Comparison of Dynamic Cupping and Instrument Assisted Soft Tissue Mobilization on myofascial trigger points in the posterior neck fascia

International associationof pain define neck pain as a pain arising from anywhere from superiorlythrough nuchal line to inferiorly by first thoracic vertebra and laterally upto shoulder. Its prevalence in general population is up to 50%.1 Mostpatients suffer from simple or non-specific neck pain, which is mainly causedby mechanical factors such as sprain and strains. They do not only include poorposture and high physical load, but also poor psychological health, stress, lowsocioeconomic status, and smoking, usually mechanical pain resolves withinthree to six months; but 14% of the patients will suffer from recurrent orpersistent pain.7

Myofascial painsyndrome is defined as sensory, motor, and autonomic symptoms resulting frompainful spots in the fascia surrounding skeletal muscle known as myofascialtrigger points (MTrPs). MTrPs are associated with palpable nodules in tautbands of muscle fibers. Compression of these points may elicit a) motordysfunction, b) local and referred tenderness, b) pain perceived at a differentspot than the site of the painful stimulus (referred pain), c) transientcontraction of the muscle (local twitch response) and d) autonomic phenomena.Diagnostic findings of MTrPs include severe ROM limitation, a palpable tautband with exquisitely tender nodule and familiar to patient pain elicited frompressure on painful Spots (jump sign).4 Thereare many therapies available to treat the neck pain like Myofascial Release,Muscle Energy Technique, massage, dry needling, Cupping, Instrument AssistedSoft Tissue Mobilization (IASTM), mobilization etc.1

IASTM techniques use special stainless-steelinstruments that enable clinicians to locate efficiently and treat soft tissuedysfunctions, such as fibrosis, adhesions, chronic inflammation, ordegeneration. Benefits from IASTM use include increased fibroblastproliferation, reduction in scar tissue and adhesions, increased vascularresponse, and remodeling of disorganized collagen fiber matrix. IASTM techniquealso has been found that it results in clinical benefits such as improvementsin range of motion, strength and pain perception following treatment. Despiteextensive use of IASTM techniques research regarding its effect on myofascialpain reduction, is limited.4 There is converging evidence that cuppingcan induce comfort and relaxation on a systemic level and the resultingincrease in endogenous opioid production in the brain leads to improved paincontrol. Other researchers proposed that the main action of cupping therapy isto enhance the circulation of blood and to remove toxins and waste from thebody.1,3In Ayurveda also mentioned use of cupping therapy by Acharaya Sushrutanamed as a raktmoshana in ‘Pradhanakarma’, it implies on blood refine fromblood stream. The main aim of this therapy is elimination of vitiated bloodfrom the body. Thought of act of cupping is mainly to increase bloodcirculation and relive painful muscle tension.1

From last few years there is growingevidences of dynamic cupping and IASTM in neck pain.IASTM and cupping therapy techniques are procedures rapidly growing inpopularity due to their effectiveness and efficiency in treating soft tissuerestrictions while remaining non-invasive.

Aim:To compare Dynamic Cupping andInstrument Assisted Soft Tissue Mobilization on myofascial trigger points inthe posterior neck fascia

OBJECTIVES**:**

• To check the effect of the treatment on Pressure algometer, visual analogue scale, cervical range of motion, neck disability index comparing subjects treated with dynamic cupping and IASTM.
• To check which treatment gives faster and better effects.

PROCEDURE

 Ethical committee approval will betaken. CTRI registration will be done. Participants would be selected based oninclusion and exclusion criteria. Participants will be informed about thestudy. Written Consent will be taken. The participants would be divided into 2groups.

Group A Dynamic cupping:Patient will be asked to lie in sidelying position on the couch with their upper torso unclothed, covered with paraffinoil then place cup on skin and suction will be created by pump. Then drawn overskin along the spine from cervical to thoracic up to lateral border maintainthe suction within skin throughout the procedure. The cup massage will beconducted for approximately 3–5 minutes. Patients will be informed that thetreatment area may become patchy and there are chances of ecchymosis on thesame area.

Group B IASTM: For IASTM, the subject was seated ina comfortable position. The subject’s will be positioned in side lying with theposterior neck fascia exposed. A lubricant (paraffin oil) will be applied tothe skin around the neck area prior to treatment and the rock blade was cleanedwith an alcohol pad. First, the Rock blade was used to find the exact areas ofrestriction in the neck region. Then the Rock blade will be used, at an angleof 45 degree and apply slow strokes along the region, without causing anydiscomfort or pain (sweeping technique) for approximately 3 min.

OUTCOME MEASURES:

GONIOMETER

PRESSURE ALGOMETER

VAS

NECK DISABILITY INDEX

For IASTM, the subject was seated ina comfortable position. The subject’s will be positioned in side lying with theposterior neck fascia exposed. A lubricant (paraffin oil) will be applied tothe skin around the neck area prior to treatment and the rock blade was cleanedwith an alcohol pad. First, the Rock blade was used to find the exact areas ofrestriction in the neck region. Then the Rock blade will be used, at an angleof 45 degree and apply slow strokes along the region, without causing anydiscomfort or pain (sweeping technique) for approximately 3 min.