RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name and address of the candidate / SHAIK MOHAMMAD IMRAN3RD MAIN HRBR LAYOUT
KALYAN NAGAR BANGALORE -43
2 / Name of the institution / FLORENCE COLLEGE OF PHYSIOTHERAPY
3 / Course of study and subject / MASTER OF PHYSIOTHERAPY
(Musculoskeletal Disorder And Sports)
4 / Date of admission of course
5 / Title of the topic / A COMPARATIVE STUDY ON THE EFFECTIVENESS OF ISCHEMIC COMPRESSION TECHNIQUE AND LASER THERAPY IN REDUCING MYOFASICAL PAIN ON UPPER TRAPEZIUS
6 / Brief resume of indented work
6.1 Need of study
Myofascial pain syndrome is one among the common disorder in the world population. Myofascial pain is a common source of discomfort and disability for many patients. Most of the IT professionals have problem with musculoskeletal dysfunction due to poor posture or over exertion leading to physical or mental stress causes muscle to spasm. This will developed pain producing myofascial pain syndrome which increases with age. As activity become less strenuous in later years, individuals tend to exhibit chiefly the stiffness and restricted motion of latent myofascial pain syndrome. Ischemic compression applied with therapist’s hand is safe, non-traumatic and effective treatment for the myofascial pain syndrome. The treatment of myofascial pain focuses on correction of muscle shortening by targeted stretching, massage, strengthening exercises of affected muscles and correction of aggravating postural and biomedical factors .Modalities like Electrical muscle stimulation, Ultrasound and Laser therapy can be useful in decreasing pain allowing the patient to participate in active exercise program. This study is essential as most of the general population suffer from this problem. This is commonly seen in upper trapezius. This study helps the physiotherapist to enhance their knowledge to treat a condition like myofascial pain syndrome.
6.2 Review of literature
1. Montanez et al (2009), concluded in their study on immediate effect of ischemic compression and ultrasound for treatment of myofascial trigger points in the trapezius muscle that both the treatment showed an immediate decrease in basal electrical activity of the trapezius muscle, improvement of A range of motion of cervical rachis and myofasical trigger point sensitivity of the trapezius muscle gaining short –term positive effects with use of ischemic compression.
2. Mark Barnes (1997), Describes that the Ischemic compression is a hands on soft tissue technique that facilitates a stretch into the restricted fascia. After few releases tissues will become softer and more pliable.
3. Lehmann and de Lateur.,(1982): concluded in their study on therapeutic heat and cold and they Observed that vascular changes due to trigger point release technique reduce myofascial pain.
4. Hong.,et al.(1993): concluded in their study on immediate effect of various physical medicine modalities on pain threshold of an active myofascial trigger point and found that ischemic compression is more effective than the other modalities.
5. Hou CR.et al.(2000): concluded in their study on immediate effect of various physical therapeutic modalities on cervical myofascial pain and trigger point sensitivity and they found that ischemic compression therapy provides immediate pain relief and Myofascial trigger point sensitivity suppression.
6. William P et al.(2000): Studied the effectiveness of home program of ischemic pressure followed by sustained stretch. They conclude that home program consisting of ischemic pressure and sustained stretching is effective in reducing trigger point sensitivity and pain intensity
7. Hakquder A etal concluded in their study on Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermo graphic evaluation and they found that Low Level Laser Therapy seemed to be beneficial for pain in Myofascial Pain Syndrome by using algometry and thermography.
8. Ilbuldu E etal has conducted a study on Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome and he found that Laser therapy could be useful as a treatment modality in myofascial pain syndrome because of its noninvasiveness, ease, and short-term application.
9. Carrasco TG etal has conducted a study on Evaluation of low intensity laser therapy in myofascial pain syndrome and he found that Low Level Laser Therapy is effective in reducing pain experienced by patients with myofascial pain syndrome.
10. Simunovic Z. He conducted a study on Low level laser therapy with trigger point’s technique: a clinical study on 243 patients and he found that Low Level Laser Therapy suggests that the laser beam can be used as monotherapy or as a supplementary treatment to other therapeutic procedures for pain treatment.
6.3 Objective of the studyThe study proposes to achieve the following objectives:
6.3.1 To study the efficacy of ischemic compression technique in reducing myofasical pain on upper trapezius.
6.3.2 To study the efficacy of laser therapy in reducing myofasical pain on upper trapezius.
6.3.3 To compare the efficacy of ischemic compression technique and laser therapy in reducing myofasical pain on upper trapezius.
6.4 Hypothesis
6.4.1 Null hypothesis
There is no significant difference between ischemic compression technique and laser therapy in reducing myofasical pain on upper trapezius.
6.4.2 Alternative hypothesis
There is significant difference between ischemic compression technique and laser therapy in reducing myofasical pain on upper trapezius.
7 / Materials and methods
7.1 Source of data
Florence rehabilitation center kalyan nagar Bangalore -43
7.2 Methods of collecting data
7.2.1 Sample and sampling technique
The study included a sample of 40 subjects.
Each group consist 20 samples and selected by random sampling method.
7.2.2 Research design
Comparative design with pre and post test data taken for both the experimental group and control group.
7.2.3 Population
The population for the study includes subjects who diagnosed as having myofascial pain of the upper trapezius
7.2.4 Selection criteria
Ø Inclusion criteria
v Patients with myofascial pain on the upper trapezius
v Age 20-40 Years
v Both sexes
v Subjects who were psychologically fit
v Subject with unilateral involvement
Ø Exclusion criteria
v Patient with dermatitis
v patients with any associated problems
v Any open wounds over trapezius
v Degenerative changes of the cervical spine
v Ankylosed cervical spine
v Patients with neurological involvement.
7.2.5 Measurement tool
Visual analogue scale is a valid and reliable tool to measure pain.
7.2.7 Materials used
1. Paper.
2. Pen.
3. Laser
.3 Intervention to be conducted
7.3 Ethical clearance
Ethical clearance will be obtained from the institution.
7.4.1 Methodology
40 samples will be selected using simple random sampling and divided into two equal groups. Group1 will receive ischemic compression technique and Group 2 will receive laser therapy. Both the groups undergo pretest assessment of pain using visual analogue scale.
ISCHEMIC COMPRESSION
After locating the trigger point, a firm digital compression was applied with a single finger pad. The pressure was gentle at the beginning and was gradually progressed deeper into tissue. It performed very slowly to accommodate the patient’s pain threshold level. The compression is maintained for 30 second and released it for 2-3 seconds. This same cycle repeated till the patient has reported a reduction in local or referred pain or an increase in pain or until 2 minutes has passed without any change in pain level. A small amount of talcum powder is applied over the trigger point, before this procedure in order to reduce the noxious skin friction.
LASER THERAPY
Patients seated in a chair with shoulders relaxed. Laser therapy given using a infra red laser with a wave length 904 nm. The area of tenderness was identified and a pulsed mode laser therapy given with a frequency of 550 Hz using direct contact method for a period of 90 seconds once a day for a period of seven days.
The post test measurement of pain collected at the end of the seventh day by visual analogue scale and appropriate statistical tools.
8 / List of references
1. Montañez et al, immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J manipulative physiol ther 2009; 32:515-520.
2. Hay C.R. Helowa A.,“Myofascial pain syndrome. A critical review of the literature” physical therapy, 1994; 46: 28 – 36.
3. Carol manheim.,(2001): The myofascial release manual 3rd edition. Basic myofascial release techniques. Page No 80-100.
4. Esenyel et al. (2000): Treatment of Myofascial pain, AM J Phy Med rehabilitation Jan – Feb,No.79 :Page No 48 – 52.
5. Hong CZ, Chen YN,Twehous DA., et al. (1996): Pressure threshold for referred pain by compression on the trigger point and adjacent area J Musculoskeletal pain 4 (3): Page No 61– 79.
6. Hong,chang-zen., et al. (1993): Immediate effect of various physical medicine modalities on pain threshold of an active Myofascial trigger point, Journal of Musculoskeletal pain, Vol 1 (2), The Haworth press.
7. Hou CR.,et.al., (2000): Immediate effect of various physical therapeutic modalities on cervical Myofascial pain and trigger point sensitivity. National Cheng Jung University, Taiwan.
8. Lehmann J.F., de Lateur B. J.,(1982): Therapeutic heat. In therapeutic heat and cold (Lehmann J. F. ed) Baltimore Williams and Wilkins, Page No 404 – 562.
9. Leon chaitow., Craid liebenson.,(2002): Muscle energy technique 2nd edition.Patterns of function and dysfunction. Page No 55-62& 190-200.
10. Lewit D,Simsons., DG.Myofascial.,(1984): Pain: relief of pain of post isometric relaxation. Arch phys Med Rehabilitation, No 65, Page No 452 – 456, Medline.
11. Lucy whyte Ferguson., Robert Gerwin.,(2000): Clinical mastery in the treatment of myofascial pain. Neck pain and restriction following whiplash. Page No 57-96.
12. Robert I.Cantu., Alan J.Grodin.,(2001): Myofascial manipulation Theory and clinical application 2nd edition. Basic evaluation of the myofascial system. Page No 140-163.
13. Treatment of Myofascial pain (2000): American Journal of physical medicine and rehabilitation Feb vol:43, Nol, Page No.323-6.
14. Wadsworth., H,Chanmugan.,(1980): Electrophysical agents in physiotherapy. Australia : Science press.
15. William P Hanten., et al. (2000): Effectiveness of home program of ischemic pressure followed by sustain stretch for treatment of MTrPs. Phys Ther Oct 80 (10) : Page No 997 — 1003.
16. Williams E.Prentice., (1998): Therapeutic modalities for allied health professional. Ultra sound therapy, Page No 263-297.
9 / Signature of the candidate :
10 / Remarks of the guide : This study can prove the effectiveness of ischemic compression and laser therapy in reducing myofasical pain on upper trapezius. This will be worth in the field of physiotherapy
11 / 11.1 Guide :
11.2 Signature :
11.3 Co-guide :
11.4 Signature :
11.5 Head of the department :
11.6 Signature :
12 / 12.1 Remarks of the chairman :
& Principal
12.2 Signature :