EFFECT OF EXTRACORPOREAL SHOCKWAVE THERAPY(ESWT)
VERSUS MYOFASCIAL RELEASE(MFR) TECHNIQUE ON PAIN,PAIN
PRESSURE THRESHOLD, NECK RANGE OF MOTION IN PATIENTS
WITH MYOFASCIAL PAIN OF UPPER TRAPEZIUS MUSCLE
STUDENT : AREESHA MIRZA (MPT-1)
GUIDE : Dr SONA KOLKE
NEED OF THE STUDY
• Neck pain is a common problem that affects almost one-third of the population with a point
prevalence between 10-15% [1]
• In conditions of the upper quarter, such as neck pain ,headache and nonspecific shoulder pain,
the upper trapezius muscle (UTM) is commonly affected by MTrPs [2]
• The Ratio of prevalence in males and females in India is 1:10. and 3-5% of the population is
affected worldwide[3]
• Myofascial release technique (MFR) is a safe and very effective hands-on technique that
involves applying gentle sustained pressure into the myofascial connective tissue restriction to
eliminate pain and restore motion[1]
• The use of extracorporeal shock wave therapy (ESWT) has expanded to the treatment of MPS.
[5]
• This study will help to provide healthcare professionals with evidence-based guidance in
selecting the most appropriate treatment for patients.
RESEARCH QUESTION
• What is the effect of ESWT and MFR on pain, pain pressure threshold and neck range of
motion in patients with myofascial pain of upper trapezius?
HYPOTHESIS
Null hypothesis :
• There will be comparable effect between ESWT and MFR on pain, pain pressure threshold and
neck ROM in patients with myofascial pain of upper Trapezius
Alternate hypothesis :
• ESWT will be more effective than MFR on pain, pain pressure threshold and neck ROM in
patients with myofascial pain of upper Trapezius.
• MFR will be more effective than ESWT on pain, on pain pressure threshold and neck ROM in
patients with myofascial pain of upper Trapezius.
Aim & Objectives:
Aim : To compare the effect of ESWT and MFR technique on pain, pain pressure threshold and
neck range of motion in patients with myofascial pain of upper trapezius.
Objectives:
To assess the effect of :
• ESWT on pain , Pain pressure threshold using and Neck range of motion in patients with
myofascial pain of Upper Trapezius
• MFR on pain , Pain pressure threshold and Neck range of motion in patients with myofascial
pain of Upper Trapezius
• To compare the effect of both techniques on pain , pain pressure threshold and neck range of
motion in patients with myofascial pain of Upper Trapezius
Methodology
• Study Design : Parallel Group Randomized Trial
• Study Population : Patients with myofascial pain of Upper Trapezius
• Study Setting : Physiotherapy OPD in Tertiary care
• Sample Size : To be calculated
• Sampling Technique : Simple random sampling
• Study Duration : 1 year
Study Material:
• Inclinometer
• Algometer
• Extracorporeal Shockwave Therapy Machine
• Consent Form
Inclusion Criteria Exclusion Criteria
Patients with : Presence of taut band, Trigger Patients with any neurological deficit
point, referred pain, local twitch response on
palpation, restricted range of motion[6,7]
Age group : 25 – 45 years Cervical Radiculopathy
Reduced cervical lateral flexion and rotation Fibromyalgia
range of motion
VAS criteria - >3mm[11] Patients in which ESWT is contradindicated –
Hypertension, coagulopathy,Renal
insufficiency ,recent severe hemorrhage,
Neoplasm, severe hepatic disease, epilepsy,
mental retardation, cutaneous
pathology,pregnancy
Operational Definition
Myofascial Pain : Myofascial pain syndrome (MPS), a musculoskeletal system disease, is a recurrent local
myofascial pain characterized by the appearance of myofascial trigger points (MTrPs)[4]
Trigger Points: It is a hyperirritable spot which is in palpable taut bands of skeletal muscle fibers[4]
Pain Pressure Threshold: It is defined as least amount of pressure applied to a particular point capable of
producing a perceived pain response.[2]
Myofascial Release : It is a soft tissue mobilisation technique which involves specifically guided low load,
long duration mechanical forces to manipulate the myofascial complex, intended to restore optimal length,
decrease pain, and improve function [5]
Outcome Measures
Outcome Measures Reliability Unit of Parametric non
measure/scoring parametric
Visual Analogue Scale ICC -0.97[9] milimeters Non Parametric
Algometer(Pain [ICC] = 0.96, 95% Kg/cm^2 Parametric
pressure threshold) confidence interval
[CI], 0.91-0.98;
interrater ICC = 0.81,
95% CI, 0.67-0.90)
[2]
Range of degrees Parametric
motion(Inclinometer)
Procedure
Approval from IEC will be
obtained
The study will be registered on
CTRI
Participants will be screened for
Inclusion and Exclusion criteria
Baseline Assessment will be
taken by Single Blinded
Assessor
The purpose and procedure will be explained to
the participant and Informed consent will be
taken
Participants will be divided into 2 group based on Computer generated Random Number Table
Group A (ESWT) Group B (MFR)
• 2 sessions /week
• F-ESWT: EFD: 0.05–0.35 • 2 sessions /week
mJ/mm2 • Direct Method for 10
• Frequency: 4–5 Hz mins [10]
• 2000–4000 pulses per session, • Trigger Point Release
300– 400 pulses per MTrPs • Tender Point Release
[12]
After the respective treatment both group will be given : active range of motion exercises for cervical
spine (10 repetitions of each movement),chin tuck exercises 10 s hold and 10 reps and scapular sets
(10 s hold and 10 reps) [13]
Statistical Analysis
Formula for sample size:
Qualitative data – n = zα˄2pq
L˄2
Quantitative data- n = zα˄2σ˄2
L˄2
• Normality of the data will be assessed by Shapiro Wilk Test
Data – Distributed Normally
Yes No
Outcome Within Group Between Group Outcome Within Group Between Group
Measures Measures
VAS Wilcoxon Mann-Whitney U
signed-rank test test VAS Wilcoxon signed-rank test Mann-Whitney U
test
Side Wilcoxon signed-rank test Mann-Whitney U
Side Flexion Paired t - Test Unpaired t Test
Flexion test
Rotation Wilcoxon signed-rank test Mann-Whitney U
Rotation Paired t - Test Unpaired t Test
test
PPT Wilcoxon signed-rank test Mann-Whitney U
PPT Paired t - test Unpaired t Test
test
REFERENCES
1. Pimpalgaonkar, Aishwarya et al. “Immediate effect of myofascial release technique and strain counterstrain technique on unilateral trapezitis in sitting
job professionals.” International journal of applied research 6 (2020): 378-382.
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Widespread Pressure Pain Threshold in Individuals With Active Upper Trapezius Trigger Points: A Randomized Clinical Trial. Journal of Manipulative
and Physiological Therapeutics. 2021 Feb;44(2):95–102.
3. Senthilkumar S, Kumar A, Sangeetha S. A Study on Effectiveness of Post Isometric relaxation Technique in Trapezitis among workers. Rese Jour of
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Patients with Upper Trapezius Spasm. JCDR
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