original paper Physiotherapy Quarterly (ISSN 2544-4395)

2021, 29(1), 17–23

© University School of Physical Education in Wrocław

Investigating the effectiveness of adding microcurrent therapy

to a traditional treatment program in myofascial pain syndrome
in terms of neck pain and function
doi: [Link]

Kadrya H. Battecha1,2, Dalia M. Kamel3, Sayed A. Tantawy4,5

1
Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
2
Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
3
Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
4
Department of Physiotherapy for Integumentary Problems, Faculty of Physiotherapy, Deraya University, Minya, Egypt
5
Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt

Abstract
Introduction. To investigate the effect of microcurrent on pain, pain threshold, range of motion, neck muscle strength, and
neck function.
Methods. It is a pilot study involving 28 female subjects (aged 18–24 years) complaining of neck pain due to active unilateral
trigger points in upper trapezius muscle. The subjects were randomly assigned to 2 groups: group I (n = 15) received microcur-
rent (frequency: 20 Hz, intensity: 25–30 µA) and traditional treatment in the form of stretching exercise for upper fibre of trapezius,
isometric strengthening exercise, ischaemic compression technique; group II (n = 13) received only traditional treatment. All
subjects received 2 sessions per week for 3 weeks.
Results. There was a significant improvement (p < 0.05) in cervical range of motion, pain level, neck disability index, and pain
threshold in both treatment groups. Isometric muscle strength was significantly increased (p < 0.05) in group I, with no significant
(p > 0.05) difference in group II. Group I showed a more significant effect in all measured variables than group II. Neck disability
index and muscle strength presented a significant change (p < 0.05) with respect to group and time interaction.
Conclusions. Microcurrent therapy added to traditional treatment increased the effectiveness of myofascial pain syndrome
treatment as compared with traditional treatment alone.
Key words: microcurrent, myofascial pain syndrome, trigger points, upper trapezius, neck pain

Introduction neural activation and potential generation of action [6]. Other

pathological findings associated with sustained hypercon-
Neck pain is the most common problem that can be seen traction are sarcomere shortening, protein degradation, and
in myofascial trigger point syndrome. Neck pain found to af- myofiber and mitochondrial swelling; all are consistent with
fect 60–80% of employees, which results in significant social, metabolic stress, reduced blood flow, and adenosine triphos-
psychological, and economic burdens. It is associated with phate (ATP) depletion [6]. In addition, cell stress triggers the
headache and pain radiating into the arm and upper back, release of myokines, inflammatory cytokines, and neurotrans-
and its occurrence is higher in women (15%) than men mitters that undoubtedly contribute to these MTrPs and myo-
(9%) [1]. Women have the highest incidence at the age of 45 fascial pain syndrome [7].
and men at the age of 60 [2]. Clinically, MTrPs are defined as active or latent. Active
Myofascial pain syndrome is characterized by local pain MTrPs are recognized as eliciting spontaneous pain, referred
originating from hyperirritable palpable spots located within pain, motor and/or autonomic symptoms on palpation [8]. In
taut bands of skeletal muscles, known as myofascial trigger turn, latent MTrPs upon palpation/compression lead to pain,
points (MTrPs) [3]. MTrPs have 2 important characteristics: a local twitch response, and referred pain [9].
referred pain and muscle twitch. They also have motor, sen- There are several causes and risk factors that result in
sory, and autonomic features. The motor features of MTrPs MTrPs, the most common ones being direct or indirect trau-
may include disturbed motor function, muscle weakness, ma, spine pathology, exposure to cumulative and repetitive
muscle stiffness, and restricted range of motion (ROM) [2]. strain, such as with tennis players, postural dysfunction like
Sensory aspects include local tenderness, referral of pain, sitting on a chair with poor back support, and factors relat-
paraesthesia, and numbness, while autonomic aspects in- ed to lifestyle, as lack of exercises [4, 6].
clude sleep disturbance [4]. There are many treatment modalities to manage MTrPs,
In all cases, MTrPs are associated with areas in a muscle such as injections, drugs, dry needle, manual therapy, and
that have stiff, tender nodules during palpation. This stiffness electrotherapy. Manual therapy is one of the most effective
might arise from hyper-contracture of the sarcomere in this treatments; it involves different skilled hands- and fingers-on
area [5]. Muscle hyper-contracture is consistent with sus- techniques directed to the body of the patient [10, 11]. Sev-
tained sarcoplasmic reticulum calcium release due to intense eral manual techniques are used to relieve MTrPs, such as

Correspondence address: Dalia M. Kamel, Department of Physical Therapy for Women’s Health, Faculty of Physical Therapy, Cairo University,
2 Ahmed Ezzat st, Dokki, Giza, Cairo, Egypt, e-mail: dr_daliakamel@[Link]

Received: 02.01.2020
Accepted: 21.03.2020

Citation: Battecha KH, Kamel DM, Tantawy SA. Investigating the effectiveness of adding microcurrent therapy to a traditional treatment
program in myofascial pain syndrome in terms of neck pain and function. Physiother Quart. 2021;29(1):17–23; doi: [Link]
pq.2020.96421.
 K.H. Battecha, D.M. Kamel, S.A. Tantawy Physiother Quart 2021, 29(1)
Microcurrent therapy in myofascial pain syndrome [Link]

manipulation, mobilization, static stretching, muscle energy Evaluation procedures

techniques, and ischaemic compression. Ischaemic com-
pression is sustained slow progressive strong pressure on Pain assessment
the painful area of the trigger point to eliminate pain and de-
crease tension in the muscle through reperfusion and tran- Pain intensity was subjectively measured with the Pa-
sient blood flow occlusion [12]. It is performed by compress- tient-Reported Outcomes Measurement Information System
ing the trigger points with tolerable pain intensity using thumb (PROMIS) form 3a, which is effective, reliable, and valid [18].
pressure or a pressure algometer, and as the degree of pain It includes 3 questions about pain intensity in the past 7 days
decreases, the intensity of compression is increased simul- and each question has a score from 1 to 5, with 1 standing for
taneously [12]. no pain and 5 for very severe pain.
Electrical stimulation is a modality that can be used with As an objective method, a pressure algometer was used
MTrPs, as it reduces pain, induces muscle stimulation and (Force One Gauge, model FDI, Wagner Instruments, Green-
stimulation of denervated muscles [13]. Recently, it has been wich, USA). The device serves to identify the pressure and
demonstrated that mechanical stimulation of MTrPs can in- force amount, eliciting pressure pain thresholds [19]. Pres-
duce central sensitization mechanisms in healthy subjects [14]. sure algometers are employed for pain threshold evaluation,
Electrotherapeutic modalities such as interferential currents, therapeutic effects determination, and follow-up treatment
magnetic stimulation, laser therapy, and ultrasound therapy surveys in many musculoskeletal diseases [20] and specifi-
are the most common modalities that can be used [15]. cally in myofascial syndrome [21]. They have high inter-rater
Microcurrent electrical stimulation is a non-invasive elec- reliability in MTrPs assessment [22]. The algometer regis-
trotherapeutic modality that can be applied to control acute ters the force applied to a tissue in terms of kilograms per
and chronic pain, as well as accelerate healing. With subsen- square centimetre. In the present study, the subjects were
sory current provided to the tissue in a millionth of an ampere, positioned comfortably, and the painful side and site were
intensities are achieved of 1–999 µA. Microcurrent increases identified. The site was palpated to determine the presence
ATP concentration and membrane transport, and enhances of MTrPs in the upper trapezius. The palpated trigger points
protein synthesis [16]. It has also been reported to decrease were marked with a skin marker. The pressure algometer
inflammation, swelling, oedema, and increase ROM, strength, probe was placed on the trigger point and a constant vertical
and muscle relaxation [16, 17]. pressure was applied to the site. The subject was instructed
Therefore, this study was performed to investigate the to express pain by raising their hand when only slight pain
effect of microcurrent therapy on pain intensity, pressure pain was felt; until then, the pressure was increased at a constant
threshold, neck ROM, neck muscle strength, and neck func- rate. The procedure was performed 3 times and the average
tion. It also aimed to verify if there was a difference between value was recorded [12]. Patients were evaluated twice, be-
using traditional treatment alone and using microcurrent fore and after the 3 weeks of treatment.
therapy combined with traditional treatment in all measured
variables. Trigger point assessment

Subjects and methods Trigger points were diagnosed while the subject was sit-
ting, by palpation of the upper trapezius muscle along its axis
Subjects with a thumb, from its origin in the occipital protuberance to its
insertion at the medial border of the lateral acromion pro-
The study involved 28 female students selected from cess. The detection of a trigger point depended on the diag-
Umm Al-Qura University who complained of neck pain due nostic criteria, which were the presence of a taut band, ten-
to active unilateral MTrPs in the upper trapezius muscle. derness at it, referred pain, local twitching response, and jump
The inclusion criteria were as follows: age ranging from 18 to sign [2, 12].
24 years, body mass index < 25, chronic neck pain for > 3
months, pain intensity of > 4 on the visual analogue scale, Neck function
presence of a palpable nodule during examination, presence
of a tender area during palpation in addition to limited neck It was measured by using the neck disability index (NDI),
extension and side bending ROM. which is commonly applied as a self-reported measure for
Participants were excluded if they had a history of head patients with neck pain symptoms and their effect on activi-
trauma, neck or shoulder operation, cervical spondylolisthe- ties and functions. NDI has 4 items related to subjective symp-
sis, cervical neuropathy, cervical stenosis, fibromyalgia, rheu- toms and 6 items related to activities of daily living. The
matoid arthritis, temporomandibular joint dysfunction, long- answers are expressed on a 6-point scale, ranging from 0
term steroid use, or use of any analgesic, anti-inflammatory (no disability) to 5 (full disability), and the numeric responses
drugs, or any medications that alter muscle tone over the for each item were summed to form a score varying from 0
preceding 24 hours. to 50 [23]. NDI has been shown to be reliable and valid in
The subjects were randomly assigned to 2 groups: group I many patient populations [24].
(study group) received microcurrent (frequency: 20 Hz, inten-
sity: 25–30 µA, duration: 9 minutes) combined with traditional Neck muscle strength
treatment (stretching exercise for upper fibre of trapezius,
isometric strengthening exercise, ischaemic compression The isometric strength was measured by a multi-cervical
technique); group II (control group) received traditional treat- unit device (BTE Technologies Inc., Hanover, USA), which is
ment only. Each treatment group received 2 sessions per a biomechanical system developed specifically to measure
week for 3 weeks. All participants were given a full explana- the cervical isometric strength [25]. The multi-cervical unit
tion of the treatment protocol. system consists of an adjustable height seat, armrest, lumbar
support, and armchair that can rotate 90° to measure neck
lateral flexion. It has a shoulder restraint system which iso-
18
Physiother Quart 2021, 29(1) K.H. Battecha, D.M. Kamel, S.A. Tantawy
[Link] Microcurrent therapy in myofascial pain syndrome

lates the cervical spine from the thoracic spine to eliminate ditional treatment involved both groups of the study, 2 times
any errors. There is also a unique head system assembly per week for 3 weeks.
(inner and outer one) to permit the head to move safely. The
inner brace is moveable and used during measuring head Statistical analysis
flexion, extension, and lateral rotation; it can insert a load cell
in it to measure isometric head strength. The load cell is con- All the collected data were tabulated and exported to
nected to a computer that collects the isometric strength the SPSS software (Statistical Package for the Social Sci-
automatically [26]. ences) version 23 for analysis. In addition to descriptive sta-
tistics, the Wilcoxon test was used to compare pre- and post-
Neck range of motion treatment pain scores, pressure pain thresholds, and NDI
values within groups. The Mann-Whitney U test determined
ROM was measured by a cervical ROM device, which is differences between pre- and post-treatment pain scores,
reliable in all neck movement directions [27]. The device was pressure pain thresholds, and NDI values between groups.
applied to the head, aligning on ears and the nose, and was For cervical ROM and isometric muscle strength, paired and
fixed to the head by a strap. The measurement was taken unpaired t-test was used to detect differences within and be-
while the subject was in a sitting position. Cervical ROM was tween groups, respectively. Two-way ANOVA was applied to
collected for rotation, flexion/extension, and lateral flexion. assess the group-time interaction for all dependent variables.
The device had 3 separate inclinometers, calibrated to 0 by The Shapiro-Wilk test served to verify data normality for both
a magnetic neck brace: the first inclinometer in the trans- groups.
verse plane for rotation, the second in the sagittal plane for
flexion/extension, and third inclinometer in the frontal plane Ethical approval
for lateral flexion [28]. The research related to human use has complied with all
the relevant national regulations and institutional policies, has
Treatment procedures followed the tenets of the Declaration of Helsinki, and has
been approved by the authors’ institutional review board or
Microcurrent electrical stimulation an equivalent committee.

While the subject was in a prone position, the microcur- Informed consent
rent electrical stimulation device was applied per skin in 2 Informed consent has been obtained from all individuals
phases. In phase 1 (trigger method), it was applied perpen- included in this study.
dicular and in slight compression on each trigger point for
3 minutes; in phase 2 (relaxation method), it was applied by Results
manual scanning in the transfer technique on the upper fibres
of the trapezius muscle for 3 minutes. A frequency of 20 Hz A total of 28 subjects participated in the study, with mean
and intensity of 25–30 µA were used, depending on the sub- age of 21.04 ± 1.3 years, weight of 53.95 ± 7.4 kg, height of
ject’s tolerance. The whole session took 9 minutes. This ap- 160 ± 5.4 cm, and body mass index of 20.95 ± 2.2 kg/m2.
plication only involved group I (study group), 2 times per week Unpaired t-test was used to compare subject demographics
for 3 weeks. in both treatment groups and there was no significant differ-
ence between the subjects’ age, weight, height, or body mass
Traditional treatment index, with the p values equal 0.90, 0.95, 0.86, and 0.98,
respectively (Table 1).
Ischaemic compression in the form of sustained pressure Regarding PROMIS scores for pain level and NDI val-
was applied for 60 seconds twice, with a 30-second rest in ues for neck function, both groups showed a significant
between, while the subjects were in a sitting position. It was within-group improvement (p < 0.05) after the treatment.
exerted by a thumb on the painful area, while applying slow Between-group comparisons revealed nonsignificant pre-
progressive pressure by the other thumb and gradually in- treatment differences (p > 0.05) and significant post-treat-
creasing pressure as the pain decreased [29]; the procedure ment differences (p < 0.05) in favour of group I (Table 2).
was performed 3 times. For cervical ROM (extension, right and left side bending),
Stretching and strengthening exercise, as well as stretch- within-group comparisons showed a significant improve-
ing exercise for trapezius upper fibres, lasting for 15–20 sec- ment (p = 0.0001) in both groups. Between-group compari-
onds, were repeated 3 times. Then, isometric strengthening sons revealed significant post-treatment differences (p =
exercise followed, giving maximum resistance for head exten- 0.001) in favour of group I; before treatment, the differences
sion and neck side flexion. Each position was maintained for between groups were nonsignificant (p > 0.05) (Table 3).
10–15 seconds and repeated 5 times. The application of tra-

Table 1. Subjects’ demographic characteristics in both groups

Group I Group II t p

Age (years) 21.00 ± 0.925 21.07 ± 1.60 –0.123 0.90

Weight (kg) 54.06 ± 8.32 53.88 ± 7.15 0.052 0.95

Height (cm) 160 ± 4.59 160 ± 6.05 0.179 0.86

Body mass index (kg/m2) 20.93 ± 2.78 20.96 ± 1.98 –0.023 0.98

Number 15 13
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 K.H. Battecha, D.M. Kamel, S.A. Tantawy Physiother Quart 2021, 29(1)
Microcurrent therapy in myofascial pain syndrome [Link]

Table 2. Changes in pain, pain threshold, and neck disability index in both groups
Group I Group II Mann-Whitney p

Before treatment 7.40 ± 1.68 3 ± 0.91 89.500 0.7216c

After treatment 2.60 ± 0.91 5.69 ± 2 6.000 < 0.001a

PROMIS
Wilcoxon value 120.00 78.00

p 0.001b 0.005b

Before treatment 3.47 ± 0.7 4.08 ± 1.39 72 0.25

After treatment 8.18 ± 1.74 6.36 ± 1.62 46 0.012a

PPT
Wilcoxon value –120.00 –75.000

p 0.0001b 0.001b

Before treatment 25.15 ± 4.5 28.25 ± 6.4 1.498 0.15

After treatment 14 ± 6.5 18 ± 3.5 1.981 0.04a

NDI
Wilcoxon value 5.462 4.522

p 0.0001b 0.0001b
Data expressed as mean ± standard deviation and percentage of improvement
PROMIS – Patient-Reported Outcomes Measurement Information System, PPT – pressure pain threshold, NDI – neck disability index
a
significant difference between both groups (Mann-Whitney test, p < 0.05), b significant difference within a group (Wilcoxon test, p < 0.05)
c
non-significant difference
Table 3. Changes in cervical ROM in both groups
Group I Group II t p

Before treatment 58.4 ± 11.32 50.45 ± 1.731 0.49 0.62

After treatment 70 ± 5.4 52.7 ± 1.21 5.31 0.001a

Extension
t 6.277 7.784

p 0.0001b 0.0001b

Before treatment 57.8 ± 2.04 56.4 ± 1.5 1.194 0.24

After treatment 63.3 ± 1.59 60.8 ±1.93 12.3 0.0001a

Right side bending
t 16.24 9.78

p 0.0001b 0.0001b

Before treatment 57.9 ± 1.94 57.2 ± 2.19 2.14 0.64

After treatment 63.5 ± 4.07 60.9 ± 1.86 15.56 0.0001a

Left side bending
t 7.427 4.57

p 0.0001 b
0.0001b
Data expressed as mean ± standard deviation and percentage of improvement
a
significant difference between both groups (unpaired t-test, p > 0.05), b significant difference within a group (paired t-test, p > 0.05)

12
10,5
10
8,4
8 6,85 6,84 6,84
5,7
[N]

6
4,55 4,24
3,57
4 2,98 3,09
2,64
2

0
Pre Post Pre Post Pre Post
Extension Rt side bending Lt side bending

Group I Group II
20 Figure 1. Isometric muscle strength in both groups
Physiother Quart 2021, 29(1) K.H. Battecha, D.M. Kamel, S.A. Tantawy
[Link] Microcurrent therapy in myofascial pain syndrome

Isometric muscle strength in each movement was tested. old values, trigger point sensitivity pain intensity [30], cervical
For group I, extension showed an increase from an average active ROM [31], and neck muscle strength [32]. Furthermore,
5.70 ± 2.28 to 10.5 ± 2.4 (p = 0.001, paired t-test), while in stretching exercises permit recovery of functional muscle
group II, the value increased from an average 6.85 ± 3.0 to length, stress relief, improvement in postural realignment, and
8.4 ± 2.1 and this was a nonsignificant difference (p = 0.14, freedom and awareness of movement [33, 34]. In turn, spe-
paired t-test). Between-group comparisons revealed a non- cific strength training is able to decrease pain and disability,
significant pre-treatment difference (p = 0.26, unpaired t-test) as well as increase strength in the muscles of the neck
and a significant post-treatment difference (p = 0.02) in fa- [35–37]. A combination of stretching and strengthening en-
vour of group I (Figure 1). Regarding within-group compar- courages the joint and muscle mechanoreceptors and pro-
isons for the right and left side bending, group I presented prioceptors [38]. This would reduce pain sensation via the in-
a significant improvement (p = 0.001 and 0.0001, respec- hibitory effects of Golgi tendon organs, which decrease the
tively, paired t-test) as it improved from 2.98 ± 0.79 to 6.84 motor neuronal discharges, leading to relaxation of the mus-
± 1.55 in right bending and changed from 2.64 ± 0.94 to culotendinous unit by resetting its resting length and modi-
6.84 ± 1.55 in left bending. In group II, right bending showed fication of Pacinian corpuscles [39].
a nonsignificant difference (p = 0.2, paired t-test) and changed Group I received additional treatment by microcurrent
from 3.57 ± 1.73 to 4.55 ± 2.15, while left bending demon- electrical stimulation and showed significant differences in
strated a very weakly significant difference (p = 0.07, paired comparison with group II (control group). Microcurrent ther-
t-test) and changed from 3.09 ± 1.58 to 4.24 ± 1.68. Between- apies are now being increasingly recognized as an adjunct for
group comparisons revealed significant post-treatment differ- pain relief and autonomic nervous system regulation [40, 41].
ences (p = 0.003 and 0.001, respectively, unpaired t-test) for The results obtained in group I can be attributed to micro-
right and left bending in favour of group I, and nonsignificant current mimicking human bio-cellular communications that
pre-treatment differences (p = 0.24 and 0.9, respectively, regulate the autonomic nervous system, which results in body
unpaired t-test) for both movements. wide therapeutic benefits [40]. Furthermore, microcurrent
Two-way ANOVA was conducted to examine the interac- activates reductions in inflammatory cytokines and increases
tion between subject group and time span. For pain, there was -endorphin release [42], leading to prolonged pain relief after
a nonsignificant interaction between the groups and assess- microcurrent electrical stimulation.
ment time for pain level (F = 0.46, p = 0.50). On the other In the current study, microcurrent therapy was combined
hand, time showed a significant reduction when measured with traditional treatment. This is consistent with Bonacci and
after 3 weeks as compared with the beginning of the study Higbie [43], who reported that the use of microcurrent alone
(p = 0.0005) but there was no difference between groups was not effective in reducing pain and increasing muscle func-
(p = 0.50). For pain threshold, there was a nonsignificant in- tion following an exhaustive bout of eccentric exercises.
teraction between the groups and assessment time for pain Thereby, the augmented effect observed in group I is a re-
threshold (F = 0.92, p = 0.34). On the other hand, time showed sult of microcurrent therapy combined with traditional treat-
a significant reduction when measured after 3 weeks as com- ment. This is also in agreement with a study by McMakin [44],
pared with the beginning of the study (p = 0.0001) but there who reported that microcurrent combined with manual ther-
was no difference between groups (p = 0.88). For NDI, there apy (chiropractic) reduced pain and increased ROM after the
was a significant interaction between the groups and assess- first 20-minute session in patients with persistent chronic
ment time for neck function (F = 10.31, p = 0.002). For ROM, MTrPs, and concluded that microcurrent therapy made chi-
there was a nonsignificant interaction between the groups ropractic very effective in patients having persistent chronic
and assessment time with respect to extension, right side MTrPs. The same observation was noted when hot packs,
bending, and left side bending (F = 0.41, p = 0.53; F = 2.13, transcutaneous electrical nerve stimulation, and deep cer-
p = 0.15; F = 2.88, p = 0.09). Regarding the isometric muscle vical flexors strengthening exercise were applied with or
strength, there was a significant interaction between the without Mulligan upper cervical manual traction in cervico-
groups and assessment time with respect to extension, right genic headache cases in terms of NDI and upper cervical
side bending, and left side bending muscle strength (F = 5.43, rotation ROM [45].
p = 0.02; F = 6.13, p = 0.02; F = 4.37, p = 0.04). In the present study, the improvement of pain relief by
Normality test was applied for all dependent variables in using microcurrent electrical stimulation may be attributed to
the 2 groups, using the Shapiro-Wilk test. All variables showed the advantage of this modality being subthreshold, and hence
normal distribution in both groups (p > 0.05), except for pain, the side effects such as tingling sensation and paraesthesia
left side bending ROM, and right and left side bending iso- that can be seen in some patients after the application of
metric muscle strength in the control group. other electrical stimulation techniques, as transcutaneous
electrical nerve stimulation, are absent. This is in line with the
Discussion results obtained by Saranya et al. [46], who demonstrated
that the group with microcurrent electrical stimulation showed
The study was conducted among 28 female students more improvement compared with the group of transcuta-
complaining of neck pain, to investigate the effect of micro- neous electrical nerve stimulation.
current electrical stimulation on MTrPs of the upper fibre of The results of this study are consistent with those achieved
the trapezius. The outcome measures were in terms of pain by Park et al. [47], who investigated the effect of microcur-
level: neck function improvement, and ROM and isometric rent electrical stimulation on myofascial neck pain and stiff-
muscle strength increase in subjects with unilateral MTrPs. ness and found that the microcurrent electrical neuromus-
Both groups received a standard treatment program con- cular stimulation improved pressure pain threshold, pain
sisting of ischaemic compression, stretching and strength- intensity, and shear wave velocity in chronic myofascial pain
ening exercises. The results showed a significant decrease syndrome in upper trapezius muscles. Furthermore, the sig-
in pain level and NDI, and increase in pressure pain thresh- nificant improvement in cervical ROM, NDI, and pain level due
old. Ischaemic compression on the trigger points of the trape- to the combination of microcurrent electrical stimulation with
zius muscle significantly improve the pressure pain thresh- stretching and strengthening exercises is supported by a simi-
21
 K.H. Battecha, D.M. Kamel, S.A. Tantawy Physiother Quart 2021, 29(1)
Microcurrent therapy in myofascial pain syndrome [Link]

lar conclusion concerning a multimodal approach of electro- 10.7326/0003-4819-136-10-200205210-00006.

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Disclosure statement 17. Vodovnik L, Karba R. Treatment of chronic wounds by
No author has any financial interest or received any finan- means of electric and electromagnetic fields. Part 1. Lit-
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Conflict of interest 18. Cook KF, Jensen SE, Schalet BD, Beaumont JL, Amt-
The authors state no conflict of interest. mann D, Czajkowski S, et al. PROMIS measures of pain,
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