Dynamic Myofascial Release in Patients With Non-specific Neck Pain.

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effects of Dynamic Myofascial Release in Patients With Non-specific Neck Pain.

Conditions
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Neck Pain

Intervention / Treatment
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* Other: Assigned Interventions
* Other: Dynamic myofascial release


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants had a complaint of non-specific pain in the neck with duration of at least 3 weeks. The area of neck pain was defined to the cervical Region, with or without radiating to head or arms. Patients with tight upper trapezius or levator scapulae or both with or without the presence of myofascial trigger points. Exclusion Criteria: NP due to traumatism, fractures, or whiplash; Neoplasia, severe osteoporosis, infectious, or inflammatory processes. Ppatient's with pacemakers, congenital anomalies, previous neck surgery, or pregnancy. Patients who had received MRT in the previous month.

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional physical therapy<br>Cervical isometrics and Muscle Stretching | Other: Assigned Interventions<br>* 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.<br>|
| Experimental: Dynamic myofascial release<br>Experimental group was given Dynamic myofascial release along with the cervical isometrics and muscle stretching | Other: Dynamic myofascial release<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric pain rating scale | The NPRS can be administered verbally or graphically for self-completion. The respondent is asked to indicate the numeric value on the segmented scale that best describes their pain intensity. High test-retest reliability has been observed (r = 0.96 and 0.95, respectively with minimum score 0 to maximum 10 | 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Inclinometer | The instrument has an inclination needle, affected by gravity that is used to measure ranges of cervical spine, with ICCs ranging from .89 to .94 | 2 weeks | 
| Neck Disability Index | The Neck Disability Index (NDI) is a 10-item questionnaire that measures a patient's self-reported neck pain related disability. It has been shown to have high test-retest reliability. The NDI has also been shown to be valid when comparing it to other pain and disability measures. Each of the 10 items is scored from 0 - 5. The maximum score is therefore 50 | 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neck Pain, Myofascial Release, Dynamic Myofascial Release