Myofascial Pain Syndrome - Neck, Myofascial Trigger Points, Neck Pain Musculoskeletal
Conditions
Keywords
Upper Trapezius, Jones Technique, Strain Counterstrain, Therapeutic Ultrasound, Transcutaneous Electrical Nerve Stimulation
Brief summary
Myofascial trigger points in the upper trapezius muscle are a common cause of neck pain and may negatively affect pressure pain threshold, upper limb function, sleep quality, and quality of life. This randomized, sham-controlled clinical trial aimed to compare the effects of the Jones Technique, combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation \[TENS\]), their combination, and a sham intervention in women with active upper trapezius myofascial trigger points. The primary outcome was pressure pain threshold. Secondary outcomes included pain intensity, upper limb disability, sleep quality, quality of life, physical activity level, and participant satisfaction.
Detailed description
Myofascial trigger points (MTrPs) in the upper trapezius muscle are frequently associated with neck pain, reduced pressure pain threshold, and impaired upper limb function. Several conservative interventions have been proposed for the treatment of MTrPs; however, evidence comparing manual therapy and combined electrotherapy remains limited. This single-center, randomized, sham-controlled, parallel-group clinical trial evaluated the effects of the Jones Technique and combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation \[TENS\]) in women aged 18 to 40 years presenting with active myofascial trigger points in the upper trapezius muscle. Participants were randomly allocated (1:1:1:1) into four groups: (1) Jones Technique; (2) combined therapy; (3) combined therapy plus Jones Technique; and (4) sham control. Randomization was performed using block randomization stratified by age. Participants underwent a single treatment session. Baseline assessments included demographic data, pain intensity measured using the Visual Analog Scale (VAS), pressure pain threshold measured with a pressure algometer, upper limb disability (DASH), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), and physical activity level (IPAQ). Immediately after the intervention, pain intensity, pressure pain threshold, and participant satisfaction were reassessed. The primary outcome was pressure pain threshold. Secondary outcomes included pain intensity, upper limb disability, sleep quality, quality of life, physical activity level, and participant satisfaction.
Interventions
PROCEDUREJones Technique
Manual therapy technique applied to active myofascial trigger points of the upper trapezius muscle. Participants were positioned in prone lying, and sustained pressure with positional release was applied to each trigger point for 90 seconds. Five trigger points were treated during a single treatment session.
DEVICECombined Therapy (Therapeutic Ultrasound + TENS)
Combined therapy consisting of pulsed therapeutic ultrasound (1 MHz, 20% duty cycle, 1.0 W/cm²) delivered simultaneously with transcutaneous electrical nerve stimulation (TENS; biphasic asymmetric waveform, 200 μs pulse duration, 100 Hz). Treatment was applied to five active upper trapezius myofascial trigger points during a single 10-minute session.
COMBINATION_PRODUCTCombined Therapy + Jones Technique
Participants received the Jones Technique followed immediately by combined therapy (therapeutic ultrasound plus transcutaneous electrical nerve stimulation \[TENS\]) during a single treatment session.
PROCEDURESham Intervention
Participants underwent sham treatment consisting of inactive combined therapy with the device turned off and a simulated Jones Technique performed without therapeutic pressure.
Sponsors
Isabel de Almeida Paz
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
* Female participants aged 18 to 40 years. * Presence of active myofascial trigger points in the upper trapezius muscle for no longer than 12 weeks. * Neck pain lasting less than 3 months. * Pain intensity of at least 3 cm on the 10-cm Visual Analog Scale (VAS). * Ability to understand the study procedures and provide written informed consent.
Exclusion criteria
* Presence of a cardiac pacemaker or other contraindications to electrotherapy. * Pregnancy. * Uncontrolled cardiovascular disease. * Psychiatric disorders that could interfere with study participation. * Thrombosis or coagulation disorders. * History of tumors or neoplasms. * Physical therapy or myofascial treatment within the previous 3 weeks. * Treatment for myofascial trigger points within the previous 3 months. * Current use of analgesic medications. * Cervical musculoskeletal disorders (e.g., cervical osteoarthritis or other cervical lesions). * History of cervical trauma or surgery. * Cervical spondylosis or spondylolisthesis with radiculopathy. * Fibromyalgia or other systemic rheumatic diseases. * Other musculoskeletal disorders that could interfere with the study outcomes.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pressure Pain Threshold (PPT) | Baseline and immediately after the intervention (single treatment session) | Pressure pain threshold assessed using a pressure algometer at five active myofascial trigger points in the upper trapezius muscle. The pressure pain threshold is recorded in kg/cm². Higher values indicate greater pressure tolerance and therefore a better outcome. |
| Pain Intensity | Baseline and immediately after the intervention | Pain intensity assessed using the Visual Analog Scale for Pain (VAS). Scores range from 0 to 10 cm, where 0 indicates no pain and 10 indicates the worst pain imaginable. Higher scores indicate worse pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Upper Limb Disability | Baseline | Upper limb disability assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Scores range from 0 to 100, where 0 indicates no disability and 100 indicates the most severe disability. Higher scores indicate worse upper limb function. |
| Sleep Quality | Baseline | Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI). Total scores range from 0 to 21, where higher scores indicate poorer sleep quality. |
| Quality of life | Baseline | Quality of life assessed using the 36-Item Short Form Health Survey (SF-36). Scores for each domain range from 0 to 100, where higher scores indicate better health-related quality of life. |
| Physical Activity Level | Baseline | Physical activity level assessed using the International Physical Activity Questionnaire (IPAQ). Participants are classified into low, moderate, or high physical activity levels based on the questionnaire scoring protocol. Higher physical activity classification indicates a better outcome. |
| Participant Satisfaction | Immediately after the intervention | Participant satisfaction assessed immediately after treatment using a 7-point Likert scale. Scores range from 1 (strongly disagree/very dissatisfied) to 7 (strongly agree/very satisfied). Higher scores indicate greater participant satisfaction. |
Countries
Brazil
Outcome results
None listed