Comparison Between Dry Needling And Ischemic Compression Therapy For Upper Trapezius Latent Trigger Points

NEED OF THE STUDY: -

•        Myofascial Triger Point (MTrPs) are frequently brought on by overuse, bad posture, or injury. The upper trapezius muscle is a common site for MTrPs and it can result in several symptoms, including stiff and painful muscles, tension headaches, neck discomfort, restricted range of motion in the neck and shoulder, referred pain to other parts of the body, dizziness, and vertigo.

 â€¢        Most persons with MTrPs can lessen their symptoms with the correct physiotherapeutic approach. According to research studies, different techniques were used in the treatment of trigger points. Dry needling, passive stretching  and ischemia compression therapy is also significantly effective. However, the most effective management for upper trapezius latent trigger point remains an area of debate and no research was done to determine which of the three is superior. Our research will concentrate to elicit the most effective therapy among these three for latent trigger point sites.

  AIMS AND OBJECTIVES: –

  Aim: -

 â€¢        The aim of this study will be to evaluate and analyze the comparative effects of Dry needling and Ischemic compression therapy for upper trapezius latent trigger points.

 Objectives: -

•        To determine the efficacy of Ischemic Compression with passive stretching in improvement of cervical range, decrease in cervical pain and deduction in disability in patients of upper trapezius latent trigger points.

•        To determine the efficacy of Dry Needling with passive stretching

|in improvement of cervical range, decrease in cervical pain and deduction in disability in patients of upper trapezius latent trigger points.

•        To determine the efficacy of Ultrasound with passive stretching in improvement of cervical range, decrease in cervical pain and deduction in disability in patients of upper trapezius latent trigger points.

ʉۢ To compare the physiotherapeutic treatment protocol РIschemic compression therapy with passive stretching, Dry needling with passive stretching and ultrasound in passive stretching in improvement of cervical range of motion, deduction in cervical disability and decrease cervical pain in patients for upper trapezius on latent trigger points.

   |Hypothesis: -

Null hypothesis (Ho) .

•        There is no significant effect of Ischemic compression therapy in the treatment of upper trapezius latent trigger points.

•        There is no significant effect of Dry needling in the treatment of upper trapezius latent trigger points.

Alternate hypothesis (H1)

•        There is significant effect of Ischemic compression therapy in the treatment of upper trapezius latent trigger points.

•        There is significant effect of Dry needling in the treatment of upper trapezius latent trigger points.

’

GROUP ALLOCATION: -

Participants will be allocated into three groups, group A, group B and group C respectively.

·        Group A participants will receive Ischemic compression therapy + passive stretching.

·        Group B participants will receive Dry needling + passive stretching.

·        Group C participants will receive Ultrasound + passive stretching

 PROCEDURE: -

·        After receiving the ethical clearance from the ethical committee of the university, the study was further started.

·        Students will be selected based on inclusion criteria.

·        A written consent was taken from all participants, and the treatment protocol, the study type and duration of the study will be explained by the therapist. Participants, will be divided into three groups Group A, Group B or group C respectively by chit method. (Ray et al., 2020)

·        Either a flat palpation or pincer palpation approach method was used to identify latent trigger points. (Kumar et al.,2014)

·        Pre and post readings of NDI, NPRS and goniometer will be evaluated.

·        Pain intensity, active ROM and palpation of the latent trigger points will be evaluated through different instruments and questionnaire which includes NDI, NPRS, goniometer as an outcome measure.

·        The set criteria in the study included the active range of cervical lateral flexion analyzed by goniometer, pain intensity on the Numeric pain rating scale (NPRS), and NDI for cervical disability. To locate the upper trapezius LTrPs, we followed the diagnostic exploration criteria established by Simons et al. (1999); this was performed by a physiotherapist with three years of clinical experience. (Sadria et al., 2016)

1)      Presence of palpable taut band in the skeletal muscle.

2)      Presence of a hypersensitive tender spot in the taut band.

3)      Local twitch response provoked by the snapping palpation of the                        taut band.

4)     4)Reproduction of the typical pain pattern of the MTrPs in response to compression.

5)     Spontaneous presence of the typical referred pain pattern and/or the patient’s recognition of the referred pain as familiar. In the cases in which the first four criteria were met, the MTrP was

|considered to be latent.

 â€¢        The subjects were randomized to receive either Ultrasound with passive stretching, Ischemic compression with passive stretching or Dry needling with passive stretching.

•        To measure cervical lateral flexion with a goniometer, follow these steps:

1.     Position the patient seated in a chair with their back supported and their feet flat on the floor.

2.     Place the fulcrum of the goniometer over the spinous process of C7.

3.     Align the stationary arm of the goniometer with the spinous process of T1.

4.     Align the moving arm of the goniometer with the dorsal midline of the head.

5.     Instruct the patient to slowly tilt their head to the side being measured.

6.     Read the measurement on the goniometer when the patient reaches their end range of motion

 Ã˜  Passive Stretching procedure: -

•        A passive stretching by a therapist was applied to upper Trapezius muscle for a count of 3 repetitions with 10-seconds hold.

•        Participant position: - Sitting on a comfortable chair with hands on the laps.

•        Therapist position: - The therapist will stand behind the patient and perform a cervical flexion, rotation, and lateral flexion stretch on the opposite side. The distal clavicle and the scapula were manually stretched by depressing them with the other hand.

                                                         |For Group A :- Ischemic compression therapy + passive****stretching

Using a pincer grasp, the therapist will place the thumb and index finger over the latent trigger in this technique.

                                                        

Until the tissue barrier is felt to release, pressure will be applied. Depending on the patient’s tolerance, the pressure will be applied intermittently at first and then continuously for 90 seconds.

|  For Group B:- Dry Needling + Passive stretching

 

The Dry needling technique for MTrPs was performed with ‘solid filiform needles’ (50 × .3 mm).

                                                   

The exercise will require the participant to lie on their back.  The skin that needs to be treated was cleaned with alcohol.  Thumb and index finger were localised over the MTrp of the taut band, and the solid filiform needle was inserted into its plastic guide tube.

                                                  

The tapping motion was used to insert the needle. was stopped after obtaining LTR. To cause a twitch in a muscle the needle was placed into the muscle bundle and moved in and out of the tissue, a process known as LTR (local twitch response).

If there was no twitch after two or three stellate movements, the needle was stopped.

For Group C :- Ultrasound + Passive stretching

Patients in the US group were given 1 MHz continuous conventional US treatment at a dose of 1.5 watts/cm2 for five minutes. The device draws intertwining circles on and around the trigger point in one-two seconds.

 DATA ANALYSIS:-

Data will be collected through purposive sampling in a random manner and will further enquire and analyzed with appropriate statistical tools.