Comparative Effects of Myofascial Decompression and Positional Release Therapies in Chronic Non-specific Neck Pain

Study Overview
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Brief Summary
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Nonspecific neck pain is defined as a neck pain not attributable to an identifiable, known specific pathology. The frequency of neck pain as found to be 84% which is exceptionally high and these are the majority of the individuals with neck pain that present to physiotherapy. In many cases, various factors contribute to the development of non-specific neck pain. These might include physical strain at work, such as working on something above you or sitting at a desk without moving enough. Emotional stress, like worries and anxiety about family or work, often plays an important role. It is thought that in some cases the cause may be an over-stretch (sprain) of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two spinal bones (vertebrae), or a minor problem with a small facet joint between two vertebrae. Objective of this study will be to compare the effects of myofascial decompression and positional release therapies on pain, range of motion and functional disability in chronic nonspecific neck pain.

Detailed Description
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Neck pain is one of the most common and painful musculoskeletal conditions. Point prevalence ranges from 6% to 22% and up to 38% of the elderly population, while lifetime prevalence ranges from 2% to 71%. For the majority of the neck disorders there is an absence of an identifiable underlying disease or abnormal anatomical structure. From this perspective .NS-NP is mainly 'diagnosed' on the basis of clinical grounds, provided there are no features to suggest a specific or more serious condition. The symptoms of nonspecific neck pain are similar to those of whiplash associated disorders (WAD) grade I and II but there is no traumatic event involved. Nonspecific neck pain (NP) is defined as pain in the posterior and lateral aspect of the neck between the superior nuchal line and the spinous process of the first thoracic vertebra with no signs or symptoms of major structural pathology and no or minor to major interference with activities of daily life as well as with the absence of neurological signs and specific pathologies. Chronic nonspecific neck pain is diagnosed as cervical pain without a known pathological basis as the underlying cause of the complaints. Some symptoms are limited cervical spine mobility and neck muscles weakness, which may be often related to other problems, such as, vertebral, neck or shoulder impaired function, and mental and physical stress at work. The natural course of non-specific 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 leading chronic nonspecific neck pain if pain duration is more than three months. As a consequence, it places a heavy burden on individuals, employers and health care services. Nonspecific neck pain is defined in the European guidelines for the management of chronic nonspecific neck pain that is not attributable to a recognizable, specific pathology (e.g., infection, tumor, osteoporosis, fracture, structural deformity, and inflammatory diseases, such as ankylosing spondylitis, radicular syndrome. Characteristic of chronic nonspecific neck pain are heavy pain, worsening with exertion and relieve with rest. In some cases the cause may be sprain or overstretch of a ligament or muscles. Nonspecific neck belongs to the group of musculoskeletal disorders, which include diverse conditions affecting muscles, bones, and/or joints of the limbs or the spine. As for most other musculoskeletal disorders, nonspecific neck is multifactorial. A variety of different types of exercise have been explored to treat chronic neck pain, including low-to-moderate intensity aerobic exercise, high intensity aerobic exercise, stretching exercise and muscular strength exercises and isometrics. However, the most effective form of exercise as a method of rehabilitation non-specific neck pain is unknown reflecting its complexity and more research is require. The rationale of the study is to compare the effects of myofascial decompression and positional release therapies on pain, range of motion and functional disability in chronic nonspecific neck pain. The main purpose of myofascial decompression therapy and positional release therapy is to release the cervical trigger points, improving end ranges and lengthening of muscle. MDT helps draw toxins out of the muscles and to the superficial veins to be removed by the body. This leads to decreased pain and tension in the tissues. The ultimate goal is to achieve pain free end ranges and flexibility of muscle in nonspecific neck pain patients.

Official Title
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Comparative Effects of Myofascial Decompression and Positional Release Therapies on Pain, Range of Motion and Functional Disability in Chronic Non-specific Neck Pain

Conditions
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Chronic Non-specific Neck Pain

Intervention / Treatment
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* Other: Myofascial Decompression Therapy
* Other: positional Release Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Neck patients age 25 to 50 years. Both male and female genders. Mild to moderate back pain with NPRS pain score value of between more than 6/10. Pain from at least past three months (12 weeks). Trigger points within the muscle. Exclusion Criteria: Diagnosis of systemic metabolic and/or neurological disorders. Patients with sensory impairments, such as diabetic sensory neuropathy. Neuropathic pain. Any referred pain or neurological involvement in lower limbs is not included.

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 50 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Myofascial Decompression Therapy<br>15 minute's moist heat will be given first. Patient was lied prone on couch with their upper torso unclothed, covered with massage oil than placed cup on skin and suction will created in cups by pump. | Other: Myofascial Decompression Therapy<br>* Group A will be given myofascial decompression therapy.15 minute's moist heat will be given first. Patient was lied prone on couch with their upper torso unclothed, covered with massage oil than placed cup on skin and suction will created by pump. Than drawn over skin along the spine from cervical to thoracic up to lateral border maintain the suction within skin throughout the procedure. The cup massage will conducted for approximately 10 minutes. Patients were informed that the treatment area may become patchy and there are chances of ecchymosis on the same area.<br>|
| Experimental: Positional Release technique<br>Positional Release technique (PRT) is apply after application of moist heat pack for 15 minute. The subjects received PRT will be in supine lying with the therapist sitting on the affected side, tender points were located along with the upper fibers of trapezius muscle. The subject's head was laterally flexed towards the side of tender point, then therapist grasps the subject's forearm and abducts shoulder to approximately 900 and adds slight flexion or extension to fine-tune. | Other: positional Release Therapy<br>* Group B will be given Positional Release technique (PRT) after application of moist heat pack for 15 minute. The subjects received PRT will be in supine lying with the therapist sitting on the affected side, tender points were located along with the upper fibers of trapezius muscle. The subject's head was laterally flexed towards the side of tender point, then therapist grasps the subject's forearm and abducts shoulder to approximately 90 degree and adds slight flexion or extension to fine-tune. The ideal position of comfort achieved was held for a period of 90 sec and followed by passive return of body part to an anatomically neutral position continued for 5 minutes. Treatment duration was 3 sessions per week for 4 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numerical Rating Scale (NPRS) | Numerical Rating Scale (NPRS) Numeric Rating Scale (NPRS) is most frequently used instruments to measure pain intensity in neck pain .The 11-point numeric with 0 representing No pain, 1-3 representing Mild Pain (nagging, annoying, interfering little with ADLs), 4-6 representing Moderate Pains (interferes significantly with ADLs), 7-10 representing Sever Pain (disabling, unable to perform ADLs) | 6th week | 
| Neck Disability Index (NDI) | The NDI can be scored as a raw score or doubled and expressed as a percent. Each section is scored on a 0 to 5 rating scale, in which zero means 'No pain' and 5 means 'Worst imaginable pain. Points summed to a total score The test can be interpreted as a raw score, with a maximum score of 50, or as a percentage.,0 points or 0% means : no activity limitations .50 points or 100% means complete activity limitation. A higher score indicates more patient-rated disability. For patients' understanding, the URDU version is used. A clinically important change was calculated as 5 points, with a sensitivity of 0.78 and a specificity of 0.80 | 6th week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ROM cervical spine (flexion) | The patient is seated with upper back supported with chair the center of goniometer is placed over the external auditory meatus, proximal arm is Perpendicular or parallel to ground and distal arm With base of nares or parallel to longitudinal axis of tongue depressor for measuring range of cervical flexion | 6th week | 
| ROM cervical spine (extension) | The patient is seated with upper back supported with chair the center of goniometer is placed over the external auditory meatus, proximal arm is Perpendicular or parallel to ground and distal arm With base of nares or parallel to longitudinal axis of tongue depressor and patient extend neck, for measuring the cervical extension ROM. | 6th week | 
| ROM cervical spine (side flexion) | The patient is seated with upper back supported with chair the center of goniometer is placed Over spinous process of C7,proximal arm over Spinous processes of thoracic vertebrae so that arm is perpendicular to ground and distal arm place over Dorsal midline of head. Reference occipital protuberance for side flexion | 6th week | 
| . ROM cervical spine (Rotation) | The patient is seated with upper back supported with a chair the center of the goniometer is placed Over center of cranial aspect of head, proximal arm is placed Parallel to imaginary line between the two acromial processes and distal arm With the tip of the nose. If using the tongue depressor, parallel to the longitudinal axis of tongue depressor for cervical rotation ROM. | 6th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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non-specific neck pain, myofascial decompression therapy, positional release therapy