Dynamic Myofascial Release in Patients With Non-specific Neck Pain.
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Dynamic myofascial release is similar to joint mobilization (active physiological movements)
      to increase ROM with the myofascial release for fascia release. It differs from myofascial
      release in a way that it is a dynamic approach in which the patient is actively involved. In
      2019 study was conducted on the effects of Dynamic myofascial release showing significant
      increase in all trunk ROMs and functional reach test in patients with chronic non-specific
      low back pain.

      To summarize, this study will going to see the effectiveness of dynamic myofascial release by
      addressing both fascia and active physiological movements and see the response of patient's
      pain level, cervical ROM, improvement in the ability to manage in activities of daily life.
      Furthermore this study helps to find out its effectiveness and its clinical importance in
      treating patients with neck pain, considering its significance of engaging multiple
      structures.
    

Detailed description: 
      Neck pain is one of the most common and painful musculoskeletal conditions. For the majority
      of the neck disorders there is an absence of an identifiable underlying disease or abnormal
      anatomical structure. As a consequence they are classified as 'non-specific'. The natural
      course of nonspecific neck pain remains unclear. While it is often self-limiting within a few
      weeks of onset, it can severely limit daily functioning, induce substantial medical
      consumption and result in prolonged sick leave and disability. As a consequence it places a
      heavy burden on individuals, employers and health care services." Non-specific neck pain,
      also referred to as mechanical neck pain, is diagnosed as cervical pain with or without
      radiation without a known pathological basis as the underlying cause of the
      complaints.Overall analysis revealed evidence that middle age and then adults, female gender,
      high job demands, low social or work support, being an ex-smoker, a history of low back
      disorders and a history of neck disorders predicts the future onset of neck pain.

      In recent years, several studies have emerged about myofascial pain syndrome among patients
      suffering from neck pain. Myofascial pain syndrome is the presentation of sensory, motor, and
      autonomic symptoms caused by Myofascial trigger points . In 2014 study concluded that the
      most prevalent active myofascial trigger points in the trapezius muscles were identified in
      93.75% of the subjects, in the levator scapulae in 82.14%, and in the multifidi in 77.68% of
      the subjects. Myofascial trigger points in the splenius cervicis reached a prevalence of
      62.5% .

      Myofascial release is a widely employed manual therapy treatment that involves specifically
      guided low load, long duration mechanical forces to manipulate the myofascial complex,
      intended to restore optimal length, decrease pain, and improve function. Myofascial release
      when used in conjunction with conventional treatment is said to be effective to provide
      immediate relief of pain and tissue tenderness.

      Myofascial release generally involves slow, sustained pressure applied to restricted fascial
      layers either directly (direct MFR technique) or indirectly (indirect MFR technique). Direct
      Myofascial release technique is thought to work directly over the restricted fascia:
      practitioners use knuckles or elbow or other tools to slowly sink into the fascia, and the
      pressure applied is a few kilograms of force to contact the restricted fascia, apply tension,
      or stretch the fascia. Indirect Myofascial release involves a gentle stretch guided along the
      path of least resistance until free movement is achieved.

      In 2018 study concluded in a study to see the effects of Myofascial release in patients with
      neck pain that both Myofascial release and Physical therapy multimodal programs provide
      improvement of pain in patients with neck pain. However, Myofascial release could be better
      than a Physical therapy multimodal program that includes Ultrasound , TENS, and massage.
      Overall, the improvement of pressure pain threshold provided by MFR was 20% greater than that
      provided by a Physical therapy multimodal program. In 2017 study found significant
      improvement in both pain and disability among patients with low back pain in response to
      myofascial release applied to the lumbar region. In 2018 study performed Myofascial release
      on thoracic spine and demonstrated that Myofascial release can be effective in increasing
      both local and distal Range of motion.
    

Intervention name(s): Assigned Interventions; Dynamic myofascial release
Intervention type(s): Other; Other
Intervention description(s): Hot pack for 10 minutes
TENS for 10 minutes
Trigger point release if any found.
Myofascial release
Home plan for stretching exercises will be prescribed to the patient. Receive two weeks intervention plan, three sessions per week.; DMFR involves a manual application of low amplitude, long duration stretch to the fascia and muscle. Participants were instructed to relax as much as possible, and the therapist proceeded to smoothly move the joints in a diagonal or horizontal direction at a slow rate within the ROM. The therapist repeatedly pushed, pulled, or shook the joint area about three to five times for about 3 seconds with slight motion at the end of ROM.
Conventional therapy will includes
Hot pack for 10 minutes
TENS for 10 minutes
Trigger point release if any found.
Myofascial release
Home plan for stretching exercises will be prescribed to the patient. Receive two weeks intervention plan, three sessions per week.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Neck Pain; Myofascial Release; Dynamic Myofascial Release