Comparative Analysis on the effectiveness of Hold Relax Technique and Ischemic Compression followed by a sustained stretch in treating Myofacial Trigger Points of Upper Trapezius: A Randomized Controlled Trial

To evaluate and to generalize the comparative effects of Hold-Relax technique and Ischemic compression followed by a sustained stretch in reducing pain and disability in patients with myofascial trigger points of upper trapezius.

A single blind Randomized controlled trial with a parallel group design of 60 patients will have a random allocation by Chit-Box method.

Patients from the Physical-Therapy departments of Khyber Teaching Hospital, Lady Reading Hospital, Peshawar Pakistan. The patients will be recruited in three groups i.e. Group A, Group B and Group C by Randomization through Chit-box method. The outcome assessor will be kept blind during the trial.The readings will be taken for two times during the whole session (one at the start and other at the end of session).

1. Inclusion Criteria Age group between 20- 45 years ,Both Male and Female patients ,Chronic cases of Upper trapezius myofacial pain ,Patients with at least 15-24 points (30-48%) score in NDI 2. Exclusion Criteria Patients receiving treatment by other methods like vapocoolants, dry needling, acupuncture injections ,Neck or shoulder surgery within the past year ,Neurological or rheumatic disorders ,Radiculopathy, myelopathy or joint disorders ,Whiplash in the previous 6 months ,Recent fracture of the cervical spine ,Cervical instability ,Cervical spondylosis ,Ankylosing spondylitis ,Disc prolapsed

Group-A patients will be treated with Hold-Relax technique, Group-B patients with Ischemic Compression followed by sustained stretch and Group-C with Both techniques. The patients in all three groups will receive a series of twelve treatments and a follow up consultation over a maximum period of four weeks.

Pain ,Disability

The patients will be recruited in three groups i.e. Group A (Hold-Relax technique), Group B (Ischemic Compression followed by sustained stretch) and Group C (Both techniques) by randomization through Chit-box method. Chit-Box Method: For random allocation of 60 cases into three groups equally, prepare 60 chits writing “A” (for Group-A) on 20 chits, “B” (for Group-B) on 20 chits and “C” (for Group-C) on 20 chits. After folding the chits and putting in a box and well mixing, draw a chit, note the letter written on it, and then draw the second chit without replacing the first, note it and proceed similarly until the last i.e. 60th chit is drawn. The generated random allocation sequence may be one as appears in Table below. According to this sequence the first case registered will go to the Group-A, second case again to the Group-A, third to the Group-C and so on to the last case to Group-B. Table: Chit-Box Method for Randomization Draw 1st 2nd 3rd -- 15th Result (Letters on chit) A A C B C B B A A A B C - C A B B Registered Case No. 1 2 3 4 5 6 7 8 9 10 11 12 -- 57 58 59 60 (No. Allocation)

The outcome assessor will be kept blind about the treatment protocols and randomization process during the whole trial.

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