The effect of integrated neuromuscular inhibition technique on trigger points pain threshold in patients with neck and shoulder muscles trigger points

Purpose of study: The effect of integrated neuromuscular inhibition technique on pain threshold of neck and shoulder muscles trigger points؛ just interventional group؛ without control group؛ not blinded؛ without placebo؛ Inclusion criteria: age: 20-40 y/o - presenting active myofascial trigger points in neck and shoulder muscles with pain recognition when pressure applied؛ Exclusion criteria: previous neck surgery(during last year) - cervical radiculopathy - participants with fibromyalgia syndrome؛ Target sample size:15؛ Intervention: integrated neuromuscular inhibition technique؛ Material and methods: All subjects provided informed consent before enroll- ment in the study. Active myofascial trigger points in neck and shoulder muscles recognized in prone position. A visual analog scale(VAS) was used to grade their level of neck pain and algometer to grade pressure pain threshold. The subjects were placed in supine position with small towel roll under their neck to reduce tension in the upper trapezius muscle. The following three techniques applied in sequential order: Ischemic compression: Pressure applied through the thumb of physical therapist directy on myofascial trigger points to produce tolerable pain. The pressure applied sustained and progressively increased by reinforcing with the thumb or finger of the other hand until tissue resistance is encountered. Contact was maintained till the tissue barrier was released and pressure was maintained to 90 s. The procedure was repeated three times per session. Strain counter strain: The pressure was maintained without complaints of referred pain pattern. Patient‟s head was passively laterally flexed towards the affected side. The therapist then held forearm and moved the affected side shoulder passively to approximately 90 degree of abduction, while monitoring the tender point pain with the other hand. Then the fine tuning was made with slight flexion or extension of the shoulder so that maximum ease was achieved. It was held for 20–30 s and repeated for three repetitions per session. Muscle Energy Technique(MET): The patient in supine position was asked to take the stabilized shoulder towards the ear (a shrug movement) and the ear towards the shoulder. The degree of contraction was mild and pain free (20% of maximum voluntary contraction). The contraction was sustained for 10 seconds. The therapist gently eased the head/neck into an increased degree of side bending and flexion to unaffected side and rotation to affected side. The stretch was maintained for 30 seconds and repeated for three repetitions per session. After appling technique، visual analog scale(VAS) was used to grade their level of neck pain and algometer to grade pressure pain threshold. One day after treatment visual analog scale(VAS) was used to grade their level of neck pain and algometer to grade pressure pain threshold. Treatment applied in one day. One day after treatment reassesment done. Outcome: Maybe pain of trigger points decrease or pressure pain threshold increase.

Vice chancellor for research, Shiraz University of Medical Sciences