Indian Journal of Physiotherapy & Occupational Therapy-An International Journal

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Efficacy of Ischaemic Compression Technique in Combination with Strain Counterstrain Technique in Managing Upper Trapezius Myofascial Trigger Point Pain


Affiliations
1 Hamdard University, India
2 Institute of Health and Management Studies, New Delhi, India
     

   Subscribe/Renew Journal


Objective

To establish the best possible long term effective choice of treatment program for deactivating MTrPs by using the combination of ischaemic compression technique with strain-counterstrain technique.

Design

Pretest-Posttest control group design.

Setting

Outpatient physiotherapy department, Northern Railway Central Hospital, New Delhi.

Patients

Fourty five subjects (only male) with Myofascial Trigger Points Pain. Subjects were randomly placed into three groups: Experimental group A (n=15), Experimental group B (n=15) and a control group C (n=15).

Intervention

The experimental group A received ischaemic compression technique in combination with straincounterstrain technique and experimental group B received ischaemic compression technique alone whereas control group received conventional treatment only. Main Outcome Measures: Pain pressure threshold was assessed with the pressure threshold meter (PTM). Pain and functional status of the patients were measured by a visual analogue scale (VAS) and the Neck Disability Index scores respectively.

Results

Within group analysis revealed significant improvement in pain pressure threshold, functional status and reduction in pain intensity in all groups. Between group analysis revealed significant difference between group A, group B and group C. Further post hoc analysis revealed significant difference between group A and B, group A and C and group B and C for all variables even after one week of follow up after the termination of intervention.

Conclusion

The combination of ischaemic compression technique with strain-counterstrain has been shown to produce greater improvement in pain pressure threshold on pressure threshold meter, function status on neck disability index scores and reduction in pain intensity on visual analogue scores even after one week of the termination of intervention. This shows the long term effectiveness of combination of two manual techniques. This study may provide a rationale for the clinical use of these two manual techniques in deactivating the myofascial trigger points pain.


Subscription Login to verify subscription
User
Notifications
Font Size


  • Imamura ST, Fischer AA, Imamura M, Teixeira MJ, Tchia Yeng Lin, Kaziyama HS, et al. Pain management using myofascial approach when other treatment failed. Phys Med Rehabil Clin North Am 1997; 8:179-96.

  • Cole TM, Edgerton VR. Musculoskeletal disorders.In: Cole TM, Edgerton VR, eds. Report of the Task Force on Medical Rehabilitation Research: June 28-29, 1990, Hunt Valley Inn, Hunt Valley, Md.Bethesda: National Institutes of Health, 1990:61-70.

  • Hong CZ, Hsueh TC. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil 1996; 77:1161-6.

  • Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:5.

  • Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth 1997;22:89-101.

  • Ling FW, Slocumb JC. Use of trigger point injections in chronic pelvic pain. Obstet Gynecol Clin North Am 1993;20:809-15.

  • Mense S, Schmit RF. Muscle pain: which receptors are responsible for the transmission of noxious stimuli? In: Rose FC, ed. Physiological aspects of clinical neurology. Oxford: Blackwell Scientific Publications, 1977:265-78.

  • Hopwood MB, Abram SE. Factors associated with failure of trigger point injections. Clin J Pain 1994; 10:227-34.

  • Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985;60:615-23.

  • Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:94-173.

  • Rachlin ES. Trigger points. In: Rachlin ES, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:145-57.

  • Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:11-93.

  • Sola AE, Bonica JJ. Myofascial pain syndromes. In:Bonica JJ, ed. The management of pain. 2d ed. Philadelphia: Lea & Febiger, 1990:352-67.

  • Hou, C.R., Tsai, L.C., Cheng, K.F., Chung, K.C., Hong, C.Z., 2002. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical and Medical Rehabilitation 82, 1406– 414.

  • Meseguer A.A, Ferna´ndez-de-las-Pen˜as C, Navarro- Poza J L, Rodri´guez-Blanco C, Bosca´ Gandia J.J. Immediate effects of the strain/counterstrain technique in local pain evoked by tender points in the upper trapezius muscle; Clinical Chiropractic: 2006 vol. 9, 112—118.

  • Jensen, M.P., Turbner, J.A., Romano, J.M., Fisher, L.D., 1999. Comparative reliability and validity of chronic pain intensity measures. Pain 83, 157–162.

  • Fischer, A., pressure algometry over normal muscle, standard values, validity and reproducibility of pressure threshold, pain 1987, 30; 115-126.

  • Simons, D., Hong, C.-Z., Simons, L., 2002. Endplate potentials are common to mid fiber myofascial trigger points. American Journal of Physical Medicine and Rehabilitation 81, 212–222.

  • Jaeger, B., Reeves, J.L., 1986. Quantification of changes in myofascial trigger point sensitivity with the pressure algometer following passive stretch. Pain 27, 203–210.

  • Hou, C.R., Tsai, L.C., Cheng, K.F., Chung, K.C., Hong, C.Z., 2002. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical and Medical Rehabilitation 82, 1406–1414.

  • Lewit, K., 1991. Manipulative Therapy in Rehabilitation of the Locomotor System, second ed. Butterworth Heinemann, Oxford.

  • Lewit D, Simons DG. Myofascial pain: relief by postisometric relaxation. Arch Phys Med Rehabil. 1984; 65:452– 456.


Abstract Views: 622

PDF Views: 0




  • Efficacy of Ischaemic Compression Technique in Combination with Strain Counterstrain Technique in Managing Upper Trapezius Myofascial Trigger Point Pain

Abstract Views: 622  |  PDF Views: 0

Authors

Amir Iqbal
Hamdard University, India
Sohrab A. Khan
Hamdard University, India
Mohd. Miraj
Institute of Health and Management Studies, New Delhi, India

Abstract


Objective

To establish the best possible long term effective choice of treatment program for deactivating MTrPs by using the combination of ischaemic compression technique with strain-counterstrain technique.

Design

Pretest-Posttest control group design.

Setting

Outpatient physiotherapy department, Northern Railway Central Hospital, New Delhi.

Patients

Fourty five subjects (only male) with Myofascial Trigger Points Pain. Subjects were randomly placed into three groups: Experimental group A (n=15), Experimental group B (n=15) and a control group C (n=15).

Intervention

The experimental group A received ischaemic compression technique in combination with straincounterstrain technique and experimental group B received ischaemic compression technique alone whereas control group received conventional treatment only. Main Outcome Measures: Pain pressure threshold was assessed with the pressure threshold meter (PTM). Pain and functional status of the patients were measured by a visual analogue scale (VAS) and the Neck Disability Index scores respectively.

Results

Within group analysis revealed significant improvement in pain pressure threshold, functional status and reduction in pain intensity in all groups. Between group analysis revealed significant difference between group A, group B and group C. Further post hoc analysis revealed significant difference between group A and B, group A and C and group B and C for all variables even after one week of follow up after the termination of intervention.

Conclusion

The combination of ischaemic compression technique with strain-counterstrain has been shown to produce greater improvement in pain pressure threshold on pressure threshold meter, function status on neck disability index scores and reduction in pain intensity on visual analogue scores even after one week of the termination of intervention. This shows the long term effectiveness of combination of two manual techniques. This study may provide a rationale for the clinical use of these two manual techniques in deactivating the myofascial trigger points pain.


References