Pressure Release Versus Thoracic Manipulation in Rhomboids MPS

Sponsor

Cairo University (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT05688800

Collaborator

(none)

Enrollment

Arms

Anticipated Duration (Months)

Study Details

Study Description

Brief Summary

The purpose of the stud will be to compare the effect of pressure release with thoracic spine manipulation on pain intensity level and pain pressure threshold, thoracic spine ROM and physical function onactive rhomboids muscle trigger point in myofascial pain syndrome.

Condition or Disease	Intervention/Treatment	Phase
Myofascial Pain Syndrome Trigger Point Pain, Myofascial	Device: conventional therapy Other: Experimental group 1 : pressure release technique Other: Experimental group 2: thoracic spine manipulation	N/A

Detailed Description

Myofascial pain syndrome (MPS) is one of the most common chronic disorders causing persistent musculoskeletal pain which is characterized by myofascial trigger points (MTrPs) in palpable taut bands of skeletal muscle. In recent years, due to our modern lifestyle people is exposed to postural stresses, inefficient biomechanics, repetitive postural dysfunction, which are some of the causes of myofascial pain syndrome .Active Rhomboid muscle trigger point are one of the main causes of inter- scapular pain, as the referral pattern of this muscle is on the medial border of the scapula. The aim of the study is to find if there any significant difference between the effect of pressure release and thoracic spine manipulation on pain intensity level, pain pressure threshold ,thoracic spine ROM and physical function and symptoms in people with musculoskeletal disorders of the upper limb on active rhomboids muscle trigger point in myofascial pain syndrome. 66 participants will be allocated randomly to three groups ; The Participants will be assigned randomly into three groups by simple methods of randomization. Control group: will receive conventional physical therapy treatment, Experimental group 1: will receive conventional physical therapy treatment in addition to pressure release Experimental group 2: will receive conventional physical therapy treatment in addition to thoracic spine manipulation.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

66 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

Control group: will receive conventional physical therapy treatment Experimental group 1: will receive conventional physical therapy treatment in addition to pressure release Experimental group 2: will receive conventional physical therapy treatment in addition to thoracic spine manipulationControl group: will receive conventional physical therapy treatment Experimental group 1: will receive conventional physical therapy treatment in addition to pressure release Experimental group 2: will receive conventional physical therapy treatment in addition to thoracic spine manipulation

Masking:

Double (Participant, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

Pressure Release Versus Thoracic Spine Manipulation in Rhomboids Myofascial Pain Syndrome

Anticipated Study Start Date :

Mar 1, 2023

Anticipated Primary Completion Date :

Jun 1, 2023

Anticipated Study Completion Date :

Sep 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Control group Each participant include 22 participants will receive conventional physical therapy treatment including TENS, continuous ultrasound ,infra-red radiation and combined stretching and strengthening exercise	Device: conventional therapy Participants in control group will receive conventional physical therapy treatment including Conventional TENS high frequency (90-130hz) low intensity according to the patient sensation for 30-45 min(Gozani, 2019) , continuous ultrasound with frequency 1 MHz and intensity 0.8 W/cm 2 will be applied by slow circular perpendicular movements with slightly deep pressure. Application time was 5 minutes at each side of the level of C7_T4 along the medial borders of the scapulae width, infra-red radiation will be four 15 minutes and directed perpendicular to the inter-scapular area, centered at the level of C7_T4 long and between the 2 medial borders of the scapulae width . Also combined stretching and strengthening exercise will be added due to its greater pain-relieving effect
Experimental: Experimental group 1 :pressure release technique Each participant include 22 participants will receive the conventional physical therapy treatment in addition to pressure release technique	Other: Experimental group 1 : pressure release technique Participants who are assigned to this group will receive conventionalphysical therapy treatment in addition to pressure release technique. the participant will be positioned either sitting or prone position according to his preferred position, the researcher will apply the pressure release procedure by a pressure below the PPT dependent onsoft tissue release. When the researcher detected a reduction in soft tissue resistance, the amount of compression will be increased. The pressure should -33- be nonpainful, applied at slow rate, and will maintained until release of tissue barrier. Further pressure was increased to reach a new barrier. The pressure will last 60 seconds. With the thumb or the second and third fingers, the non-painful manual therapy approach was applied to the active MTrPs of therhomboid muscle
Experimental: Experimental group 2: thoracic spine manipulation Each participant include 22 participants will receive the conventional physical therapy treatment in addition to thoracic spine manipulation	Other: Experimental group 2: thoracic spine manipulation Thoracic spine manipulation will be performed as screw thrust manipulation technique; the vertebral transverse processes will beforced from posterior to anterior direction. The direction of the manipulation should be identified by applying springing test to the adjacent spinous process to determine the painful and stiff segment. Patient will be prone and researcher hand placement will be positioned as the following one pisiform on the right facet of the above, and the other pisiform on the left facet of the below vertebrae.A slack will be taken up. The thrust applied directly toward the patient once

Arm

Intervention/Treatment

Active Comparator: Control group

Each participant include 22 participants will receive conventional physical therapy treatment including TENS, continuous ultrasound ,infra-red radiation and combined stretching and strengthening exercise

Device: conventional therapy

Participants in control group will receive conventional physical therapy treatment including Conventional TENS high frequency (90-130hz) low intensity according to the patient sensation for 30-45 min(Gozani, 2019) , continuous ultrasound with frequency 1 MHz and intensity 0.8 W/cm 2 will be applied by slow circular perpendicular movements with slightly deep pressure. Application time was 5 minutes at each side of the level of C7_T4 along the medial borders of the scapulae width, infra-red radiation will be four 15 minutes and directed perpendicular to the inter-scapular area, centered at the level of C7_T4 long and between the 2 medial borders of the scapulae width . Also combined stretching and strengthening exercise will be added due to its greater pain-relieving effect

Experimental: Experimental group 1 :pressure release technique

Each participant include 22 participants will receive the conventional physical therapy treatment in addition to pressure release technique

Other: Experimental group 1 : pressure release technique

Participants who are assigned to this group will receive conventionalphysical therapy treatment in addition to pressure release technique. the participant will be positioned either sitting or prone position according to his preferred position, the researcher will apply the pressure release procedure by a pressure below the PPT dependent onsoft tissue release. When the researcher detected a reduction in soft tissue resistance, the amount of compression will be increased. The pressure should -33- be nonpainful, applied at slow rate, and will maintained until release of tissue barrier. Further pressure was increased to reach a new barrier. The pressure will last 60 seconds. With the thumb or the second and third fingers, the non-painful manual therapy approach was applied to the active MTrPs of therhomboid muscle

Experimental: Experimental group 2: thoracic spine manipulation

Each participant include 22 participants will receive the conventional physical therapy treatment in addition to thoracic spine manipulation

Other: Experimental group 2: thoracic spine manipulation

Thoracic spine manipulation will be performed as screw thrust manipulation technique; the vertebral transverse processes will beforced from posterior to anterior direction. The direction of the manipulation should be identified by applying springing test to the adjacent spinous process to determine the painful and stiff segment. Patient will be prone and researcher hand placement will be positioned as the following one pisiform on the right facet of the above, and the other pisiform on the left facet of the below vertebrae.A slack will be taken up. The thrust applied directly toward the patient once

Outcome Measures

Primary Outcome Measures

Pain Intensity level [up to three weeks]
pain intensity level will be measured by visual analogue scale (VAS)
Pressure Pain threshold level (PPT) [up to three weeks]
pressure pain threshold level (PPT) will be measured by digital algometer

Secondary Outcome Measures

Rom of Motion [up to three weeks]
rom will be measured by digital inclinometer
Physical function [up to three weeks]
physical function will be measured by Disability of Arm, Shoulder, and Hand questionnaire (DASH)

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 30 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Participants ages will be from 18 to 30 years Participants will be from both genders. Participants that have Myofascial pain syndrome due to at least one active trigger points in rhomboid muscle (Haleema and Riaz, 2021). Participants have myofascial pain syndrome since more than three months. Presence of a palpable taut band in a skeletal muscle

Exclusion Criteria:

Malignancy. Fractures of the Thoracic spine. Cervical radiculopathy or myelopathy. Vascular syndromes such as vertebrobasilar insufficiency. Rheumatoid arthritis. Neck or upper back surgery. Taking anticoagulants. Local infection. Whiplash injury. Open wounds. Pregnancy. Receiving radiation or chemotherapy. Scapular pain due to any degeneration disease. Osteoporosis. Cardiac pacemaker. Any contraindication for thoracic manipulation