Dry Needling Versus Graston Technique in Active Myofascial Trigger Points on Upper Trapezius

Study Overview
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Brief Summary
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This study will compare the effects dry needling and Graston technique in active myofascial trigger points on upper trapezius. Half of the study participants will receive dry needling whereas other half will receive Graston technique.

Detailed Description
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This is a single blinded randomized controlled trial, will be conducted at Rawal General & Dental Hospital, Islamabad. Both dry needling and Graston Techniques are used to release active Myofascial Trigger points with different mechanism. Dry needling is technique in which without any medication or injection, dry needles are inserted into hyper irritable points in muscle. Graston technique is done with specially designed tools to locate knots within muscle by running the tools over the skin. This study is planned with objectives to compare both treatment techniques on active myofascial trigger points in patients with neck pain. Effects of these will be measured on Neck Pain, Range of Motion, functional status and trigger points.

Official Title
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Comparison of Dry Needling and Graston Technique in Active Myofascial Trigger Points on Upper Trapezius

Conditions
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Trigger Points

Intervention / Treatment
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* Other: Dry Needling Group
* Other: Graston Technique Group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient with non-specific pain in neck (acute and sub-acute) Age: 20-40 years Patient agrees to use the dry needling or Graston exclusively Exclusion Criteria: Patients that were using any medication to reduce the pain and/or have any effect in the skeleton muscle. Patient taking other treatment in the same period of research. Patients having malignancy, tuberculosis, spinal cord injury, neurodegenerative diseases radiculopathies and hematoma. Patients on anticoagulants. Patient with chronic neck pain.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There will be two treatment groups of participants, One group will receive Dry Needling whereas other will receive Graston technique for treatment of Myofascial Trigger points.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dry needling<br>Dry needling will be applied on active myofascial trigger points in upper trapezius along with conservative physical therapy management. | Other: Dry Needling Group<br>* Hot Pack will be applied on upper trapezius muscles before session for general relaxation for 7-10 minutes. Generalized Stretching and strengthening neck exercises will be performed. Then after wearing gloves and appropriate personal protective measures, a thin filiform needle will be inserted which will penetrate into the skin and stimulate underlying myofascial trigger points. The treatment will be continued for 2 weeks with 2 sessions per week.<br>|
| Active Comparator: Graston<br>Graston Technique will be applied on active myofascial trigger points in upper trapezius along with conservative physical therapy management. | Other: Graston Technique Group<br>* Hot Pack will be applied on upper trapezius muscles before session for general relaxation for 7-10 minutes. Generalized Stretching and strengthening neck exercises will be performed. Later, lubricant will be applied to the skin, and Graston technique will be applied using instrument over the active myofascial trigger points in upper trapezius. The treatment will be continued for 2 weeks with 2 sessions per week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | Numeric Pain Rating Scale (NPRS) is used to assess pain. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score. | Baseline | 
| Numeric Pain Rating Scale (NPRS) | Numeric Pain Rating Scale (NPRS) is used to assess pain. It scores ranges from 0-10, 0 means No pain and 10 means Severe pain. Patient will be asked to verbally report the pain score. | Post 2nd week | 
| cervical range of motion (CROM) | A cervical range of motion (CROM) inclinometer will be use to assess cervical range of motion in flexion, extension, left right lateral flexion and left-right rotation. Participants will be seated upright and asked to actively move their neck in each direction. | Baseline | 
| cervical range of motion (CROM) | A cervical range of motion (CROM) inclinometer will be use to assess cervical range of motion in flexion, extension, left right lateral flexion and left-right rotation. Participants will be seated upright and asked to actively move their neck in each direction. | Post 2nd week | 
| Myofascial Diagnostic Scale (MDS) | It is a scale using the signs of a Myofascial trigger point as indicators to assess the extent to which the patient suffers from Myofascial Pain Syndrome. The signs include: referred pain in the zone of reference, local twitch response, palpable taut band, and focal or spot tenderness. Spot tenderness or soft tissue tenderness consisted of five grades or indicators: grade 0 - no tenderness = 0, grade 1 - tenderness to palpation without grimace or flinch = 1, grade 2 - tenderness with grimace and/or flinch to palpation = 2, grade 3 - tenderness with withdrawal = 3, grade 4 - withdrawal to non-noxious stimuli = 4. The presence of a local twitch response and the presence of a palpable taut band were indicated by a score of 4 on the scale. The presence of referred pain was indicated by a score of 5. A total score of 9 or more was indicative of active trigger points. | Baseline | 
| Myofascial Diagnostic Scale (MDS) | It is a scale using the signs of a Myofascial trigger point as indicators to assess the extent to which the patient suffers from Myofascial Pain Syndrome. The signs include: referred pain in the zone of reference, local twitch response, palpable taut band, and focal or spot tenderness. Spot tenderness or soft tissue tenderness consisted of five grades or indicators: grade 0 - no tenderness = 0, grade 1 - tenderness to palpation without grimace or flinch = 1, grade 2 - tenderness with grimace and/or flinch to palpation = 2, grade 3 - tenderness with withdrawal = 3, grade 4 - withdrawal to non-noxious stimuli = 4. The presence of a local twitch response and the presence of a palpable taut band were indicated by a score of 4 on the scale. The presence of referred pain was indicated by a score of 5. A total score of 9 or more was indicative of active trigger points. | Post 2nd Week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck Disability Index (NDI) | Neck Disability Index (NDI) is a questionnaire designed to assess how neck pain has affected patient's ability to manage in everyday life. It has total 10 sections, For each section the total possible score is 5: if the first statement is marked the section score = 0, if the last statement is marked it = 5. If all ten sections are completed the score is calculated and converted into percentages. The maximum Score of Neck Disability Index (NDI) is 50. | Baseline | 
| Neck Disability Index (NDI) | Neck Disability Index (NDI) is a questionnaire designed to assess how neck pain has affected patient's ability to manage in everyday life. It has total 10 sections, For each section the total possible score is 5: if the first statement is marked the section score = 0, if the last statement is marked it = 5. If all ten sections are completed the score is calculated and converted into percentages. The maximum Score of Neck Disability Index (NDI) is 50. | Post 2nd week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Trigger Area, Myofascial Pain Syndromes, Instrument assisted soft tissue tecnique