Controlled intervention to compare the efficacies of manual pressure release and the muscle energy technique for treating mechanical neck pain due to upper trapezius trigger points

Abstract

PurposeThis study aimed at comparing the clinical efficacies of two manual therapies to determine the most beneficial result-oriented physiotherapeutic approach for treating nonspecific neck pain due to myofascial trigger points (MTrPs).MethodsThis was a randomized, controlled pretest–posttest experimental study that compared manual pressure release (MPR), the muscle energy technique (MET), and a control condition. These techniques were compared using a convenience sample of 45 female participants with neck pain due to MTrPs (mean age±SD=21.49±3.66; age range=18–30 years). The visual analog scale, pressure pain threshold, Neck Disability Index Questionnaire, and a standardized measuring tape were used to assess the participants’ neck pain, muscle tenderness, functional disability due to neck pain, and range of neck rotation, respectively, at baseline (day 0), day 1, and day 5 postintervention and at days 10 and 15 during follow-up. All groups were given postural advice and at-home neck exercises. Repeated-measures ANOVA and one-way ANOVA were used to analyze the data.ResultsThe within-group analyses showed significant improvement (P<0.05) in all outcome measures at days 1 and 5 postintervention and at days 10 and 15 during the follow-up for all groups. The between-group analyses confirmed nonsignificant differences (P>0.05) between all groups for all variables.ConclusionMPR and the MET are equally effective for reducing pain and muscle tenderness and for improving neck disability and range of rotation in patients with nonspecific neck pain. Furthermore, advice promoting postural correction can be an adjunct to physiotherapeutic interventions for reducing neck pain and its symptoms. A combination of these manual therapies with postural advice might be a good treatment option for nonspecific pain in physiotherapy clinics.

Muscle Energy Technique in the Rehabilitative Treatment for Acute and Chronic Non-Specific Neck Pain: A Systematic Review

“…Similarly for the second question: “Is MET combined with conventional therapy effective in the treatment of pain, disability and restoration of joint function in acute and chronic non-specific neck pain compared to conventional therapy alone or to the latter combined with another method?”, with regard to patients with neck pain in the acute phase and in the chronic phase, MET is very effective in improving health outcomes such as pain, disability and joint function. The results showed that the combination of conventional therapy, whether it is analgesic instrumental therapy, active stretching or postural education, and MET is very effective with significantly relevant results, in accordance with the guidelines for the treatment of cervical pain that recommend a multifactorial approach in the management of problems related to this pathology [ 34 , 37 , 38 , 42 , 43 , 46 ]. On this assumption, the third question was examined: “Can MET combined with other methods be effective in the treatment of acute and chronic nonspecific neck pain?”.…”

“…Characteristics of included studies are summarized in Table 2 and Table 3 . We used 15 studies [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ] to analyze the effects of MET in patients with non-specific acute neck pain, and 6 studies [ 49 , 50 , 51 , 52 , 53 , 54 ] to analyze the effects of MET in patients with non-specific chronic neck pain. Articles had sample sizes ranging from 28 to 90, contributing to a total sample size of 913 participants, consisting of 527 females and 386 males with a mean baseline age of 18 to 55 years with an average of 32.18 (±7.59).…”

“…Six studies were considered about the efficacy of MET in combination with traditional physical treatment (TPT) compared with only TPT or TPT with other rehabilitative techniques. In an RCT published in 2018, Kashyap et al [ 34 ] compared the clinical effect of manual pressure release (MPR) with the muscle energy technique (MET) for neck pain. The study enrolled 45 female participants (mean age ± SD = 21.49 ± 3.66; age range = 18–30 years).…”

Efficacy of Combination Therapies on Neck Pain and Muscle Tenderness in Male Patients with Upper Trapezius Active Myofascial Trigger Points

“…Recently, Faqih et al (2019) conducted a study using MET in patients with postsurgical elbow stiffness and found that the application of MET immediately after postsurgical elbow brought a significant improvement in pain intensity (VAS scores), ROM, and functions (DASH scores) [35]. Kashyap et al (2018) revealed that the MPR and the MET are equally effective in improving the VAS, PPT, NDI, and range of rotation scores among the participants with nonspecific neck pain due to MTrPs [23]. In addition, our findings have been supported by Iqbal and colleagues (2013), who worked on combination therapies including only male patients and reported that the positional release technique in combination with MET showed immediate and short-term effectiveness in reducing the intensity of neck pain (VAS scores) as well as improving muscle tenderness (PPT scores) and functional status of the neck (NDI scores) in male patients with upper trapezius active MTrPs [22].…”

“…MET used alone or in combination with SCS was previously proven effective in immediate, short-term, and longterm management of neck pain caused by active MTrPs of the upper trapezius muscle [14,15,22,23]. However, no studies to date have attempted to reveal the effectiveness of MET combined with ICT for short-term or complete resolution of neck pain and muscle tenderness due to upper trapezius active MTrPs.…”