects are divided in two groups, 16 participants in
      experimental group and 16 in control group. The study duration is of six months. Sampling
      technique applied is purposive non probability sampling technique. Only 18-45 years
      participants with myofascial trigger points of the upper trapezius is included. Tools used in
      the study are Visual analog scale (VAS), Pain Pressure Threshold (PPT), active cervical
      contra-lateral flexion (ACLF), Cranio vertebral angle (CVA) and neck disability index (NDI).
      Data analyzed through Statistical Package for the Social Sciences (SPSS) version 23.
    

Detailed description: 
      Muscular and skeletal structures can change into an incorrect shape due to a reduction in
      physical activity and inappropriate posture habits in daily living. Kong YS et al defined
      Forward head posture (FHP) as a posture that adopts upper cervical extension and lower
      cervical flexion. The center of gravity of the head in this posture is positioned at the
      front rather than the vertebral body weight.

      FHP weakens the deep cervical flexor muscle, the mid thoracic rhomboid muscle for scapular
      retraction, and the mid and lower trapezius muscles. FHP also shortens the pectoralis major
      and neck extension muscles. Upper trapezius muscle activity is increased more in FHP than in
      correct anatomic positions, and most patients complain of pain from muscle overuse.

      The craniovertebral angle (CVA) is defined as an angle made by the intersection of a line
      joining the midpoint of the tragus of ear to the skin overlying the C7 spinous process and a
      horizontal line passing through the C7 spinous process. There is a correlation between FHP,
      neck pain, and CVA. One of the studies reported that subjects having smaller CVA had FHP and
      were prone to have increased severity of neck pain.

      D'souza CJ et al stated that positional Release Therapy (PRT) is a noninvasive treatment
      which can be used in conjunction with several electrical modalities. In this technique, in
      order to facilitate restoration of normal tissue length and to treat excessive muscle tension
      or spasm, tissues are placed in a Position of comfort for a brief period (90 sec) to resolve
      the associated dysfunction.

      In 2017 a study conducted which shows that PRT has beneficial effects on myofascial trigger
      points (MTrPs). In this regard, Kelencz et al. reported that PRT is effective in reducing
      pain and muscle tension among patients with upper-trapezius MTrPs. Amini A et al studied on
      30 female university students, who were identified with latent MTrPs of the upper trapezius,
      according to the results, both Manual Passive Muscle Shortening (MPMS) and PRT were effective
      techniques in immediate pain relief of upper-trapezius MTrPs.

      Kojidi MM et al concluded that Positional Release Therapy was found to be effective in
      reducing pain and increasing Pressure pain threshold in three treatment sessions in 19-45
      year-old female computer users with at least 2 h of work and with latent upper trapezius
      trigger points. Mohamadi M et al state that PRT is a potential treatment option with no
      reported side effects for patients with Tension Type Headache (TTH).

      In general, PRT and Therapeutic Massage were both successful at decreasing MTrP sensitivity
      and stiffness. However, there appeared to be a slight benefit for pain reduction with PRT up
      to 2 days post treatment.

      Varshney K et al concluded that the patients who received positional release therapy along
      with moist heat pack has more impact on pain and disability as compared to those received
      deep transverse friction massage along with moist heat pack follow-up 4 weeks protocol.

      Study concluded that the difference from 1st to 21th day in VAS &NDI score which shows that
      Positional release therapy (PRT) is more effective than conventional Physiotherapeutic
      intervention in order to decrease pain and disability in patients with no-specific neck pain.

      Manzoor S et al treated a 62 year female who was suffering tension type headache from last 14
      months was treated by combined positional release therapy and ischemic compression in 6
      sessions, concluded that combination of positional stretch and Ischemic compression is
      effective treatment for patients with trigger points in cervical muscles, most commonly upper
      trapezius and sternocleidomastoid causing cervicogenic headache.

      There is poor evidence regarding the effects of PRT on MTRPs with forward head posture on
      Cranio-vertebral angle. So this study aims to find the effectiveness of PRT for myofascial
      trigger points of the upper trapezius with forward head posture as there is less literature
      available about the gender based effect of PRT, as most of the studies have done on female
      population, basically this study will target the effect of PRT on male computer users with
      FHP on Pain, ROM, disability and Cranio vertebral angle.
    

Intervention name(s): Positional release technique; Traditional physical therapy
Intervention type(s): Other; Other
Intervention description(s): Experimental group is given Positional Release Technique along with the hot pack, muscle stretching and posture correction.
Positional release technique position will maintained for almost 90 seconds. This technique will be repeated for three times each session, with 10 sec relaxation, 3 days/week.
Upper trapezius stretching 5 repetitions×1 set, 3 days/ week. Total of 3 sessions were given each consisting of 30 min.
Posture correction in ADLs as well as in working place by advising correct sitting posture, the participants will advised to relieve muscle tension after every 20-30 minutes of work by getting up; stretching the arm, shoulder, neck, and back muscles.; Hot pack for 15-mins. Upper trapezius stretching 5 repetitions×1 set, 3 days/ week. Total of 3 sessions are given each consisting of 30 min.
Posture correction in ADLs as well as in working place by advising correct sitting posture, the participants will advised to relieve muscle tension after every 20-30 minutes of work by getting up; stretching the arm, shoulder, neck, and back muscles.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: myofascial trigger points of the upper trapezius; Positional Release technique; Neck Pain Disability index; Cranio vertebral angle