Comparative Effects of Dry Needling and Ischemic Compression Technique on Scalene Myofascial Pain Syndrome

Study Overview
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Brief Summary
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Myofascial Pain Syndrome (MPS) is a medical term used to describe chronic regional pain syndrome that presents with hyperirritable spots called trigger points (TPs) and/or tender spots (TSs) that arise from taut bands (TB) in the skeletal muscle. Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. Functionally, MPS causes the muscle to become weak and stiff, leading to reductions in range of movement. Thus, MPS is known as a major cause of morbidity, with a significant impact on daily activity, function and quality of life. The aim of this study is to compare the effects of dry needling versus ischemic compression technique on trigger points of scalene in neck pain, related disability and neck active range of motion among patients with scalene myofascial pain syndrome.

Detailed Description
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A Randomized clinical trial will be conducted at DHQ Gujranwala and Sikandar medical complex Gujranwala through convenience sampling technique on 24 patients. Patients with scalene myofascial pain syndrome between age from 18 years to 45 with positive Scalene Cramp Test will be included in study. Patients will be accessed for neck pain, disability and active range of motion. They will be allocated through simple random sampling through sealed opaque envelopes into group A and group B. Patients in dry needling (DN) group will receive a single session of DN with sterile needles insert on trigger points in scalene muscles as first twitch response will obtained needles will be manipulated in and out of the muscles to get 2 or 3 more local responses. Patients in Group B will receive a single session of ischemic compression technique for this ischemic compression technique sustained pressure on the trigger points will be maintained for 30 seconds. Control treatment will be same for both groups. Pre and post treatment values will be identified after one month follow-up.

Official Title
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Comparative Effects of Dry Needling and Ischemic Compression Technique on Pain, Disability and Range of Motion With Scalene Myofascial Pain Syndrome

Conditions
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Scalenus Syndrome

Intervention / Treatment
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* Other: Ischemic compression
* Other: Dry needling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with scalene myofascial pain syndrome Age from 18 years to 45 Patients with positive Scalene Cramp Test Exclusion Criteria: Whiplash injury Thoracic dysfunction any cervical radiculopathy Age below 18 and more than 45 years Any psychiatry disorder or Any contraindication to Dry Needling

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 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 |
| --- | --- |
| Experimental: Ischemic compression<br>Patients in Group B will receive a single session of ischemic compression technique for ischemic compression technique sustained pressure on the trigger points will be maintained for 30 seconds. | Other: Ischemic compression<br>* Ischemic compression technique is a massage technique that consists of moderate compression, typically applied with the fingers, to the MTrP. Application of this technique to an MTrP results in a positive effect on pain-pressure threshold. Patients in Group B will receive a single session of ischemic compression technique for ischemic compression technique sustained pressure on the trigger points will be maintained for 30 seconds.<br>|
| Active Comparator: Dry Needling<br>Patients in dry needling (DN) group will receive a single session of DN of 10 minutes with sterile needles insert on trigger points in scalene muscles as first twitch response will obtained needles will be manipulated in and out of the muscles to get 2 or 3 more local responses. | Other: Dry needling<br>* Trigger-point dry needling is an invasive procedure where a fine needle or acupuncture needle is inserted into the skin and muscle. Patients in dry needling (DN) group will receive a single session of DN of 10 minutes with sterile needles insert on trigger points in scalene muscles as first twitch response will obtained needles will be manipulated in and out of the muscles to get 2 or 3 more local responses.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | The Numeric Pain Rating Scale (NPRS) an outcome measure that is a unidimensional measure of pain intensity in adults, including those with chronic pain. The NPRS is a segmented numeric version in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of pain. The 11-point numeric scale ranges from '0' representing one pain extreme (e.g. no pain) to '10' representing the other pain extreme (e.g. pain as bad as you can imagine or worst pain imaginable). The NPRS takes <1 minute to complete The NPRS is a valid and reliable scale to measure pain intensity; High test-retest reliability has been (r = 0.96 and 0.95, respectively) For construct validity, the NPRS was shown to be highly correlated: correlations range from 0.86 to 0.95. | follow up at 4th week | 
| Neck Disability Index (NDI) | This questionnaire has been designed to give us information as to how your neck pain has affected your ability to manage in everyday life. Every section is marked in each section only the one box that applies to you. We realise you may consider that two or more statements in any one section relate to you, but please just mark the box that most closely describes your problem. Intended population includes: Chronic neck or upper back pain and musculoskeletal neck pain. Scoring: 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. | follow up at 4th week | 
| Universal Goniometer (UG) | A goniometer is an instrument that measures the available range of motion at a joint. To measure the range of motion physical therapists most commonly use a goniometer. It is necessary that a single notation system is used in goniometry. The neutral zero method (0 to 180- degree system) is the most widely used method. The same goniometer should always be used to reduce the chances of instrumental error. | follow up at 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pain, dry needing, myofascial pain, disability