Progressive Pressure Release Versus Dry Needling on Cervical Latent Trigger Points

This study was conducted at the out patient clinic of faculty of Physical Therapy, Cairo University , Egypt. After signing an informed consent form, thirty subjects with latent myofascial trigger points (L-MTrPs) were assigned into two equal groups; (A) 15 subjects received passive stretching and progressive pressure release; 3 times per week for 4 weeks. Group (B) 15 subjects received passive stretching exercise and dry needling using acupuncture needles, 3 times per week for 4 weeks.. A certified physical therapist with more that 7 years experience carried out the assessment procedure. Clinical identification of L-MTrPs was based on Travel and Simon (1999) essential criteria, where the upper trapezius was placed in a stretched and relaxed position to easily locate L-MTrPs. Flat or pincer palpation was used to locate L-MTrPs. Essential criteria for L-MTrPs included; 1- Palpable taut band: which includes a tender nodule. 2- Exquisite spot tenderness of a nodule: Palpating through a taut band, there was a tender nodular area. 3- Limited range of motion at the end of range: it is a common characteristic of myofascial trigger points to restrict the range of motion and produce pain at the end of range (Fernndez et al., 2007 and Mullaney et al., 2010). He then marked an "X" on the L-MTrPs found, that were; L-MTrP1: was found in the mid portion of the anterior border of the upper trapezius and involves the most vertical fibers that attach anteriorly to the clavicle. L-MTrP2: lies caudal and slightly lateral to L-MTrP1 which was located in the middle of the more nearly-horizontal fibers of the upper trapezius Measurement outcome included pressure pain threshold using an electronic digital algometer and active cervical side bending and rotation using an inclinometer. Measurements were taken at the first treatment as baseline measurement and the end of the 4 weeks trial; at the last session as post-test measurement. Each subject had a sheet, where outcome measures were recorded in as well as attendance of sessions was registered in. Another certified physical therapist with 5 years experience carried out the progressive pressure release on the marked "X" L-MTrP and passive stretch treatment procedure. Passive stretch was applied while the patient was in seated position, the head was then taken to flexion, side bending to the opposite side and rotation to the same side, this position was maintained for 30-60 seconds and repeated 3 times. Progressive pressure release technique was applied using the thumbs; steady pressure was applied, moving inward toward the center. Once tissue resistance was felt, we stopped and waited until resistance dissipated, and then when a slow release or a "melting away" sensation of the tissue under treating fingers was felt, further steady pressure moving again inward toward the center was applied for 2-3 minutes. This was repeated 4 times. The muscle was placed in a position to maximize stretch, but in a relaxed one. A third certified acupuncture therapist applied the dry needling treatment procedure. where patients were placed in a comfortable sitting position and encouraged to maintain complete relaxation. The selected L-MTrP (marked by an "X") was prepared by wiping the area with an alcohol pad, and an acupuncture needle with its plastic guide tube in place was placed over the L-MTrP. With pincer palpation, the needle was applied to a depth of 1-1.5 cm. Needle movement was performed with rotation along its long axis in an effort till eliciting a small muscle twitch around the nodule; a local twitch response, which took from 30 sec to 2 min then the needle was removed.