Interferential Current And Trapezius Myofascial Trigger Points

Study Overview
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Brief Summary
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To investigate the effect of different carrier frequencies of interferential current on pressure pain threshold, neck disability, cervical range of motion and upper trapezius muscle activity when applied on upper trapezius chronic myofascial trigger points: Randomized Controlled Trial

Detailed Description
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Interferential current (IFC) is a medium frequency current derived from the interference of two symmetrical, but asynchronous alternating currents ranged from 1 to 10 KHz. The two main currents resulting in a single interference current with properties uniquely different from the two original currents.The lesser current of the two original currents is termed the carrier frequency and the interference current is called the beat frequency. A specific beat frequency can be obtained from several possible interference currents as long as the difference between the original currents is the same. For electro pain modulation, IFC is commonly used form of electrotherapy. It has the advantage of reducing the skin impedance, deeper penetration into tissues and is perceived as more comfortable. Myofascial pain syndrome (MPS) is a common form of chronic musculoskeletal pain that widely spread and contributing to a significant financial burden and job- related disability. It represents the most common disorder in patients with nonspecific chronic neck pain.The main characteristics of MPS include the presence of myofascial trigger points (MTrPs) which are defined as hyperirritable nodule in a taut band of skeletal muscle fibers which is palpable and tender during physical examination. Trigger points (TrPs) are usually seen in the upper fiber of trapezius. TrPs can be clinically classified as either active or latent. Active TrPs was defined as: MTrPs that refer pain during activity and during rest without any pressure. They prevent full muscle lengthening and induce their weakness. Latent TrPs was defined as: MTrPs that is painful only when palpated. Evidence on the effect of IFC on pain modulation is not confirmed up till now. This might be attributed to multiple factors such as limited number of studies, inappropriate use of the parameters or using single carrier frequency (4 KHz) in majority of studies and the physiological effects of all our modalities are dose dependent. Dose depends on details of parameters including frequency. For IFC, the carrier frequency of the current has been suggested as an important parameter to achieve the most effective hypoalgesic response. However, there remains no evidence to support the selection of one carrier frequency over another. Few studies were conducted to examine the effect of different carrier frequencies by comparing their individual effects. Further researches are needed to prove which carrier frequency is more effective in treatment. Therefore, this study will be conducted to compare the effect of different carrier frequencies of the IFC in the management of upper trapezius chronic TrPs.

Official Title
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Effect of Different Carrier Frequencies of Interferential Current on Upper Trapezius Myofascial Trigger Points: A Randomized Controlled Trial

Conditions
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Upper Trapezius Trigger Points

Intervention / Treatment
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* Other: Stander treatment
* Device: Interferential current with carrier frequency 2 KHz
* Device: Interferential current with carrier frequency 4 KHz
* Device: Interferential current with carrier frequency 8 KHz
* Device: placebo interferential current


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ages from18-29 years old with unilateral chronic myofascial trigger points in upper trapezius muscle will be included in this study. Participants have chronic myofascial trigger points if they have pain with pressure, local twitch response, jump sign, limited range of motion and referred pain lies over the lateral aspect of the upper trapezius fibers and superiorly to the ipsilateral occiput. Normal body mass index (BMI) from 18-24.9 Kg/m (BMI = body mass in kg divided by participant height in meters). Exclusion Criteria: Onset of pain less than 3 months History of whiplash injury History of cervical spine surgery Cervical radiculopathy or myelopathy and cervical disc lesion Cervical spondylolisthesis Having multiple sclerosis, thyroid dysfunction and chronic infection Having rheumatologic condition as poly articular osteoarthritis, rheumatoid arthritis and advanced cervical spine degenerative diseases Skin disease and impaired sensation Phobia of using electrical current Pregnancy, tumor, thrombosis and pacemaker Administration of regular analgesic drugs or any medications that affect skin sensation. Receiving physical therapy intervention during the past three months.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 29 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
Interventional Model Description: This trial has four groups; three experimental and one group control.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Standard treatment and interferential current with carrier frequency 2 KHz<br>Standard treatment and interferential current with carrier frequency 2 KHz will be received three times a week for four weeks. | Other: Stander treatment<br>* Standard treatment will be (active cervical range of motion exercises, myofascial release to upper trapezius muscle and postural advices at home).<br>Device: Interferential current with carrier frequency 2 KHz<br>* Interferential current treatment parameters will be as following; carrier frequency 2 KHz and beat frequency 15 Hz performed for 45 minutes per session.The intensity will be raised according to the subject's tolerance, remaining in the sensory level.<br>|
| Experimental: Standard treatment and interferential current with carrier frequency 4 KHz<br>Standard treatment and interferential current with carrier frequency 4 KHz will be received three times a week for four weeks. | Other: Stander treatment<br>* Standard treatment will be (active cervical range of motion exercises, myofascial release to upper trapezius muscle and postural advices at home).<br>Device: Interferential current with carrier frequency 4 KHz<br>* Interferential current treatment parameters will be as following; carrier frequency 4 KHz and beat frequency 15 Hz performed for 45 minutes per session.The intensity will be raised according to the subject's tolerance, remaining in the sensory level.<br>|
| Experimental: Standard treatment and interferential current with carrier frequency 8 KHz<br>Standard treatment and interferential current with carrier frequency 8 KHz will be received three times a week for four weeks. | Other: Stander treatment<br>* Standard treatment will be (active cervical range of motion exercises, myofascial release to upper trapezius muscle and postural advices at home).<br>Device: Interferential current with carrier frequency 8 KHz<br>* Interferential current treatment parameters will be as following; carrier frequency 8 KHz and beat frequency 15 Hz performed for 45 minutes per session.The intensity will be raised according to the subject's tolerance, remaining in the sensory level.<br>|
| Placebo Comparator: Standard treatment and placebo interferential current<br>Standard treatment and placebo interferential current will be received three times a week for four weeks. | Other: Stander treatment<br>* Standard treatment will be (active cervical range of motion exercises, myofascial release to upper trapezius muscle and postural advices at home).<br>Device: placebo interferential current<br>* Interferential current intensity will not be raised.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pressure pain threshold | Pressure pain threshold will be measured by digital pressure algometer | Immediately after the end of the treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pressure pain threshold | Pressure pain threshold will be measured by digital pressure algometer | 12 weeks following the end of the treatment | 
| Change in neck disability | Neck disability will be measured by Arabic neck disability index | Immediately after the end of the treatment | 
| Change in neck disability | Neck disability will be measured by Arabic neck disability index | 12 weeks following the end of the treatment | 
| Change in cervical range of motion | Cervical range of motion will be measured by cervical range of motion device | Immediately after the end of the treatment | 
| Change in cervical range of motion | Cervical range of motion will be measured by cervical range of motion device | 12 weeks following the end of the treatment | 
| Change in upper trapezius muscle activity | Muscle activity will be measured by electromyography in the form of root mean square | Immediately after the end of the treatment | 
| Change in upper trapezius muscle activity | Muscle activity will be measured by electromyography in the form of root mean square | 12 weeks following the end of the treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Interferential current, Carrier frequency, Upper trapezius, Trigger points