Comparison of Bowen's Technique and Myofascial Release Technique On Pain And Disability in Trapezitis
Condition: Trapezius Muscle Strain
Study type: Interventional

Summary: 
      The aim of this research is to compare the effects of Bowen's technique and Myofascial
      Release technique on pain and disability in patients with trapezitis.Randomized controlled
      trials done at Islamabad Physiotherapy and Rehabilitation Centre(IPRC) and Benazir Bhutto
      Hospital. The sample size was 66. The subjects were divided in two groups, 33 subjects in
      Bowen's Technique group and 33 subjects in Myofascial Release Technique group. Study duration
      was of 6 months. Sampling technique applied was non probability purposive sampling technique.
      The patients aged 20-40 years and clinicaly diagnosed with Trapezitis(spasm,trigger
      points,tenderness,stiffness) were included in the study. Tools used in the study are Cervical
      ROMs, NPRS, NDI, Isometric Scapular Pinch Test and Lateral Scapular Slide Test.
    

Detailed description: 
      Trapezitis is a condition that involves inflammation of the trapezius muscle. The upper
      fibers of trapezius, being the postural muscles, are highly susceptible to overuse injuries
      and thus the inflammation.This results in pain that is present during the rest, is aggravated
      with activity and is referred to the other areas. The pain results in protective spasm of the
      antagonistic muscle group that also restricts the passive range of motion and makes it
      painful too. In people working for long hours at a desk and computers or spending many hours
      driving, the low level of upper trapezius activity is frequently found because of head
      posture during sitting and standing , which is common cause of tension and neck pain in such
      people.Various recent studies have hypothesized that trapezitis occurs due to muscle tissue
      overloading and injury, that results in involuntary shortening of localized muscle fibers.
      The stressed soft tissue area thus receives less glucose, oxygen and nutrients supply;
      subsequently high levels of metabolic waste products are accumulated. And this cascade of
      events ends in altered status of tissue, pain and the development of the Trigger points in
      the muscle.

      Myofascial Release(MFR) is a soft tissue mobilization technique that is defined as " the
      facilitation of mechanical, neural and psycho physiological adaptive potential as interfaced
      via the myofascial system".MFR decreases the pain and restores the proper alignment by
      changing the ground substance's viscosity to more fluid state resulting in elimination of
      excessive pressure of fascia on the pain sensitive structures.

      There is one more soft tissue technique called 'Bowen Technique' that is useful and indicated
      in myofascial pain. The Bowen technique is defined as:

      '…dynamic system of muscle and connective tissue therapy which balances the body to allow it
      to heal itself. The work consists of a series of precise moves on specific points of the
      body. These moves are light and can be done through clothing. There are frequent and
      important pauses between each series of moves giving the body time to benefit from each. The
      technique uses positive moves that initiate a positive energy flow and negative moves that
      isolate this energy to a specific area' (Rentsch and Rentsch,1997) The Bowen technique was
      developed by late Tom Bowen in Geelong, Australia in 1950. It is a connective tissue
      technique that uses subtle inputs called 'Bowen moves' to the body that stimulates the body's
      self-healing. The Bowen moves applied are in several sets in a complete session of 15-45
      minutes duration. While applying the technique, the therapist uses the thumb when the Bowen
      move is executed away from the patient's body and two fingers are used when the Bowen move is
      executed towards the patient's body. The technique can be used anywhere on the origin,
      insertion or the belly of the muscle and produces a physical and an energetic action.

      This technique can be used to treat many types acute and chronic injuries and other health
      issues. It does this by using holistic approach in which body's innate healing mechanism is
      stimulated. This technique has been recommended in many conditions like headache, cervical
      pain, back pain, whiplash injury, TMJ dysfunction, herniated disk, tennis elbow, hamstring
      tightness and frozen shoulder, work related injuries etc.

      An RCT was done by Ekta S. Chaudhary, Nehal Shah, Neeta Vyas, Ratan Khuman1, Dhara Chavda1,
      Gopal Nambi that compared the effectiveness of MFR and cold pack in Upper trapezius Spasm and
      concluded both MFR and cold pack along with exercises to be effective in upper trapezium
      muscle spasm but the overall effects of MFR surpassed the cold therapy. Another study by
      Pooja Mane , Amrutkuvar Pawar , Trupti Warude compared the effects of Myofascial Release
      technique with Deep Friction Massage on pain and cervical ROM, the results concluded both
      therapies to bring improvement in pain and cervical ROM but MFR was more effective.
      Similarly, a systematic review of RCTs was conducted to determine the effectiveness of MFR in
      decreasing pain , improving function and elongate length and concluded MFR to be emerging
      strategy with strong evidence base and solid treatment option for many conditions. A study
      was conducted to compare the effects of MFR with hot pack in reducing pain and improving
      passive ROM in shoulder joint and that concluded both to be effective but MFR proved to be
      more favorable because of the less time spent and no need of equipment.

      A study has been done to see the effects of Bowen technique as an adjunct therapy to
      conventional physiotherapy treatment on the pain and functional outcomes in patient with
      Acute trapezitis and the results established Bowen technique to be effective in decreasing
      pain and improving functional outcomes in Acute trapezitis.A few studies were conducted that
      evaluated the effectiveness of Bowen technique in frozen shoulder and concluded this
      technique as a positive intervention in improving mobility, functional status and decreasing
      pain. A few studies were conducted that compared the effects of Bowen technique vs MET in
      treatment of hamstring tightness.And few other worked to establish the effectiveness of Bowen
      technique in different complex and common conditions and found positive results.A study was
      done to show Bowen technique to be effective in health service workplace to improve physical
      as well as mental well-being of the working staff.

      This study aims to compare the short term effects of Bowen Technique and MFR on pain and neck
      disability in patients with trapezitis. Also it intends to study the short term effects of
      both techniques on scapular motions. Bowen technique is a relatively new technique, having
      easier application and has been less worked on. So, if this study proves the effectiveness of
      Bowen technique in comparison with MFR in patient with trapezitis. Further studies can be
      conducted to evaluate its efficacy as an independent and preferable procedure in treatment of
      other conditions and further work can be conducted on other areas as well. As this is a
      holistic technique, so it could be a beneficial addition in the daily clinical practice.
    

Intervention name(s): experimental Bowen Technique; Experimental Myofacial release technique
Intervention type(s): Other; Other
Intervention description(s): Patient was in lying position. Therapist placed thumb on the effected side muscke. Then hooked thumb on lateral edge of muscle to apply pressure against the muscle. Took a pause. Thumb flattened in a medial direction and pluck was created in muscle.
Set of 15-20 bowen moves on upper , middle and lower fibres each with 2 mins gap between each set.
Total treatment time: 20 mins; Patient was in lying position. MFR applied via ulnar border of both palms while patient being in contralateral side flexion.
20 mins
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Bowen therapy; Myofacial Release Technique; Isometric Scapular pinch test; Lateral Scapular Slide test; NDI