Muscle Energy Techniques and Trigger Point Therapy in Asymptomatic Persons With Latent Trigger Point

Study Overview
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Brief Summary
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The main objective of this study is to evaluate the effectiveness of therapy which will be a combination of Muscle Energy Technique (MET) and Trigger Point Therapy (TPT), performed bilaterally on the upper trapezius muscle in the group of asymptomatic persons with latent trigger point. The study will show whether one-time therapy has an impact on: mobility of the cervical spine, biophysical parameters (muscle tone, stiffness and elasticity) of soft tissues and pressure pain threshold of upper trapezius muscle. An additional goal will be to compare the effectiveness of the three treatments used: combination of MET with TPT, single MET and single TPT. Research hypotheses: The combination of MET with TPT will increase the angular ranges of basic cervical spine movements immediately after the therapy and these effects will persist the second day after the intervention. The combination of MET with TPT will increase the elasticity and reduce muscle tone and stiffness in the area of the upper trapezius immediately after the therapy, and these effects will persist the second day after the intervention. The combination of MET with TPT will increase the pressure pain threshold of upper trapezius muscle immediately after the therapy, and this effect will persist the second day after the intervention. The combination of MET with TPT will be more effective than single MET and single TPT methods. Muscle Energy Techniques (MET) can be defined as a group of soft tissue manipulation methods. They are a multi-task techniques that can be performed to improve the function of the musculoskeletal system and reduce pain. METs are used by clinicians who treat various myofascial and joint dysfunctions as well as a form of prevention and protection of the musculoskeletal system. Trigger point therapy (TPT) uses manual techniques such as ischemic compression (IC), positional release (PR), dry needling and soft tissue manipulations [TP1]. Their main purpose is to reduce or eliminate the symptoms generated by myofascial trigger points (TrPs), which are defined as severely irritated areas within the hypertonic muscle fiber band or the fascia itself. Latent TrPs are described as those that do not generate symptoms on their own. However, they can cause refered pain at the time of provocation, i.e. pressure at the place of their occurrence. In the scientific literature there are no reports on the assessment of the combination of MET with TPT

Detailed Description
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The randomized study will focus on assessing the effectiveness of 3 different physiotherapeutic interventions. The physiotherapist with 10 years of professional experience will be responsible for performing all diagnostic procedures and therapeutic interventions. Diagnosis of latent trigger point will be performed on subjects in the supine position. The therapist using a pincer grip will perform palpation in the area of the entire upper trapezius muscle. Testing for the presence of trigger point can be considered positive when it is noted: 1) the presence of a detectable strained band in the muscle, 2) the presence of an excessively sensitive area in the strained muscle band, 3) the response of local vibration caused by compression of the strained band, 4) occurrence of characteristic transferred symptoms (pain radiating to the posterior-lateral side of the neck, and/or mastoid process of the temporal bone, and/or the temporal bone area, and/or the angle of the jaw) as a result of compression of the hypersensitive muscle band. The test will be performed on both sides of this muscle. The following measurement methods are planned to be used: Electrogoniometry of the cervical spine. A Penny & Giles strain tensometric electrogoniometer will be used. Using this device, the angular values of cervical spine movements will be examined. The SG150 two-plane sensor and the Q110 single-plane sensor will be used. The lower edge of the upper sensor will be attached around the occipital tuberosity, while the upper edge of the lower sensor on the C7 spinous process. The examined person will be in a sitting position. Double-sided tape from Biometrics will be used to stick the electrogoniometer sensors. For the measurements of each movement, the subject will perform 3 repetitions. Then the mean value will be calculated, which will be the result. Myotonometry. In order to examine the biophysical parameters of soft tissues a MyotonPRO will be used. Measurements will be made on the upper part of the trapezius muscle at the point located in the middle of the segment between the C7 spinous process and the shoulder angle of the acromion. During measurements, the subject will be lying down. Pressure pain threshold (PPT). The Wagner Instruments Algometer will be used to assess the subjective parameter - pressure pain threshold of first discomfort. The place of measurement will be the point located on the upper trapezius muscle in the middle of the segment between the C7 spinous process and the shoulder angle of the acromion. The subject will be lying down on his back. Pressure from the algometer sensor will be applied from above and perpendicular to the examined muscle. Three measurements will be taken alternately for both sides of the upper trapezius. The mean value will be calculated, which will be the results for the right and left sides of the examined muscle. The order of measurements will be: 1) myotometry, 2) pressure pain threshold test, 3) cervical spine electrogoniometry. Participation in the study will be voluntary, free and fully anonymous. The participant will be able to opt out of the study at any stage. All planned therapeutic and measurement methods are non-invasive and safe. They do not threaten the health and life of the respondents.

Official Title
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Determining the Effect of a Combination of Muscle Energy Techniques and Trigger Point Therapy on Subjective and Objective Indicators Assessing the Condition of the Musculoskeletal System in Asymptomatic Persons With Latent Trigger Point

Conditions
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Asymptomatic Condition

Intervention / Treatment
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* Other: Muscle Energy Technique (MET)
* Other: Trigger Point Therapy (TPT)
* Other: Muscle Energy Technique (MET) combined with Trigger Point Therapy (TPT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: right-handed people amateur practicing symmetrical sports (eg. swimming, running, cycling, gym, roller skates) asymptomatic subjects (without pain symptoms of the cervical spine and shoulder girdle) occurrence of latent trigger point of the upper trapezius muscle Exclusion Criteria: age above 21 years no latent trigger point on the upper trapezius muscle pain in the cervical spine or shoulder girdle any neurological symptoms in the upper limb previous operations in the cervical spine or shoulder girdle practicing asymmetrical sports professional sports

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 21 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The first stage will involve recruitment. 60 people will be gathered based on the qualifying and disqualifying criteria. This group of participants will be randomized. Each participant will draw a number that will determine the assignment to a specific group (MET plus TPT group, single MET or single TPT group). Preliminary measurements will be collected before the intervention. Each participant will have a specific intervention depending on which research group they belong to. The therapist will be responsible for performing the given therapeutic technique. Immediately after the intervention and on the second day, data will be collected by the researcher. The person conducting the function of coordinator will supervise the proper conduct of the scientific research. The collected data will be analyzed by the outcomes assessor.
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Muscle Energy Technique combined with Trigger Point Therapy<br>For this group of participants, combined therapy (Muscle Energy Technique with Trigger Point Therapy) will be used | Other: Muscle Energy Technique (MET) combined with Trigger Point Therapy (TPT)<br>* For this type of intervention, TPT will first be performed on both sides of the upper trapezius muscle, followed by MET, which will also be performed bilaterally. The detailed method of performing the applied therapeutic techniques for the combined procedure will be identical as in the case of isolated (single) methods.<br>|
| Active Comparator: Muscle Energy Technique<br>For this group of participants, a single method (Muscle Energy Technique) will be used | Other: Muscle Energy Technique (MET)<br>* The Contract-Relax Agonist-Contract (CRAC) technique will be used, which belongs to the broad MET group. The participant will be in the supine position. The therapist will set the cervical segment in the lateral flexion until a slight soft tissue tension is felt. The technique will consist of two stages. In the first phase (contraction phase), the upper trapezius will be activated against the therapist's resistance (shoulder girdle elevation) - 10 seconds. Then the person undergoing the procedure breathes in and out deeply. Then 10 seconds of antagonist group contraction (shoulder girdle depression) will be performed. Next, the therapist will passively move the participant's shoulder girdle towards the depression. Then the second phase will follow (stretching phase), during which the participant will passively lie in the back position for 30 seconds. Both phases will make up the therapeutic cycle. Each participant will have 5 cycles on each side of the upper trapezius.<br>|
| Active Comparator: Trigger Point Therapy<br>For this group of participants, a single method (Trigger Point Therapy) will be used | Other: Trigger Point Therapy (TPT)<br>* The technique of Positional Release (PR) will be used, which is one of the broadly understood Trigger Point Therapy. It will consist in compressing the trigger point with a simultaneous shortening of muscle attachments (slight lateral flexion towards the relaxed muscle). The muscle on both sides will be treated. The pressure exerted by the therapist's pincer grip will be acceptable to the patient. The duration of the technique will be 2 minutes for each muscle. While performing this technique, the participant will passively lie on his back.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cervical Anterior Flexion before the intervention | Electrogoniometric measurement of the angular range of motion immediately before the intervention. | PRE (immediately before the intervention) | 
| Cervical Anterior Flexion after the intervention | Electrogoniometric measurement of the angular range of motion immediately after the intervention. | POST (immediately after the intervention) | 
| Cervical Anterior Flexion on the next day after the intervention | Electrogoniometric measurement of the angular range of motion on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Cervical Posterior Flexion before the intervention | Electrogoniometric measurement of the angular range of motion immediately before the intervention. | PRE (immediately before the intervention) | 
| Cervical Posterior Flexion after the intervention | Electrogoniometric measurement of the angular range of motion immediately after the intervention. | POST (immediately after the intervention) | 
| Cervical Posterior Flexion on the next day after the intervention | Electrogoniometric measurement of the angular range of motion on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Cervical Right Flexion before the intervention | Electrogoniometric measurement of the angular range of motion immediately before the intervention. | PRE (immediately before the intervention) | 
| Cervical Right Flexion after the intervention | Electrogoniometric measurement of the angular range of motion immediately after the intervention. | POST (immediately after the intervention) | 
| Cervical Right Flexion on the next day after the intervention | Electrogoniometric measurement of the angular range of motion on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Cervical Left Flexion before the intervention | Electrogoniometric measurement of the angular range of motion immediately before the intervention. | PRE (immediately before the intervention) | 
| Cervical Left Flexion after the intervention | Electrogoniometric measurement of the angular range of motion immediately after the intervention. | POST (immediately after the intervention) | 
| Cervical Left Flexion on the next day after the intervention | Electrogoniometric measurement of the angular range of motion on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Cervical Right Rotation before the intervention | Electrogoniometric measurement of the angular range of motion immediately before the intervention. | PRE (immediately before the intervention) | 
| Cervical Right Rotation after the intervention | Electrogoniometric measurement of the angular range of motion immediately after the intervention. | POST (immediately after the intervention) | 
| Cervical Right Rotation on the next day after the intervention | Electrogoniometric measurement of the angular range of motion on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Cervical Left Rotation before the intervention | Electrogoniometric measurement of the angular range of motion immediately before the intervention. | PRE (immediately before the intervention) | 
| Cervical Left Rotation after the intervention | Electrogoniometric measurement of the angular range of motion immediately after the intervention. | POST (immediately after the intervention) | 
| Cervical Left Rotation on the next day after the intervention | Electrogoniometric measurement of the angular range of motion on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Stiffness (S) of the upper right trapezius muscle before the intervention | Myotonometric examination of soft tissue properties immediately before the intervention. | PRE (immediately before the intervention) | 
| Stiffness (S) of the upper right trapezius muscle after the intervention | Myotonometric examination of soft tissue properties immediately after the intervention. | POST (immediately after the intervention) | 
| Stiffness (S) of the upper right trapezius muscle on the next day after the intervention | Myotonometric examination of soft tissue properties on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Stiffness (S) of the upper left trapezius muscle before the intervention | Myotonometric examination of soft tissue properties immediately before the intervention. | PRE (immediately before the intervention) | 
| Stiffness (S) of the upper left trapezius muscle after the intervention | Myotonometric examination of soft tissue properties immediately after the intervention. | POST (immediately after the intervention) | 
| Stiffness (S) of the upper left trapezius muscle on the next day after the intervention | Myotonometric examination of soft tissue properties on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Elasticity (D) of the upper right trapezius muscle muscle before the intervention | Myotonometric examination of soft tissue properties immediately before the intervention. | PRE (immediately before the intervention) | 
| Elasticity (D) of the upper right trapezius muscle after the intervention | Myotonometric examination of soft tissue properties immediately after the intervention. | POST (immediately after the intervention) | 
| Elasticity (D) of the upper right trapezius muscle on the next day after the intervention | Myotonometric examination of soft tissue properties on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Elasticity (D) of the upper left trapezius muscle before the intervention | Myotonometric examination of soft tissue properties immediately before the intervention. | PRE (immediately before the intervention) | 
| Elasticity (D) of the upper left trapezius muscle after the intervention | Myotonometric examination of soft tissue properties immediately after the intervention. | POST (immediately after the intervention) | 
| Elasticity (D) of the upper left trapezius muscle on the next day after the intervention | Myotonometric examination of soft tissue properties on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Muscle tone (F) of the upper right trapezius muscle before the intervention | Myotonometric examination of soft tissue properties immediately before the intervention. | PRE (immediately before the intervention) | 
| Muscle tone (F) of the upper right trapezius muscle after the intervention | Myotonometric examination of soft tissue properties immediately after the intervention. | POST (immediately after the intervention) | 
| Muscle tone (F) of the upper right trapezius muscle on the next day after the intervention | Myotonometric examination of soft tissue properties on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Muscle tone (F) of the upper left trapezius muscle before the intervention | Myotonometric examination of soft tissue properties immediately before the intervention. | PRE (immediately before the intervention) | 
| Muscle tone (F) of the upper left trapezius muscle after the intervention | Myotonometric examination of soft tissue properties immediately after the intervention. | POST (immediately after the intervention) | 
| Muscle tone (F) of the upper left trapezius muscle on the next day after the intervention | Myotonometric examination of soft tissue properties on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Pressure pain threshold (PPT) of the upper right trapezius muscle before the intervention | Examination of the first discomfort threshold using an algometer immediately before the intervention. | PRE (immediately before the intervention) | 
| Pressure pain threshold (PPT) of the upper right trapezius muscle after the intervention | Examination of the first discomfort threshold using an algometer immediately after the intervention. | POST (immediately after the intervention) | 
| Pressure pain threshold (PPT) of the upper right trapezius muscle on the next day after the intervention | Examination of the first discomfort threshold using an algometer on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 
| Pressure pain threshold (PPT) of the upper left trapezius muscle before the intervention | Examination of the first discomfort threshold using an algometer immediately before the intervention. | PRE (immediately before the intervention) | 
| Pressure pain threshold (PPT) of the upper left trapezius muscle after the intervention | Examination of the first discomfort threshold using an algometer immediately after the intervention. | POST (immediately after the intervention) | 
| Pressure pain threshold (PPT) of the upper left trapezius muscle on the next day after the intervention | Examination of the first discomfort threshold using an algometer on the next day after the intervention. | FOLLOW-UP (the next day after the intervention) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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muscle energy techniques, trigger point therapy, range of motion, soft tissue properties, pressure pain threshold, combination of therapeutic methods