The Effects of Active Release Technique and Proprioceptive Neurological Facilitation on Surface EMGs of Hypertonic Upper Trapezius Musculature

Both ART and PNF are soft tissue techniques used to decrease muscle hypertonicity, myospasm, and/or trigger points and increase the overall function of muscles.

Active-release technique, or ART®, is a form of myofascial therapy used in pain management that involves soft-tissue manipulation. ART has the expressed goal of restoring optimal texture, motion, and function of the soft tissue while releasing entrapped nerves or blood vessels. An injury to a soft-tissue structure commonly causes the muscle to shorten to guard or protect the area. A clinician who is performing ART makes a soft contact with one hand on the patient just distal to the injured area while the other hand develops tension on the soft tissue. While the contact tension is maintained, the structure is lengthened using an "active motion." During the motion, the lesion is palpated and the physical contact with the patient is changed or moved slightly in order to concentrate the tension in the appropriate tissue (Swann, et al).

Active Release Technique was developed by Dr. Michael Leahy and is widely used in rehabilitative and sports medicine for myofacial pain syndromes. The ART group will be treated by one investigator in concurrence with treatment methods outlined in Dr. Leahy's ART instructional manual. An ART treatment pass involves taking the tissue from a shortened position to a lengthened position while the administer maintains manual contact. We will perform three passes of ART with a 10 second rest period between passes. We will only perform ART on the symptomatic side (side that fits inclusion criteria); if both sides are involved, each side will be considered as a separate analysis.

The research backing ART is inadequate. Although there are numerous testimonials, limited published research studies could be found. Dr. George's study of the effect of ART, HVLA and no treatment on the temporomandibular joint and masticatory muscles showed no significant difference between the pre- and post-treatment mouth opening measurements. Another ART study of lateral epicondylitis concluded that the technique was successful in removing adhesions and promoting restoration of normal tissue but also stated that research was inadequate (Howitt, et al). A carpal tunnel study completed in 2006 used EMG to measure the effectiveness of ART. There were significant improvement in symptom severity and functional status after treatment, but no significant differences found in the EMG analyses (George, Tepe, and Busold 119-122).

Proprioceptive neuromuscular facilitation (PNF) stretching techniques are commonly used in the athletic and clinical environments to enhance both active and passive range of motion (ROM) with a view to optimizing motor performance and rehabilitation by elongating the muscle (Sharman, et al).