MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Effectiveness of LASER Therapy in Managing Upper

Trapezius-Myofascial Pain Syndrome: A Randomized

Control Trial

A Research Presented to the

College of Physical Therapy

Medical Colleges of Northern Philippines

In partial fulfillment of the Requirements for the

Degree

Bachelor of Science in Physical Therapy

Presented by:

Felipe, Jan Wesley D.

Laguatan, Maebelle Anne D.

Manuel, Angelica P.

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Chapter 1

The Problem and Its Background

INTRODUCTION

Myofascial pain syndrome (MPS) is considered one of the leading

causes of work/school absences. It is characterized by regional

pain originating from hyperirritable spots located within taut

bands of skeletal muscle, known as myofascial trigger points

(MTrPs).

These muscles develop focal regions, or knots of increased

contraction. These focal areas are not able to get proper blood

flow. The contracted fibers close down nearby capillaries that

supply individual fibers with essential nutrients and oxygen.

Because the blood flow is insufficient, muscle fibers are unable

to get rid of toxic waste products (e.g. lactic acid) that build

up during normal resting metabolic states. A chronic cycle of pain

ensues in the affected tissues which is difficult to break and may

be palpated beneath the skin and cause pain.

MTrPs often arise from sustained repetitive activities, like

lifting heavy objects at work or working on a computer all day.

This can also be caused by repetitive motions used in jobs or

hobbies or by stress-related muscle tension.

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A combination of contributing factors may include

poor posture ,sitting for a long time in awkward positions,

nutritional deficiencies, serious lack of exercise or movement,

any injury to the musculoskeletal system or intervertebral disks,

generalized fatigue, lack of sleep, hormonal changes

(menopause),intense cooling of muscles (such as when sleeping in

front of an air conditioner),emotional problems

depression, anxiety, other pain or inflammatory conditions,

obesity or smoking.

Studies have shown that people who frequently experience stress

and anxiety may be more likely to develop trigger points in their

muscles. One theory holds that these people may be more likely to

clench their muscles which is a form of repeated strain that leaves

muscles susceptible to trigger points.

Methods to release myofascial trigger points have been studied,

including the three most common methods-

therapeutic ultrasound, transcutaneous electrical nerve

stimulation(TENS) and LASER therapy.

Clinically some therapists find the application of therapeutic

ultrasound an effective means of inactivating trigger points.

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These machines transmit sound waves into tissue through a sound-

conducting gel applied to the skin. The sound waves can heat up

and relax muscles, improve blood flow, and remove scar tissue.

The 2nd treatment approach is TENS (Transcutaneous Electrical

Nerve Stimulation), it is a method of electrical stimulation which

primarily aims to provide a degree of symptomatic pain relief by

exciting sensory nerves and thereby stimulating either the pain

gate mechanism and/or the opioid system. The different methods of

applying TENS relate to these different physiological mechanisms.

The 3rd treatment approach is LASER therapy, the term LASER

is the acronym for Light Amplification by Stimulated Emission

of Radiation. A laser light is monochromatic, collimated, and

coherent. A laser is a device that produces light. Low level

laser therapy (LLLT) is used by some physiotherapists to treat

various musculoskeletal condition. LLLT is a non-invasive light

source treatment that generates a single wavelength of light.

It emits no heat, sound, or vibration. It is also called

photobiology or biostimulation. LLLT is believed to affect the

function of connective tissue cells (fibroblasts), accelerate

connective tissue repair and act as an anti-inflammatory agent.

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Lasers with different wavelengths, varying from 632 to 904 nm,

are used in the treatment of musculoskeletal disorders.

In clinical practice, some rehabilitation institutions

combine the three modalities in one treatment program, thus

requiring more money spent for the therapy. This is also one of

the reasons why this research is also committed to determine if

there is only one modality among the three abovementioned, which

can decrease pain, decrease limitation of motion (LOM) and

decrease neck disability index (NDI) score.

To sum up, myofascial pain syndrome is not a fatal condition

but it can significantly reduce quality of life and is a major

cause of time lost from work and determining the more effective

treatment approach for this condition will significantly

contribute to the reduction of cases involving MPS worldwide.

Since, LASER therapy is one of the newest treatment approach in

the Philippines nowadays and different rehabilitation institutions

had purchased the abovementioned machine, the researchers were

inspired to conduct this study to assess the effectiveness of this

treatment approach in terms of managing pain, improving range of

motion (ROM) and decreasing NDI score. Furthermore, since

therapeutic ultrasound and TENS are also two of the most commonly

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used modalities in treatment of MPS, this study also aims to asses

if there is a significant difference on the effect of LASER

therapy, ultrasound therapy and TENS in terms of decreasing pain

perception, decreasing LOM and decreasing NDI score of patients

with upper trapezius-MPS.

THEORETICAL FRAMEWORK

This study used the International Classification of

functioning/disability (ICF) and health conditions of Model of

disablement theory by World Health Organization (WHO)[2002] which

major advantage for the patient is the integration of the physical,

mental and social aspects of his or her health conditions. All

aspects of a person’s life including development, participation

and environment are incorporated into the ICF instead of focusing

solely on his or her diagnosis.

ICF model also emphasizes the function of a patient rather

than her disease. It studies how can the disease affect patient’s

function and the patient’s prognosis rather than considering only

the nature of his/her condition.

Knowing how a disease affects one’s functioning enables

better planning of services, treatment and rehabilitation. The ICF

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provides a description of situations with regard to human

functioning and disability and serves as a framework to organize

outcomes and tests (WHO, 2002).

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Research Paradigm

INPUT PROCESS OUTPUT

Demographic profile of a. Collection of data There is a significant
the subjects as to: through difference between the
questionnaire, mean pre and post VAS,
a. Age interviews and LOM towards left
b. Sex objective cervical rotation and
c. Occupation assessment, pre left cervical lateral
d. Civil status VAS,ROM and NDI flexion and NDI score
e. Duration of time was obtained. of subjects under LASER
spent in upright b. Subjects were group.
posture. randomly assigned
to 3 groups There is no significant
Brief history of the difference on the
namely, LASER
patient as to: effect of LASER
group, Ultrasound
group and TENS therapy, Ultrasound
group. therapy and TENS in
c. Subjects received decreasing pain,
treatment three decreasing LOM and
Objective assessment times. decreasing NDI score.
done by researchers d. Post VAS, ROM and
and assessor which NDI was assessed.
includes: e. Statistical
analysis and
a. Palpation-
interpretation of
assessing
data.
presence of taut
-Frequency
bands,…
-Percentage
b. Pre VAS score
-Ranking
c. Pre ROM score
f. Test for
d. Pre NDI score
significant
difference
between mean pre
and post VAS, LOM
and NDI of
subjects under
LASER group.
g. Test for
significant
difference on the
effect of LASER
therapy,
Ultrasound
therapy and TENS
in the mean pre
and post VAS, LOM
and NDI of
subjects under
each group.

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Figure 1.1. This paradigm shows the subject’s demographic profile,

brief patient history and objective assessment done in correlation
with the eligibility, inclusion and exclusion criteria set by the
researchers. This also shows the procedure done, before the first
treatment session and after the last treatment session which
depicts how and when the data was obtained and how the three
modalities were utilized. The subject’s group indicates what
modalities they received. Furthermore, it shows the outcome which
says there is a significant difference between the mean pre and
post VAS, LOM towards left cervical rotation and left cervical
lateral flexion and NDI score of subjects under LASER group.
Moreover, the result also says there is no significant difference
on the effect of LASER therapy, Ultrasound therapy and TENS in
decreasing pain, decreasing LOM and decreasing NDI score.

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STATEMENT OF THE PROBLEM

The study sought to assess and evaluate the effectiveness of

LASER therapy in decreasing pain perception, decreasing LOM and

decreasing NDI score of subjects with upper trapezius- myofascial

pain syndrome. Specifically, it aims to answer the following.

1. What is the demographic profile of the subjects as to:

a. Age

b. Sex

c. Civil status

d. Occupation

e. Duration of time spent in upright posture.

2. What is the mean pre and post VAS, cervical LOM and NDI score

assessment of subjects under the LASER group?

3. Is there a significant difference between the mean pre and

post VAS, cervical LOM and NDI score assessment of subjects

under the LASER group?

4. What is the mean pre and post VAS, cervical LOM and NDI score

assessment of subjects under the:

a. Ultrasound group

b. TENS group

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5. Is there a significant difference between the mean pre and

post VAS, cervical LOM and NDI score assessment of subjects

under the:

a. LASER group

b. Ultrasound group

c. TENS group

6. Is there a significant relation of the subject’s demographic

profile in the development of upper trapezius-MPS?

HYPOTHESES

1. There is no significant difference between the mean pre and

post VAS, cervical LOM and NDI score assessment of subjects

under the LASER group.

2. There is no significant difference between the mean pre and

post VAS, cervical LOM and NDI score assessment of subjects

under the LASER group, Ultrasound group and TENS group.

SIGNIFICANCE OF THE STUDY

This study is beneficial to the field of rehabilitation medicine

because this will assess and evaluate the effectiveness of LASER

therapy in decreasing pain, LOM and NDI scores of patients with

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upper trapezius- myofascial pain syndrome. The result of this study

will be helpful to the following:

Students- Any significant findings could help students to

increase awareness regarding the more effective therapeutic

approach for MPS.

MCNP-ISAP- This study will help the school in revising the

current therapeutic approaches lessons taught to BSPT students,

thus the students will be more aware of the latest trends in the

field.

Rehabilitation Medicine- The result will contribute to the

current volume of evidences regarding effectiveness of LASER

therapy in decreasing pain, LOM and NDI scores of patients with

upper trapezius- myofascial pain syndrome.

Patients- The result will increase patient’s awareness

regarding the effective therapeutic modalities for treatment of

upper trapezius- myofascial pain syndrome.

Future Researches- The result will serve as reference tool of

those who want to develop topics related to effective treatment

approach for MPS, effectiveness of LASER therapy, compared to

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Ultrasound therapy and TENS in decreasing pain, LOM and NDI scores

of patients with upper trapezius- myofascial pain syndrome.

Researchers- This will serve as a guide for them to assess and

evaluate the effectiveness of LASER therapy, compared to

Ultrasound therapy and TENS in decreasing pain, LOM and NDI scores

of patients with upper trapezius- myofascial pain syndrome. This

will assist to provide essential recommendations that could put

emphasis on the use of more effective therapeutic approach in MPS

treatment.

SCOPE AND DELIMITATION

This study is limited only on the assessment and evaluation of

the effectiveness of LASER therapy, compared to Ultrasound therapy

and TENS in decreasing pain, LOM and NDI scores of patients with

upper trapezius- myofascial pain syndrome, it does not seek to

study the effectiveness of other treatment options in treating MPS

such as dry needling, stretching, manual myofascial release,

ischemic pressure and etc.

The subjects include 15 MCNP-ISAP students and employees

experiencing pain on upper trapezius muscle and are qualified based

on the eligibility and inclusion criteria set by the researchers.

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Moreover, an exclusion criteria was also used to determine patients

who cannot qualify or has contraindications for LASER therapy,

Ultrasound therapy and TENS. The abovementioned criteria include:

ELIGIBILITY CRITERIA

 Ages eligible for study: 18 years above

 Sexes eligible for study: All

 Accepts healthy Volunteers: No

INCLUSION CRITERIA

 Age > 18 year-old

 Subjects who were assessed by a licensed physical therapist

and are qualified to have upper trapezius- MPS based on

diagnostic tool criteria for MPS diagnosis (appendix) used by

physical therapist in clinical setting.

 Baseline visual analogue scale (VAS) more than or equal

to 4 at upper trapezius MTrPs.

 Baseline NDI greater than or equal to 2%.

EXCLUSION CRITERIA

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 During the past 2 weeks had received injection or physical

therapy at upper trapezius muscle or shoulder area.

 Had experienced LASER therapy, Ultrasound therapy or TENS 2

months before the conduct of research.

 Had history of accident or severe trauma to shoulder or

cervical region.

 Had serious musculoskeletal condition that need surgical

intervention such as acute shoulder subluxation or abnormal

neurological examination.

 Skin or sensory impairment around shoulder or cervical area.

 Skin infection at shoulder or cervical area.

 Had contraindication for LASER therapy, Ultrasound therapy

and TENS such as pregnancy, cemented prosthesis, cardiac

pacemaker, SCI, post laminectomy, impaired sensation and

growing endplates.

 Unable to communicate.

 Unable to complete three treatment sessions for the duration

of 2 months that the study will be implemented and unable

follow protocol.

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DEFINITION OF TERMS (edit this when you’re done)

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Chapter 2

REVIEW OF RELATED LITERATURE

Ma’am to follow po ung updated na chapter 2. Maghahanap palang

ako ng magandang internet sa weekend hehe.

This section represents literature regarding the efficacy of

combined US-TENS therapy, efficacy of conventional US therapy,

validity and reliability of outcome measures used in the study,

diagnostic tool for MPS, existence of machines with combination

therapy

EFFICACY OF COMBINED US-TENS THERAPY (COMBINATION THERAPY)

On a study conducted by Loharjun et al on 2013, they stated

that in the recent clinical practice, there is a new type of

combined treatment unit which composes of electrotherapy (TENS)

and ultrasound therapy in one unit.Loharjun et al conducted a study

to prove the efficacy of this treatment and the result of the study

highlighted that this combination therapy is effective in

treatment of MPS.

However, literature said that combination therapy was already

known before. Based on a study conducted by Travell & Simons on

1999, TENS and Ultrasound are being used in physical therapy to

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inactivate trigger points. Many papers have been published in the

issues of the effect of ultrasound & TENS in musculoskeletal

disorders . But very few studies studied both effect of Ultrasound

& TENS on pain & range of motion (Bonica, 1957 & Novich,1965).

This is the reason why researchers aim to conduct studies to assess

the effectiveness of this combination therapy in treatment of pain

and improvement of ROM.

The field of rehabilitation medicine fully aware of the lack of

evidence to support the effectiveness of combination therapy

continuously conducted researchers to study this matter. In fact,

a study conducted by Mukkannavar et al on 2008 revealed that

immediately after application of combination therapy, a

significant decrease in pain and increase in ROM was seen in

patients with MPS however, the study has no functional outcome

measure so this is considered as limitation for this study.

Despite the number of researchers which concluded that

combination therapy is effective, these researchers including the

study of Robert et al on 2013, still recommended that further

research must be made to assess the effectiveness of this therapy

in various specific conditions.

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This is the reason why the researchers for this study aim to

assess the effectiveness of this combination therapy in treatment

of pain and improvement of ROM of patients with upper trapezius-

MPS.

EFFICACY OF CONVENTIONAL US THERAPY

There are a lot of researchers in the literature which will

prove the efficacy of conventional US therapy because it is one of

the current therapeutic approach used by physical therapist

worldwide.

Kavadar et al concluded in their study that the results revealed

that conventional US therapy is effective in treatment of MPS.The

same results were obtained by different researchers that is why

conventional US therapy had proven effective.

However,on a study conducted by Rita A Wong, Britta Schumann,

Rose Townsend and Crystal A Phelps on 2016, only 49.3% of the

population studied uses Ultrasound for pain management in

different conditions where pain is one of the patient’s complaints.

Wong stated that the result shows that more clinicians now prefer

to use different modalities other than US for treatment of pain.

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Despite these, conventional US therapy is still considered by

the US National Library of medicine as one of the most effective

therapeutic approach in the field of rehabiltation medicine.

So this study aims to assess the effectiveness of this

therapeutic approach in treatment of pain and improvement of ROM

of patients with upper trapezius-MPS.

LITERATURE REVIEW OF OUTCOME MEASURES USED

I. Review of Visual Analogue Scale (VAS)

A Visual Analogue Scale (VAS) is a measurement

instrument that tries to measure a characteristic or

attitude that is believed to range across a continuum

of values and cannot easily be directly measured. It is

often used in epidemiologic and clinical research to

measure the intensity or frequency of various

symptoms. For example, the amount of pain that a patient

feels ranges across a continuum from none to an extreme

amount of pain. From the patient's perspective, this

spectrum appears continuous ± their pain does not take

discrete jumps, as a categorization of none, mild,

moderate and severe would suggest. It was to capture

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this idea of an underlying continuum that the VAS was

devised. (physiopedia)

Test–retest reliability has been shown to be good,

but higher among literate (r= 0.94, P= 0.001) than

illiterate patients (r = 0.71,P= 0.001) before and after

attending a rheumatology outpatient clinic.

In the absence of a gold standard for pain, criterion

validity cannot be evaluated. For construct valid-ity,

in patients with a variety of rheumatic diseases, the

pain VAS has been shown to be highly correlated with a

5-point verbal descriptive scale (“nil,” “mild,”

“moderate,” “severe,” and “very severe”) and a numeric

rating scale (with response options from “no pain” to

“unbear-able pain”), with correlations ranging from

0.71–0.78 and 0.62–0.91, respectively). The correlation

between ver-tical and horizontal orientations of the

VAS is 0.99.

There are different reason why VAS is the most common

outcome measure for pain. These include: VAS is more

sensitive to small changes than are simple descriptive

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ordinal scales in which symptoms are rated,for example,

as mild or slight,moderate,or severe to agonizing; these

scales are of most value when looking at change within

individuals;VAS takes < 1 minute to complete and no

training is required other than the ability to use a

ruler to measure distance to determine a score.

II.Review of Numerical Pain Rating Scale (NRS)

Based on a study by Hawker et al, NRS is a segmented

numeric version of the visual analog scale (VAS) in which

a respondent selects a whole number (0 –10 integers) that

best reflects the intensity of their pain.

The common format is a horizontal bar or line. Similar

to the pain VAS, the NRS is anchored by terms describing

pain severity extremes.

The pain NRS is a single 10-point numeric scale. 10 -

point numeric scale (NRS 11) with 0 representing one pain

extreme (e.g., “no pain”) and 10 representing the other

pain extreme (e.g., “pain as bad as you can imagine” and

“worst pain imaginable”). The NRS can be administered

verbally (therefore also by telephone) or graphically for

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self-completion. The respondent is asked to indicate the

numeric value on the segmented scale that best describes

their pain intensity.

The number that the respondent indicates on the scale

to rate their pain intensity is recorded. Scores range

from 0 –10. Higher scores indicate greater pain intensity.

The pain NRS takes 1 minute to complete. The pain NRS

is easy to administer and score.

III. Review for Neck Disability Index (NDI)

The NDI is a modification of the Oswestry Low Back

Pain Disability Index . It is a patient-completed,

condition-specific functional status questionnaire with

10 items including pain, personal care, lifting,

reading, headaches, concentration, work, driving,

sleeping and recreation.

The NDI can be used to evaluate the patients status

presence and to evaluate the evolution during the

therapy.

NDI is intended for chronic neck pain,

musculoskeletal neck pain, whiplash injuries

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and whiplash associated disorders and cervical

radiculopathy.

The NDI can be scored as a raw score or doubled and

expressed as a percent . Each section is scored on a 0

to 5 rating scale, in which zero means 'No pain' and 5

means 'Worst imaginable pain'. Al the points can be

summed to a total score. The test can be interpreted as

a raw score, with a maximum score of 50, or as a

percentage.

0 points or 0% means : no activity limitations ,

50 points or 100% means complete activity limitation.

A higher score indicates more patient-rated

disability. There is no statement in the original

literature on how to handle missing data. To use the

NDI for patient decisions, a clinically important change

was calculated as 5 points, with a sensitivity of 0.78

and a specificity of 0.80.

Mean duration of the test: 3 to 7.8 minutes.

Some benchmarks can be found in literature but

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methodologically they were not described and their

validity and reliability are questionable.

Vernon and Moir presented the following

interpretation.

 0-4points (0-8%) no disability

 5-14points ( 10 – 28%) mild disability

 15-24points (30-48% ) moderate disability

 25-34points (50- 64%) severe disability

 35-50points (70-100%) complete disability

The NDI has a fair to moderate test-retest

reliability in patients with mechanical neck pain but

also for patients with cervical radiculopathy .

Although intra class correlations can change between

0,50 and 0,98 . These difference may occur because some

studies do not separate chronic or acute neck pain or

due to the fact that the study only used patients with

acute neck pain and the retestinterval was 72 hours.

The NDI has a good construct validity.

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The NDI is seen as a valid tool to measure neck pain

and disabilities in patients with neck pain due to acute

or chronic conditions as well as in patients suffering

from musculoskeletal dysfunctions, whiplash -

associated disorders and cervical radiculopathy.

According to MacDermid et al who conducted a systematic

review of the measurement properties of NDI on 2009, NDI

has sufficient support and usefulness to retain its

current status as the most commonly used self-report

measure for neck pain.

Mior et al also concluded that NDI achieved a high

degree of reliability and internal consistency.

IV. Review of Goniometric Measurement for ROM

Goniometric measurements are used by physical

therapists to quantify baseline limitations of motion,

decide on appropriate therapeutic interventions, and

document the effectiveness of these interventions.

Probably our most widely used evaluation procedure,

goniometry, can be considered a fundamental part of the

"basic science" of physical therapy.

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Historically, goniometry developed over the last 60

years in conjunction with the rapid growth of the field

of physical medicine and rehabilitation. A recent

article by Smith et al provides an interesting account

of this development.Our review of the literature

revealed a surprising number of articles describing

different methods of measuring ROM, from simple visual

estimation to high-speed cinematography. To most

physical therapists, however, the universal goniometer

(ie, full-circle manual goniometer) remains the most

versatile and widely used instrument in clinical

practice.

The design of the universal goniometer and the

procedures for its use have been described in detail in

numerous publications including Norkin and White.

According to Bohannon et al, for most applications to

the extremities, the universal fullcircle goniometer

probably is the preferred instrument for measuring ROM.

Although the literature abounds with studies about the

reliability of ROM measurements, applying their results

to clinical practice may be difficult because of

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differences in study designs. Because the reliability of

goniometry is dependent on a host of factors, such as

differences among the motions measured, methods of

application, and variations among different patient

types, clinicians working in the same setting should

adopt standardized methods of testing. These methods

would require a thorough orientation for both students

and staff. Physical therapists should be careful in the

interpretation and reporting the results of goniometric

findings. As a rule, ROM measurements are just that, not

measurements of muscle "tightness," the length of

specific structures, or other factors that may affect

ROM.

DIAGNOSTIC TOOL FOR MPS

According to Travell and Simons, interestingly, there is a lack

of specific diagnostic criteria for MPS. Electrodiagnostic and

morphological findings have been identified; however, they cannot

be practically applied in the clinical setting due to cost and

time constraints. This adds to the difficulty of definitive

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treatment, particularly when considering elusive underlying

pathology and persistent MTrPs.

On a meta-analysis review of ‘variability of criteria used to

diagnose myofascial trigger point pain syndrome’ conducted by

Campbell et al, there are 19 different diagnostic criteria for

MPS. The 4 most commonly applied criteria were: "tender spot in a

taut band" of skeletal muscle, "patient pain recognition,"

"predicted pain referral pattern," and "local twitch response."

There was no consistent pattern to the choice of specific

diagnostic criteria or their combinations. However, one pair of

criteria "tender point in a taut band" and "predicted or recognized

pain referral" were used by over half the studies. The great

majority of studies cited publications by Travell and more recently

Simons as a principal authoritative source for MTrP pain syndrome

diagnosis, yet most of these studies failed to apply the diagnostic

criteria as described by these authorities.

Moreover, the study concluded that there is as yet limited

consensus on case definition in respect of MTrP pain syndrome.

Further research is needed to test the reliability and validity of

diagnostic criteria. Until reliable diagnostic criteria have been

established, there is a need for greater transparency in research

papers on how a case of MTrP pain syndrome is defined, and claims

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for effective interventions in treating the condition should be

viewed with caution.

EXISTENCE OF MACHINES WITH COMBINATION THERAPY

Combination Therapy involves the combined use of ultrasound

and electrical stimulation modalities into one versatile and

effective machine. Combination therapy devices typically

integrate ultrasound and electrical stimulation to reduce

muscle and other soft tissue pain in patients and to promote

healing. Combo units are standard pieces of clinical equipment

for physical therapists, chiropractors, and other medical

professionals.

Loharjun et al conducted an experimental study on 2013

wherein they used a machine with combination therapy. The

therapeutic ultrasound machine in this study was Sonopuls 492

TM (Enraf-Nonius), this device has treatment head described by

the manufacturers as having surface area as 5.8 cm2, ERA

(Effective Radiating Area) of 5.0 cm2 and BNR (Beam Non-uniform

Ratio) as max. 5.0. For electrotherapy unit which composes of

2 channels, output characteristics are constant current (CC) or

constant voltage (CV), resolution of output signal is in steps

[30]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

of 0.2 mA and timer is limited to 30 minutes during ultrasound

and combination therapy are operated.Use ultrasound treatment

parameters as continuous mode, 1 MHz in frequency and 1 w/cm2

for intensity and circular stroking of sound head over affected

upper trapezius muscle throughout treatment period. For

simultaneous TENS parameters as pulse frequency 100-150 pps,

pulse duration 50- 80 s and adjust amplitude as produce tingling

for 10 minutes.

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

CHAPTER 3

RESEARCH METHODOLOGY

Research Design

This study used the randomized control trial research design.

In this design, subjects are randomly allocated to receive one of

the several clinical interventions being studied, in this

research, there are three interventions namely, LASER therapy,

Ultrasound therapy and TENS.

A total of 15 patients with an upper trapezius -myofascial pain

syndrome was recruited. They were randomly assigned to 3 groups,

with 5 members each. Following random allocation of patients to

three groups, the LASER group and Ultrasound group received three

treatments with one-day interval while the TENS group received

treatment in a daily basis for three days.

Pain scale through the use of VAS; cervical LOM and NDI score

were measured at baseline, immediately before the first treatment,

and was reassessed after the last treatment session.

Respondents of the Study

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

This study was conducted at MCNP-ISAP main campus. This site

was chosen because of accessibility and availability of subjects

and modalities to be used.

15 subjects were recruited to participate in the study. The

subjects were chosen purposively. To be included, they should

qualify on the eligibility and inclusion criteria set by the

researchers and they should undergo thorough history taking and

objective assessment done by the researchers and an assessor who

is a licensed physical therapist. The subjects should have a

physical therapy impression stating the presence of myofascial

pain syndrome with MTrPs located at both upper trapezius muscle.

A diagnostic tool criteria was adopted to support the physical

therapy impression.

Those with conditions stated in the exclusion criteria were

excluded, with emphasis on contraindications for LASER therapy,

Ultrasound therapy and TENS; an initial VAS equal or greater than

4 and a NDI score equal or greater than 2%. Those who were qualified

based on the criteria and consent to participate in the study were

assigned randomly to 3 groups, namely LASER group, Ultrasound group

and TENS group, each group with 5 members.

Data Gathering Tool

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

The researchers utilized outcome measures used by various

researchers in the past. These includes Visual Analogue Scale (VAS)

for pain, goniometric measurement for range of motion (ROM) to

determine the Limitation of motion (LOM) which is the variable

used in the analysis of data and Neck Disability Index (NDI) to

measure the effect of MPS to patient’s function and quality of

living.

A. Visual Analogue Scale

The visual analogue scale (VAS) is commonly used as the

outcome measure for studies. It is usually presented as a

100-mm horizontal line on which the patient’s pain intensity

is represented by a point between the extremes of “no pain

at all” which is rated pain scale 1/10 and “worst pain

imaginable” rated as pain scale 10/10. Its simplicity,

reliability, and validity, as well as its ratio scale

properties, make the VAS the optimal tool for describing

pain severity or intensity.

In this research, the subjects from the three groups were

asked to rate their pain intensity from 1 to 10, 1 being the

least pain experienced and 10 being the worst pain

experienced. The pre-VAS was assessed initially before the

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

first treatment session and the post VAS was assessed after

the last treatment session. The difference between the pre

and post VAS will indicate if the treatment modalities can

reduce or decrease the pain perception of the subjects.

B. Neck Disability Index (NDI)(Appendix)

NDI was used to assess self-rated disability due to neck

pain. This test includes pain intensity, personal care,

lifting, reading, headaches, concentration, work, driving,

sleeping and recreation. Each 10 sections is scored on a 0-5

rating scale, in which zero means “no pain” and 5 means “worst

imaginable pain”. All the points can be summed to a total

score and percentage is computed. In cases where in one

section is not applicable to the patient, the formula is

changed. The proper way of computing the percentage of the

patient is stated below the second page of the index.

The test can be interpreted as raw score, with a maximum

score of 50, or as a percentage. The following are the

interpretation of the scores presented by Vernon and Moir:

 0-4points (0-8%) no disability

 5-14points (10 – 28%) mild disability

 15-24points (30-48%) moderate disability

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

 25-34points (50- 64%) severe disability

 35-50points (70-100%) complete disability

D. Goniometric measurement

A goniometer is a device used in physical therapy to measure

the range of motion around a joint in the body. The word goniometer

is derived from the Greek terms gonia and metron, which mean angle

and measure, respectively.

A goniometer is usually made of plastic and is often

transparent. Occasionally goniometers are made of metal. There are

two "arms" of the goniometer: the stationary arm and the moveable

arm. Each arm is positioned at specific points on the body and the

center of the goniometer is aligned at the joint to be measured.

There are hash marks on the center of the goniometer that your

physical therapist uses to precisely measure joint range of motion.

Goniometers come in different sizes. Small goniometers are

available to measure range of motion around the joints of your

fingers, thumbs and hands. Large goniometers are used to measure

the range of motion around your hips or knees.

[36]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

In this research, the range of motion measured includes cervical

flexion, cervical extension, cervical rotation to the right and

left and lateral flexion to the right or left. Each motion has a

normal range, for cervical flexion-50 degrees, cervical extension-

60 degrees, cervical rotation to the right and left- 80 degrees

and lateral flexion to the right or left-45 degrees. The value

obtained is deducted from the normal range of motion and the

resultant value is called limitation of motion (LOM). The value

used in this research is the LOM which indicates the range of

motion limited on the subject. Pre LOM was assessed initially

before the first treatment session and post LOM was assessed after

the last treatment session. The difference between the pre and

post LOM shows if the modalities are effective in reducing or

decreasing LOM.

Data Gathering Procedure

Conduct of the Study

The objective of the preparation phase is to formulate a

sound and feasible thesis proposal. After a thorough data gathering

regarding the research topic, the thesis proposal was then drafted,

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

the chapter 1-3 was initially presented before the panel for topic

approval and was revised based on the panel’s feedback.

The identification of the prospective subjects, sites of the

studies, formulation of letters, questionnaires and personal

subject profile was done during this phase.

Pre testing

The objective of the pre-testing is to identify prospective

subjects. A letter to the office__ head asking permission to

conduct the study was sent personally by the researchers

(appendix). After several days, the request was followed up. Upon

approval, all the prospective subjects were visited for initial

assessment and interview. They were asked to sign an informed

consent, a copy of the informed consent was also provided for them.

Those who signed the informed consent was assessed and were

asked to answer the NDI. Those who were qualified based on the

eligibility, inclusion and exclusion criteria and those with

presentation of MPS as designated by the licensed physical

therapist assessor was randomly assigned into three groups. Each

subject was informed of the modality or form of treatment that

they will receive.

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Implementation phase

Subjects under the LASER group were treated for 10

minutes, Ultrasound group were treated for 15 minutes and TENS

group was treated for 20 minutes for three sessions.

Post-testing

The objective of the post-testing is to evaluate the

effect of LASER therapy, Ultrasound therapy and TENS on pain, LOM

and NDI score.

All subjects were reassessed after the third treatment

session. Post VAS, post LOM and post NDI score was obtained.

Data Analysis

Frequency, percentage distribution and mean were used to

assess the personal demographic profile of the subjects.

A paired T-test was used to determine the significant

difference between the Pre and post VAS, LOM and NDI score.

One-Way ANOVA (Analysis of Variance) was used to test if there

is significant difference between pre and post VAS, LOM and NDI

score of subjects under LASER group, Ultrasound group and TENS

group.

[39]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

CHAPTER IV

Presentation of Data, Analysis and Interpretation

This chapter includes tabular presentation of the

statistically treated data, the analysis and the interpretation of

the data gathered. The sequence of presentation, analysis and

interpretation of the data was arranged according to the specific

statement of the problem.

Table 1.1

Frequency and Percentage Distribution of Subjects according to Age

Std.
N Minimum Maximum Mean
Deviation

Age of the

Respondents 15 19 59 25.80 10.98

(Years)

As shown on Table 1.1, data revealed that the youngest of the

respondents is 19 years old while the oldest is 59 years old.

The average age is 25.8. This is supported by a study…

[40]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Table 1.2

Frequency and Percentage Distribution of Subjects

according to Occupation

Cumulative
Frequency Percent
Percent

College
10 66.7 66.7
Student

Clinical
3 20.0 86.7
Instructor

Teacher 1 6.7 93.3

Secretary 1 6.7 100.0

Total 15 100.0

As shown on the Table 1.2, majority of the subjects with upper

trapezius-myofascial pain syndrome are college students with a

frequency of 10. 3 are college instructors, 1 teacher and 1

secretary. This can be supported by…

Table 1.3

Marital Status

Cumulative
Frequency Percent
Percent

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Single 11 73.3 73.3

Married 4 26.7 100.0

Total 15 100.0

As shown on table 1.3, majority of the respondents are still

single, which is 73.3% (11 out of 15) of them. The rest are

married.

Table 1.4

Time In Upright Posture

Cumulative
Frequency Percent
Percent

4 4 26.7 26.7

5 2 13.3 40.0

6 1 6.7 46.7

8 6 40.0 86.7

10 2 13.3 100.0

Total 15 100.0

As shown on table 1.4, most of the respondents (40%) spend 8

hours in upright posture per day. This is supported by…

[42]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Table 2.1

Mean respondents rating of pre and post VAS, LOM and NDI score

of subjects under LASER group

Std.
Std.
Mean N Error
Deviation
Mean

Visual

Analogue 7.60 5 1.52 0.68

Scale – Pre

Pair 1 Visual

Analogue
2.60 5 1.95 0.87
Scale –

Post

Cervical

Flexion – 16.00 5 6.52 2.92

Pre
Pair 2
Cervical

Flexion – 13.00 5 10.95 4.90

Post

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Cervical

Extension – 12.00 5 8.37 3.74

Pre
Pair 3
Cervical

Extension – 8.00 5 9.08 4.06

Post

Right

Cervical
32.00 5 13.04 5.83
Rotation –

Pre
Pair 4
Right

Cervical
25.00 5 13.23 5.92
Rotation –

Post

Left

Cervical
32.00 5 13.04 5.83
Rotation –
Pair 5
Pre

Left
13.00 5 9.75 4.36
Cervical

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Rotation –

Post

Right

Cervical
17.00 5 11.51 5.15
Lateral –

Pre
Pair 6
Right

Cervical
10.00 5 5.00 2.24
Lateral –

Post

Left

Cervical
20.00 5 7.07 3.16
Lateral –

Pre
Pair 7
Left

Cervical
6.00 5 4.18 1.87
Lateral –

Post

Neck

Pair 8 Disability 25.60 5 20.84 9.32

Index – Pre

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Neck

Disability
10.00 5 10.58 4.73
Index –

Post

This table shows the mean assessment of pre and post VAS, LOM

and NDI score of the 5 subjects under LASER group.

Table 3.1

Effectiveness of LASER therapy in reducing pain, LOM and NDI

score

Paired Samples Test

Paired Differences

95%

Confidence p-value
Std. Std.
Interval of t df (one
Mean Deviati Error
the sided)
on Mean
Difference

Lower Upper

Pair VAS_Pr
5.00 3.24 1.45 0.98 9.02 3.450 4 .013
1 e -

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

VAS_Po

st

CF_Pre

Pair - -
3.00 13.51 6.04 19.77 .497 4 .323
2 CF_Pos 13.77

CE_Pre

Pair -
4.00 4.18 1.87 -1.19 9.19 2.138 4 .050
3 CE_Pos

RCR_Pr

Pair e -
7.00 8.37 3.74 -3.39 17.39 1.871 4 .067
4 RCR_Po

st

LCR_Pr

Pair e - 19.0
11.40 5.10 4.84 33.16 3.726 4 .010
5 LCR_Po 0

st

Pair RCL_Pr
7.00 9.08 4.06 -4.28 18.28 1.723 4 .080
6 e -

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

RCL_Po

st

LCL_Pr

Pair e - 14.0
9.62 4.30 2.06 25.94 3.255 4 .016
7 LCL_Po 0

st

NDI_Pr

Pair e - 15.6
15.50 6.93 -3.65 34.85 2.250 4 .044
8 NDI_Po 0

st

This table shows there is a significant difference between the

pre and post VAS, pre and post LOM towards left cervical

rotation and left cervical lateral flexion and pre and post NDI

of subjects who received LASER therapy. This is supported by…

Table 4.1

Mean respondents rating of pre and post VAS, LOM and NDI score

of subjects under Ultrasound group

Paired Samples Statistics

[48]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Std.
Std.
Mean N Error
Deviation
Mean

Visual

Analogue 7.00 5 2.74 1.22

Scale - Pre

Pair 1 Visual

Analogue
3.80 5 1.30 0.58
Scale –

Post

Cervical

Flexion – 18.00 5 11.51 5.15

Pre
Pair 2
Cervical

Flexion – 17.00 5 8.37 3.74

Post

Cervical

Pair 3 Extension – 21.00 5 11.40 5.10

Pre

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Cervical

Extension – 14.60 5 9.26 4.14

Post

Right

Cervical
34.00 5 19.81 8.86
Rotation –

Pre
Pair 4
Right

Cervical
30.80 5 19.32 8.64
Rotation –

Post

Left

Cervical
46.00 5 13.87 6.20
Rotation –

Pre
Pair 5
Left

Cervical
26.80 5 17.81 7.96
Rotation –

Post

Right
Pair 6 18.00 5 9.75 4.36
Cervical

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Lateral –

Pre

Right

Cervical
9.00 5 5.48 2.45
Lateral –

Post

Left

Cervical
19.00 5 9.62 4.30
Lateral –

Pre
Pair 7
Left

Cervical
10.60 5 8.56 3.83
Lateral –

Post

Neck

Disability 12.60 5 5.68 2.54

Index - Pre

Pair 8 Neck

Disability
4.40 5 6.69 2.99
Index –

Post

[51]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

This table shows the mean pre and post VAS, LOM and NDI score of

subjects who received Ultrasound therapy.

Table 4.2

Mean respondents rating of pre and post VAS, LOM and NDI score

of subjects under TENS group

Paired Samples Statistics

Std.
Std.
Mean N Error
Deviation
Mean

Visual

Analogue 6.00 5 1.58 0.71

Scale - Pre

Pair 1 Visual

Analogue
2.40 5 0.89 0.40
Scale –

Post

Cervical

Pair 2 Flexion – 10.00 5 6.12 2.74

Pre

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Cervical

Flexion – 16.00 5 5.48 2.45

Post

Cervical

Extension – 18.00 5 11.51 5.15

Pre
Pair 3
Cervical

Extension – 23.20 5 9.55 4.27

Post

Right

Cervical
42.00 5 10.95 4.90
Rotation –

Pre
Pair 4
Right

Cervical
38.80 5 11.54 5.16
Rotation –

Post

Left

Cervical
Pair 5 39.00 5 12.45 5.57
Rotation –

Pre

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Left

Cervical
31.20 5 12.54 5.61
Rotation –

Post

Right

Cervical
15.80 5 8.76 3.92
Lateral –

Pre
Pair 6
Right

Cervical
10.40 5 6.77 3.03
Lateral –

Post

Left

Cervical
18.00 5 12.04 5.39
Lateral –

Pre
Pair 7
Left

Cervical
10.00 5 7.07 3.16
Lateral –

Post

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Neck

Disability 12.40 5 7.50 3.36

Index - Pre

Pair 8 Neck

Disability
2.60 5 3.97 1.78
Index –

Post

This table shows the mean respondents rating of pre and post

VAS, LOM and NDI score of subjects who received TENS as

intervention.

Table 5.1

Comparison on the effectiveness of the 3 modalities

Descriptives

95%

Confidenc

Std. Std. e
Minim Maximu
N Mean Deviat Erro Interval
um m
ion r for Mean

Low Upp

er er

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Bou Bou

nd nd

0.9 9.0
Visua Laser 5 5.00 3.24 1.45 1.00 10.00
8 2
l
Ultraso 0.2 6.1
Analo 5 3.20 2.39 1.07 1.00 7.00
und 4 6
gue
2.4 4.7
Scale TENS 5 3.60 0.89 0.40 3.00 5.00
9 1
Diffe
2.6 5.2
rence Total 15 3.93 2.34 0.61 1.00 10.00
4 3

-
19. -
Laser 5 3.00 13.51 6.04 13. 15.00
Cervi 77 20.00
77
cal
-
Flexi Ultraso 12. -
5 1.00 9.62 4.30 10. 15.00
on und 94 10.00
94
Diffe
-
rence - 5.9 -
TENS 5 9.62 4.30 17. 10.00
6.00 4 15.00
94

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

-
- 5.4 -
Total 15 11.00 2.84 6.7 15.00
0.67 2 20.00
6

-
9.1
Laser 5 4.00 4.18 1.87 1.1 0.00 10.00
9
9

Cervi -
Ultraso 13.
cal 5 6.40 5.90 2.64 0.9 0.00 12.00
und 72
Exten 2

sion -
- 15. -
Diffe TENS 5 16.66 7.45 25. 14.00
5.20 49 25.00
rence 89

-
7.8 -
Total 15 1.73 11.00 2.84 4.3 14.00
3 25.00
6

-
Right 17.
Laser 5 7.00 8.37 3.74 3.3 0.00 20.00
Cervi 39
9
cal
-
Rotat Ultraso 17. -
5 3.20 11.34 5.07 10. 15.00
ion und 29 10.00
89

[57]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Diffe -
14. -
rence TENS 5 3.20 9.34 4.18 8.3 14.00
79 10.00
9

-
9.5 -
Total 15 4.47 9.23 2.38 0.6 20.00
8 10.00
4

19.0 4.8 33.

Laser 5 11.40 5.10 5.00 30.00
Left 0 4 16

Cervi Ultraso 19.2 10. 28.

5 7.19 3.22 10.00 27.00
calRo und 0 27 13

tatio -
20.
n TENS 5 7.80 10.21 4.57 4.8 -5.00 20.00
47
Diffe 7

rence 15.3 9.4 21.

Total 15 10.59 2.73 -5.00 30.00
3 7 20

Right -
18.
Cervi Laser 5 7.00 9.08 4.06 4.2 -5.00 15.00
28
cal 8

Later Ultraso 2.2 15.

5 9.00 5.48 2.45 0.00 15.00
al und 0 80

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Diffe -
11.
rence TENS 5 5.40 4.56 2.04 0.2 0.00 10.00
06
6

3.6 10.
Total 15 7.13 6.36 1.64 -5.00 15.00
1 65

14.0 2.0 25.

Laser 5 9.62 4.30 5.00 30.00
0 6 94
Left
-
Cervi Ultraso 19.
5 8.40 9.04 4.04 2.8 -6.00 15.00
cal und 63
3
Later
-
al 18.
TENS 5 8.00 8.37 3.74 2.3 0.00 20.00
Diffe 39
9
rence
10.1 5.2 15.
Total 15 8.82 2.28 -6.00 30.00
3 5 02

Neck -
15.6 34.
Disab Laser 5 15.50 6.93 3.6 0.00 36.00
0 85
ility 5

Index -
Ultraso 17.
Diffe 5 8.20 7.40 3.31 0.9 0.00 20.00
und 38
rence 8

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

2.3 17.
TENS 5 9.80 5.97 2.67 2.00 16.00
8 22

11.2 5.5 16.

Total 15 10.26 2.65 0.00 36.00
0 2 88

This table shows the summary of mean ratings of the three

groups.

Table 5.2

Effectiveness of LASER therapy, Ultrasound therapy and TENS in

decreasing pain, LOM and NDI score of patients with upper

trapezius-MPS

ANOVA

p-

Sum of Mean value

df F
Squares Square (two

sided)

Between
8.93 2 4.47 .788 .477
Groups
VAS
Within
Difference 68.00 12 5.67
Groups

Total 76.93 14

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Between
223.33 2 111.67 .912 .428
Groups
CF
Within
Difference 1470.00 12 122.50
Groups

Total 1693.33 14

Between
374.93 2 187.47 1.704 .223
Groups
CE
Within
Difference 1320.00 12 110.00
Groups

Total 1694.93 14

Between
48.13 2 24.07 .253 .781
Groups
RCR
Within
Difference 1143.60 12 95.30
Groups

Total 1191.73 14

Between
425.73 2 212.87 2.234 .150
Groups
LCR
Within
Difference 1143.60 12 95.30
Groups

Total 1569.33 14

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Between
32.53 2 16.27 .366 .701
Groups
RCL
Within
Difference 533.20 12 44.43
Groups

Total 565.73 14

Between
112.53 2 56.27 .691 .520
Groups
LCL
Within
Difference 977.20 12 81.43
Groups

Total 1089.73 14

Between
151.60 2 75.80 .688 .522
Groups
NDI
Within
Difference 1322.80 12 110.23
Groups

Total 1474.40 14

This table shows there is no significant difference on the

effect of LASER therapy, ultrasound therapy and TENS in

decreasing pain, LOM and NDI score of patients with upper

trapezius- MPS. This is supported by…

[62]
MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Chapter V

Summary of Findings, Conclusions, and Recommendations

The main purpose of this study was to determine the

effectiveness of LASER therapy as to decreasing pain, LOM and NDI

score of patients with upper trapezius-MPS. In addition to this,

this study also aimed to determine which among LASER therapy,

Ultrasound therapy and TENS is more effective in decreasing pain,

LOM and NDI score of patients with the same disease.

In this chapter, answers to the specific statement of the

problem are presented.

Summary of Findings

From the previous chapter, the researchers obtained the

following simplified findings:

As to the subject’s age, data revealed that the youngest of

the respondents is 19 years old while the oldest is 59 years

old and the average age is 25.8, all the respondents are

female, most of the subjects are single, majority are college

students and most of them spend 8 hours per day in upright

posture.

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

There is a statistically significant effect of LASER

therapy in decreasing pain with p-value of 0.013, in

decreasing LOM towards left cervical rotation with p-value of

0.010, in decreasing LOM towards left cervical lateral

flexion with p-value 0.016, and in decreasing NDI score with

p-value 0.044.

There is no statistically significant difference between

the mean respondents rating of pre and post VAS, LOM and NDI

score of subjects who received LASER therapy, Ultrasound

therapy and TENS.

Conclusion

Based on the results from the experiments done during

the experimental study, the following conclusions were made:

LASER therapy is effective in managing upper trapezius-

MPS as reflected in decreased pain, LOM and NDI score of the

subjects comparing before and after the intervention. On the

other hand, there is no significant difference on the effect

of LASER therapy, Ultrasound therapy and TENS in decreasing

pain, LOM and NDI score of patients with upper trapezius-MPS.

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MEDICAL COLLEGES OF NORTHERN PHILIPPINES COLLEGE OF PHYSICAL THERAPY

Recommendation

A follow up study is recommended to further validate the

findings and conclusions of this study.

The future researchers are recommended to include a

greater sample for more reliable and valid results. They are

also recommended to use a different brand of LASER, Ultrasound

and TENS machine for comparison. The future researchers are

also recommended to include both male and female respondents

for comparison of pain perception. Adding different factors

such as assessment of ergonomics, daily load of activities,

type of work, type of personality and postural assessment are

also recommended for determining factors that may contribute

to the development of upper trapezius-MPS.

A further study is recommended to compare the

effectiveness of LASER therapy, Ultrasound therapy and TENS.

This study is also recommended as a basis for further

studies.

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