A Study on the Effects of Different Application Speeds of the Graston Technique on Trapezius Muscle Stiffness, Pressure Pain Threshold, Pain Intensity, and Muscle Oxygenation in Individuals With Bruxism
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 36
- 试验地点
- 1
- 主要终点
- Muscle stiffness
研究概览
简要总结
This randomized crossover study aims to address an important gap in manual therapy by examining the acute physiological effects of different Graston Technique application speeds (60 BPM vs. 120 BPM) on the dominant upper trapezius muscle in patients with bruxism. Although the Graston Technique is widely used, the specific impact of application speed on parameters such as muscle stiffness, muscle oxygenation, pressure pain threshold, and pain intensity remains under-investigated. By utilizing a crossover design with a 1-week washout period, this study allows for a precise within-subject comparison of the two speeds. The findings will clarify the optimal application frequency, providing objective data to guide the development of more effective, evidence-based manual therapy protocols for bruxism management.
详细描述
Background and Rationale: Bruxism is a condition characterized by repetitive jaw muscle activity, which frequently leads to secondary musculoskeletal symptoms in the cervical region, particularly increasing muscle stiffness and pain in the upper trapezius muscle. While Instrument-Assisted Soft Tissue Mobilization (IASTM), specifically the Graston Technique, is a widely utilized intervention for managing myofascial restrictions, the optimal application parameters remain unclear. Specifically, the physiological impact of the application speed (frequency) on tissue properties and hemodynamics has not been systematically investigated in this population.
Study Design and Protocol: This study utilizes a prospective, randomized, crossover design to evaluate the acute effects of two different Graston Technique application speeds. A total of 36 participants diagnosed with bruxism will be included. Using a block randomization method, participants will be assigned to one of two intervention sequences (AB or BA) to ensure a balanced distribution.
Intervention Protocol: The study targets the dominant upper trapezius muscle. Each participant will complete two sessions separated by a 1-week washout period to prevent carry-over effects. The interventions are as follows:
Slow Speed Application (60 BPM): The Graston technique will be applied at a frequency of 60 beats per minute (1 Hz).
Fast Speed Application (120 BPM): The Graston technique will be applied at a frequency of 120 beats per minute (2 Hz).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 55 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosed with bruxism.
- •Aged 18-55 years.
- •Presence of trigger points in the trapezius muscle, according to the criteria defined by Travell and Simons.
排除标准
- •Acute tears, tendon ruptures, or severe muscle injuries.
- •Conditions that prevent the application of the Graston Technique (e.g., skin lesions, open wounds, infections).
- •Having received botox injections in the temporomandibular joint (TMJ) region within the last 6 months.
- •Psychological disorders that may affect participation or measurements.
研究组 & 干预措施
Sequence A slow then fast
Participants assigned to this sequence will receive the Graston Technique application at a slow speed (60 BPM) in the first session. After a mandatory 1-week washout period to prevent carry-over effects, they will cross over to receive the Graston Technique application at a fast speed (120 BPM) in the second session.
干预措施: Graston Technique 60 BPM (Behavioral)
Sequence B fast then slow
Participants assigned to this sequence will receive the Graston Technique application at a fast speed (120 BPM) in the first session. After a mandatory 1-week washout period to prevent carry-over effects, they will cross over to receive the Graston Technique application at a slow speed (60 BPM) in the second session.
干预措施: Graston Technique 120 BPM (Behavioral)
结局指标
主要结局
Muscle stiffness
时间窗: Baseline and immediately post-intervention for each treatment session
Shear Wave Elastography (SWE), an ultrasound-based imaging method, will be used to assess muscle stiffness in the participants. Ultrasonography will be performed using a high-resolution LOGIQ P10 device (ML6-15-RS; GE Healthcare Inc., Chicago, IL, USA). During the examination, L3-12 Hd and L8-18i linear probes will be used. To measure upper trapezius muscle stiffness, the ultrasound probe will be placed 2 cm lateral to the midpoint between the acromion of the scapula and the spinous process of the seventh cervical vertebra (C7). Measurements will be taken when several muscle fascicles are visible continuously along the imaging plane. Each measurement will be repeated three times for the assessed muscle, and stiffness parameters will be calculated quantitatively. The average of the three measurements will be recorded in meters per second (m/s).
Muscle oxygenation
时间窗: Baseline and immediately post-intervention for each treatment session
Using near-infrared spectroscopy (NIRS) to evaluate trapezius muscle oxygen levels. Measurements will be performed both at rest and during muscle contraction. The measurement area will be shaved if necessary to prevent errors caused by hair. The area will then be cleaned with a cotton pad soaked in 70% alcohol solution. Participants will be seated with their feet flat on the floor, knees and hips flexed at 90°, and arms resting loosely on their thighs. For the upper trapezius muscle, the location of the probe will be determined as the midpoint of the line extending from the acromion to the spinous process of the C7 vertebra.
次要结局
- Pressure pain threshold(Baseline and immediately post-intervention for each treatment session)
- Pain intensity(Baseline and immediately post-intervention for each treatment session)
研究者
Fadime GULCAN
physiotherapist
Gazi University