Art and Surface Electromyography (EMG)
Condition: Fatigue
MeSH terms: Fatigue
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      The general purpose of this research project is to use surface electromyography to compare
      the effect of Active Release Technique versus Proprioceptive Neuromuscular Facilitation on
      the electrical activity of the upper trapezius muscle at rest and during contraction.
    

Detailed description: 
      Both ART and PNF are soft tissue techniques used to decrease muscle hypertonicity, myospasm,
      and/or trigger points and increase the overall function of muscles.

      Active-release technique, or ART®, is a form of myofascial therapy used in pain management
      that involves soft-tissue manipulation. ART has the expressed goal of restoring optimal
      texture, motion, and function of the soft tissue while releasing entrapped nerves or blood
      vessels. An injury to a soft-tissue structure commonly causes the muscle to shorten to guard
      or protect the area. A clinician who is performing ART makes a soft contact with one hand on
      the patient just distal to the injured area while the other hand develops tension on the soft
      tissue. While the contact tension is maintained, the structure is lengthened using an "active
      motion." During the motion, the lesion is palpated and the physical contact with the patient
      is changed or moved slightly in order to concentrate the tension in the appropriate tissue
      (Swann, et al).

      Active Release Technique was developed by Dr. Michael Leahy and is widely used in
      rehabilitative and sports medicine for myofacial pain syndromes. The ART group will be
      treated by one investigator in concurrence with treatment methods outlined in Dr. Leahy's ART
      instructional manual. An ART treatment pass involves taking the tissue from a shortened
      position to a lengthened position while the administer maintains manual contact. We will
      perform three passes of ART with a 10 second rest period between passes. We will only perform
      ART on the symptomatic side (side that fits inclusion criteria); if both sides are involved,
      each side will be considered as a separate analysis.

      The research backing ART is inadequate. Although there are numerous testimonials, limited
      published research studies could be found. Dr. George's study of the effect of ART, HVLA and
      no treatment on the temporomandibular joint and masticatory muscles showed no significant
      difference between the pre- and post-treatment mouth opening measurements. Another ART study
      of lateral epicondylitis concluded that the technique was successful in removing adhesions
      and promoting restoration of normal tissue but also stated that research was inadequate
      (Howitt, et al). A carpal tunnel study completed in 2006 used EMG to measure the
      effectiveness of ART. There were significant improvement in symptom severity and functional
      status after treatment, but no significant differences found in the EMG analyses (George,
      Tepe, and Busold 119-122).

      Proprioceptive neuromuscular facilitation (PNF) stretching techniques are commonly used in
      the athletic and clinical environments to enhance both active and passive range of motion
      (ROM) with a view to optimizing motor performance and rehabilitation by elongating the muscle
      (Sharman, et al).

      A second investigator will perform all the PNF using the published protocol from Warren
      Hammer, DC, MS, DABCO, in the text Functional Soft Tissue Examination and Treatment by Manual
      Methods, which is as follows:

      The patient is supine with the examiner supporting the head so that the neck is in
      contralateral sidebending and ipsilateral rotation and flexion. The whole cervical spine and
      occiput is fixed and held in long-axis traction. With the other hand, the examiner contacts
      the shoulder with the forearm parallel to the table and pushes inferiorly to determine end
      feel. While maintaining the above position, the examiner asks the patient to resist by
      pushing the shoulder superiorly against the examiner's resistance for 7 seconds. The examiner
      then asks the patient to let go and, while stabilizing the head and neck, depresses the
      shoulder as far as possible for 12 seconds.

      A previous study of PNF concluded that the technique caused short-term deficits in strength,
      power output, and muscle activation; it also increased ranges of motion (Marek, et al). A
      second previous study concluded that PNF caused an increase in electromyographic activity of
      the masticatory muscles (Olivo, et al).

      Surface EMG is a reliable, non-invasive tool used for measuring muscular electrical activity.
      Electromyography (EMG) can provide unique information about the mechanical and motor control
      strategies during various types of muscle actions. EMG measures muscle activation, with
      surface EMG reflecting the algebraic sum of electric muscle action potentials that pass
      within the recording areas of the EMG electrodes. There, EMG amplitude quantifies muscle
      activation, which can be altered by the number of motor units recruited and the firing rates
      of the activated motor units. Thus, decreases in EMG amplitude due to decreases in muscle
      activation (Marek, et al). The surface EMG protocol will be performed completely by a third
      investigator.

      Farina, et al published an article showing that the EMG can give reliable indications of
      muscle activity and fatigue. A previous study of muscle activity using surface EMG noted that
      based on visual inspections, all surface EMG variables showed consistent linear to moderately
      curvilinear behavior as a function of time (Muhammed, et al). Surface EMG has been widely
      used and accepted however care must be taken in pad placement as incorrect placement will
      give readings of improper musculature, as concluded in a study by Susan Mercer.
    

Intervention name(s): ART; PNF; No Treatment
Intervention type(s): Other; Other; Other
Intervention description(s): ART to the levator scapulae.; PNF to the levator scapulae.; No treatment will be given. The participant will sit in the treatment room with the doctor for 4 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Muscle