The relative effectiveness of myofascial trigger point manipulation as compared to proprioceptive neuromuscular facilitative stretching in the treatment of active myofascial trigger points: a pilot clinical investigation
Myofascial pain syndrome (MPS) is defined as the sensory, motor and autonomic symptoms caused by myofascial trigger points (MFTPs), or hyperirritable spots within skeletal muscles that are associated with palpable nodules in a taut band. The fact that MFTPs have been described in the literature for acupuncturists, anaesthesiologists, chronic pain managers, dentists, family practitioners, gynaecologists, neurologists, nurses, orthopaedic surgeons, paediatricians, physical therapists, physiologists, rheumatologists and veterinarians is evidence of the syndrome’s clinical importance. As a result of a large amount of research, a large number of different treatments have been shown to be clinically effective in the treatment of MFTP. These treatments include amongst others: - Ischaemic compression. - Myofascial manipulation. - Spray and stretch. - Ultrasound. - Transcutaneous electrical nerve stimulation. - Dry needling. As can be seen from the above, it is important to be able to treat MPS effectively because it is such a common disorder. According to Schneider an effective treatment is needed for MPS, despite the array of treatments available to a clinician. Han and Harrison agree that more studies are required to determine the efficacy of these treatments. The aim of this study is to evaluate the relative effectiveness of Myofascial Trigger point Manipulation (MFTPM) as compared to Proprioceptive Neuromuscular Facilitative (PNF) stretching in the treatment of active Myofascial Trigger Points (MFTPs) in the trapezius muscle (TP 1 and/or TP 2) in terms of subjective and objective clinical findings. The study required a total of 60 patients, which following acceptance were then randomly divided into two groups of 30, with an equal number of male patients in Group one (MFTPM) and two (PNF), and female patients in Group one and Group two. Each patient had four consultations (three treatments and one follow up visit) in a two week period. Subjective and Objective Data was recorded at each consultation prior to the treatment. Subjective measurements (Numerical Pain Rating Scale and Short Form McGill Pain Questionnaire) were taken prior to the treatment at all four visits. Objective measurements (Cervical Range of Motion Meter and Algometer) were also taken prior to the treatment at all four visits, except for Algometer readings which were taken at the initial consultation and the fourth treatment only. SPSS version 11.5 was used for analysis of data (SPSS Inc, Chicago, Ill, USA). Baseline comparisons were done between treatment groups using Pearson’s chi square tests or Fisher’s exact tests as appropriate for categorical variables, and student’s t-tests for quantitative normally distributed variables. Treatment effect was assessed with repeated measures ANOVA. A significant time by group interaction indicated a significant differential treatment effect. A p value <0.05 designated statistical significance. The direction of the treatment effect was assessed with profile plots. Evaluation of data collected from both groups showed a significant improvement in terms of objective and subjective clinical findings to a value of p=< 0.001. There was no statistical difference between the two groups in terms of objective and subjective clinical findings, although a trend was shown when looking at the objective findings that suggest that MFTPM was more effective than PNF stretching. The sample population was drawn from a very homogenous group of people (i.e. SARS call centre), in order to achieve greatest emphasis on clinical outcomes. This process however limits the clinical applicability of the results and thus will not always be applicable to all patients within the population. It is therefore the researcher’s conclusion that there is no statistical difference between MFTPM and PNF stretching in terms of objective and subjective clinical findings. Both treatment modalities have been shown to be equally effective in the treatment of subacute active TPs in the upper tarpezius. There is a definite trend when looking at the objective data that may support the hypothesis that MFTPM is as effective as, if not more effective than PNF stretching. It is of the opinion of the author that a larger sample size is needed to make it clinically significant.