Effectiveness of manual versus electrical physiotherapy interventions in cervical myofascial pain syndrome in people with spinal injury.

1. Intervention: Manual therapy The manual therapy protocol was focused on the treatment of selected trigger points of the following muscles, in this particular order: right and left levator scapulae (upper-medial border trigger point), right and left trapezium upper fibers (central trigger point) and right and left sternocleidomastoid (apophysis mastoid insertional trigger point). Trigger points were identified by palpation and irradiated pain response according to Travel & Simons criteria. Manual therapy protocol: Application of pressure release technique for three minutes for each muscle and side (six minutes in total), massage therapy for three minutes for each muscle and side (six minutes in total), and stretching for three minutes for each muscle and side (six minutes total). Each session took eighteen minutes in each muscle (ipsilateral and contralateral as a whole), adding up to a total of fifty-four minutes in the entire musculature. Preferentially, participants were at decubitus supine. Each participant received 12 sessions, twice a week on alternating days, until 1.5 months. The only material needed was almond oil to perform massage therapy intervention. 2. Additionally, during the manual therapy protocol (12 sessions), participants also received education intervention (see 2.1; 10 minutes during all 12 sessions) and a global/general intervention (see 2.2; 20 minutes per session during all 12 sessions after the manual therapy in a self-perceived moderate intensity in motoMED or bicicle). 2.1 Education: focused on a review of the importance of ergonomics, therapeutic exercise and physical activity. It consisted in two parts: the first, aimed at explaining ergonomics and exercises performance; the second, focused on the performance of the exercises (cervical movements, stretching, isometric/eccentric contractions) with supervision. The participants were encouraged to perform the exercises once a day when the whole MANUAL THERAPY and ELECTROTHERAPY interventions ended. 2.2 Global/general intervention: measures always considered in spinal cord injury (SCI) treatment, as free movements of extremities with motomed or bicycle, depending on the level of SCI. They took 20 minutes while performing the modality-dependent activities, but participants were able to enlarge if devices were available. Total duration of the study: 11 months; 24 sessions (manual therapy + electrotherapy). While one group was receiving manual therapy, the other group received electrotherapy. After a resting period of 3.5 months, participants received the other intervention (crossed design). Strategies used to monitor adherence: session attendance checklists. All the interventions were face-to-face delivered by 4 experienced Physical therapist (minimum 5 years of experience) at the Centro Base de Personas con Discapacidad (Palma de Mallorca, Balearic Islands). All Physical therapist received face-to-face education about intervention procedures in 10 sessions along three months (between 12/2014-02/2015). Participants had to attend a 100% of MANUAL THERAPY and ELECTROTHERAPY sessions (12 + 12).