Muscle Energy Technique Versus Strain Counterstrain for Upper Trapezius Myofascial Pain Syndrome

Study Overview
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Brief Summary
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This study will be conducted to examine the superiority of effectiveness between muscle energy technique combined with physical therapy, strain counterstrain combined with physical therapy, and physical therapy alone in terms of pain intensity, pain pressure threshold, cervical lateral flexion and rotation range of motion, and neck function for patients with upper trapezius myofascial trigger points.

Detailed Description
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Myofascial pain syndrome represents a common, overlooked, and under-diagnosed disorder that have very critical negative effects on people's lives. In addition, it overloads the societies and causes several burdens on healthcare systems. However, this disorder is usually dismissed by many clinicians keeping the patients in pain for long periods. The central feature of myofascial pain syndrome is the myofascial trigger points that when managed properly, the painful symptoms disappear. Muscle energy technique and strain counterstrain immediate effects were compared in a recent comparative study for patients with upper trapezius myofascial trigger points in terms of pain intensity, pain pressure threshold, and neck mobility. The results showed that there were improvements of both techniques with no significant differences between them. Regarding the evidence of the two techniques; muscle energy technique and strain counterstrain in the management of patients with upper trapezius myofascial trigger points, there is lack of high-quality evidence investigating the effectiveness and safety of both techniques for this population and there is a need for well-developed randomized controlled trial to take a step in the pyramid of levels of evidence for the use and applicability of them. After reviewing the available literature, it was found that there is no study directly combined both techniques with physical therapy protocol in a randomized clinical trial for patients with upper trapezius myofascial trigger points; this will enable us to compare the effects of them in a controlled design to examine and find out the differences between the three treatment protocols.

Official Title
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Muscle Energy Technique Versus Strain Counterstrain in Treatment of Upper Trapezius Myofascial Pain Syndrome: A Double-Blinded Randomized Controlled Trial

Conditions
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Physical Therapy

Intervention / Treatment
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* Procedure: Muscle energy technique combined with the physical therapy program.
* Procedure: Strain counterstrain technique combined with the physical therapy program
* Procedure: The physical therapy program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Patients will be included in the study if they fulfil the following criteria: They have active myofascial trigger points in the upper trapezius muscle bilaterally according to the established criteria for myofascial trigger points examination. They have neck pain less than three months. Their age ranges from 18 to 40 years old. Exclusion Criteria Patients will be excluded from the study if they fulfil the following criteria: Patients with chronic pain syndrome. Patients having myofascial trigger points in other neck muscles. Patients having a history of an injury or surgery or instability or deformity including both; cervical spine and shoulder. Patients diagnosed with a neurological disorder including altered sensation, migraine, cervical spondylosis, radiculopathy, or myelopathy, and tumour. Patients with a systemic disease including rheumatoid arthritis, Reiter's syndrome, diabetes, fibromyalgia syndrome, and severe medical or psychiatric disorders.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 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: Randomized controlled trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A<br>Experimental group 1. | Procedure: Muscle energy technique combined with the physical therapy program.<br>* A manual therapy technique<br>|
| Experimental: Group B<br>Experimental group 2. | Procedure: Strain counterstrain technique combined with the physical therapy program<br>* A manual therapy technique<br>|
| Experimental: Group C<br>Experimental group 3. | Procedure: The physical therapy program<br>* Electrotherapy and exercise.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pain intensity. | Measurement of pain intensity using the visual analogue scale. | Change from Baseline pain intensity at one month. | 
| Change in the right side pain pressure threshold. | Measurement of right side pain pressure threshold using the pressure algometer. | Change from Baseline right side pain pressure threshold at one month. | 
| Change in the left side pain pressure threshold. | Measurement of left side pain pressure threshold using the pressure algometer. | Change from Baseline left side pain pressure threshold at one month. | 
| Change in cervical flexion range of motion. | Measurement of cervical flexion range of motion using the cervical range of motion device. | Change from Baseline cervical flexion range of motion at one month. | 
| Change in cervical extension range of motion. | Measurement of cervical extension range of motion using the cervical range of motion device. | Change from Baseline cervical extension range of motion at one month. | 
| Change in cervical right lateral flexion range of motion. | Measurement of cervical right lateral flexion range of motion using the cervical range of motion device. | Change from Baseline cervical right lateral flexion range of motion at one month. | 
| Change in cervical left lateral flexion range of motion. | Measurement of cervical left lateral flexion range of motion using the cervical range of motion device. | Change from Baseline cervical left lateral flexion range of motion at one month. | 
| Change in cervical right rotation range of motion. | Measurement of cervical right rotation range of motion using the cervical range of motion device. | Change from Baseline cervical right rotation range of motion at one month. | 
| Change in cervical left rotation range of motion. | Measurement of cervical left rotation range of motion using the cervical range of motion device. | Change from Baseline cervical left rotation range of motion at one month. | 
| Change in neck function. | Measurement of neck function using the neck disability index-Arabic version. | Change from Baseline neck function at one month. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Muscle energy technique, strain counterstrain, trapezius.