CHAPTER I

INTRODUCTION

Myofascial pain syndrome (MPS) is a form of myalgia that is characterized

by local regions of muscle hardness that are tender and that cause pain

to be felt at a distance, i.e., referred pain. The central component of the syndrome

is the trigger point that is composed of a tender, taut band. Stimulation of the

band, either mechanically or with activity, can produce pain.

Muscle pain is a common problem that is underappreciated and often undertreated.

Myofascial pain syndrome (MPS) is a myalgic condition in which muscle and

musculotendinous pain are the primary symptoms. The heart of the syndrome is the

myofascial trigger point. The trigger point is a small, painful, locus of abnormal

muscle which is the source of the muscular dysfunction.

MPS is that a small region within the muscle harbors multiple foci of trigger points,

more accurately called trigger zones, which generate pain. The trigger point itself

is a tender region in a taut band in skeletal muscle. The taut

band is formed by a group of contracted muscle fibers, and is readily palpable.

There may be a degree of nodularity in the taut band, particularly at the region of
greatest hardness, which is also usually the region of greatest tenderness.​ (Simons ​et al​.,

1999).

The trigger point is responsible for the clinical symptoms of MPS

Local tenderness . Pain at a distance is characteristic of MPS. It represents referred pain

that is the result of trigger point-induced central sensitization. Nociceptive

activity that arises in foci of painful muscle activates spinal cord dorsal horn neurons

and sensitizes the central nervous system, causing central sensitization, hyperalgesia,

and referred pain.Muscle weakness without atrophy occurs due to trigger point

induced motor inhibition. Restricted range of motion occurs because of the

shortening of the contracted taut band, and perhaps because of pain.. Impaired

reciprocal inhibition results in cocontraction of agonists and antagonists, thus

interfere with fine motor control and coordination. Autonomic disturbances can

accompany trigger point activation, leading to changes in skin temperature and color,

piloerection (goosebumps), and lacrimation​.(R.D.Gerwin ​et al.,​ 2010).

Trpezius pain is the classic stress pain and it is the most common musculoskeletal disorder

.It is caused by placing too much stress strain over the trpezius muscle .the upper

trapezius muscle is designated as postural muscle and it is highly susceptible to over

use. Trapezius muscle can help with the function of neck rotation ,side bending and

extension .tightness in these muscle can decrease the range of motion of the neck.the

decrease in motion can negatively affect the mobility of the cervical joint.Limited
 range of motion can creates an increase in soft tissue tightness ,with ensuing

pain-spasm cycle which can be difficult to break​(A.Kumaresan ​et al​., 2012).

Symptoms of myofascial pain in upper trapezius is posteriolateral neck pain that often is

constant and usually is associates with temporal head ache on the same side

.occationally pain is projected to the angle of the jaw ,dizziness and vertigo(in

conjuction with the sternoclediod muscle).stiff neck, limited range of motion

,intolerance to weight on your shoulders.

The upper trapezius may be srtained by direct or indirect trauma, spine pathology,

and physical deconditioning​.(Dvid.G simons ​et al., 1​ 997).

TRAPEZIUS

The trapezius is large superficial muscle.

It has three functional regions :

● Upper part(descending part)

● Middle part(transverse part)

● Lower part(ascending part)

ORIGIN:

● Medial one third of superior nuchal line

● External occipital protuberance

 ● Ligementum nuchae

● C7 spine

● T1-T12 spines

● Corresponding supraspinous ligaments

INSERTION:

● Upper fibers​ into the posterior border of lateral one-third of clavicle

● Middle fibers ​into the medial margin of the acromian and upper lip of the

crest of the spine of scapula

● Lower fibers​ on the apex of traiangular area at the medial end of the spine

,with a bursa intervening.

NERVE SUPPLY:

● Spinal part of accessory nerve is motor

● Branches from C3,C4 are proprioceptive

BLOOD SUPPLY:
 ACTION:

● Upper fibers act with levator scapulae, and elevate the scapula, as in

shrugging

● Middle fibers act with rhomboids ,and retact the scapula

● Upper and lower fibers act with serratus anterior,and rotate the scapula

forwards round the chest wall thus playing an important role in abduction of

the arm beyond 90 degree

● Steadies the scapula​(BD.Chaurasia ​et al.​ , 2013)

Positional Release Therapy ​is a very specialized technique focusing on treating protective

muscle spasm in the body. This technique involves finding a tender point in

thepatient’s body (muscles, ligaments, tendons and joints) and then moving the

patient’s body orbody part away from the restricted motion barrier and towards the

position of greatest comfort. Once in this position of comfort, the point should no

longer be tender. This precise position isheld for a minimum of 90 seconds but can

be held for several minutes. During this time period,the patient can feel heat,

vibration, pulsation and can even reproduce their symptoms. Once the release is

complete, the heat, vibration, pulsation and pain will diminish and there will be a

sense of lengthening and relaxation in the tissues. Once the release is felt, the

patient is slowly taken out of the position of comfort and the tissues should be

relaxed. The tendor spot is completely gone or 70% better​( ​Jagathesan 2005​).
 ​Stretching exercise is defined as stretching any therapeutic maneuver designed to

lengthen(Elongated) pathologically shortened soft tissue structures ,thereby

increasing the range of motion​(​Carolyn kisner 2013​)​ .

1.1 Statement of the study

A study to find out the effectiveness of positional release technique and stretching

exercise in management of myofascial pain syndrome of upper trapezius.

1.2 Objective of the study

The objective of study are:

● To study the effect of positional release technique in the management of

myofascial pain syndrome of upper trapezius.

● To study the effect of stretching exercise in the management of myofascial

pain syndrome of upper trapezius.

● To study the effect of positional release release technique and stretching

exercise in the management of myofascial pain syndrome of upper trapezius.

1.3 Need of the study

The reason of the study is to find out the effectiveness of positional release technique and

stretching exercise in the management of myofascial pain syndrome of upper

trapezius.

1.4 Hypothesis

● It is hypothesized that there may be a significant difference in pain and disability

following posiotional release technique.

● It is hypothesized that there may be a significant difference in pain and disability

following stretching exercises.

● It is hypothesized that there may be a no significant difference in pain and disability

following positional release therapy and stretching exercise.

1.5 Operational definition

Pain

Pain is defined as “an unpleasant, sensory and emotional experience associated with
actual or potential tissue damage or described in terms of such damage”​(​Merskey 1994​)

Disability

Disability is the consequence of an impairment that may be physical, mental,

sensory,developmental or some combination of these that result in restriction on an

individual’s ability to participate in what is considered “normal” in their everyday

society​(Jewish​ et al., 1​ 989).

Myofascial pain syndrome

Myofascial pain syndrome(MPS), the other common muscle pain syndrome is

associated with discrete taut bands of hardened muscle that contain regions of exquisite

muscle tenderness​(Robert D. Gerwin ​et al​., 2005).

Positional release technique

The aim of PRT is to remove restrictive barriers of movements in the body. This is

by decreasing protective muscle spasm, fascial tension, joint hypomobility, pain

and swelling and increasing circulation and strength​(Jagatheesan​et al., ​ 2012)​.

CHAPTER II

REVIEW OF LITERATURE
Section A: Studies on effect of positional release technique in the management of

myofascial pain syndrome of upper trapezius.

Section B: Studies on effectiveness of stretching exercise technique in management of the

myofascial pain syndrome of upper trapezius.

Section C: Studies on reliability and validity of visual analogue scale in measuring pain

Section D: Studies related to reliability and of neck disability index scale

Section A: Studies on effect of positional release technique in the management of

myofascial pain syndrome of upper trapezius​.

Mohammadi​ ​et al., (​2016)​ did a study to investigate the effect of positional release

technique in computer users via latent trigger points(LTrPs) of the upper trapezius muscle.

28women with the trapezius MTrPs participated in this study. Subjects were

randomly classifiedinto two groups(14 in each group). The subjects in the group 1

received positional releasetechnique in shortened position while those in the group 2

received sham control in the neutralposition of the upper trapezius muscle. Both

groups showed alleviation of pain and increase inPPT during three sessions of

therapy although positional release therapy to be more effective inthese patients.

 Sweety ​et al.​ ,(2014) study stated that trapezius stretching combined with positional

release technique have sound effective in trapezitis. The purpose of the study is to

find the effectof positional release technique on pain intensity, functional disability

and range of motion insubjects with subacute trapezitis. Total 40 subjects, 20

subjects in each group. Group A receivedpassive trapezius muscle stretching while

group B received positional release technique withpassive trapezius muscle

stretching for 8 sessions in 2 weeks. Data was collected aftercompleted the study. It

is concluded that the positional release technique with trapeziusstretching found to

be significantly more added effect than trapezius stretching alone inimproving pain,

functional disability and cervical movements for subjects with subacutetrapezitis.

Jagatheesan ​et al.​ , (2012)​ conducted a study to find the effect of positional

release therapy on unilateral upper trapezius tender points. 60 subjects between age group

20and 30 years having unilateral upper trapezius tender points were randomly

allocated to 3 groups. Intervention was given for 7 consecutive days. Pain measured

by numeric pain rating scale and active range of ipsilateral neck flexion measured

by goniometer were used as outcome measures. All groups were showing

statistically significant improvement values with P value less than or equal to 0.001.
 Conventional treatment with positional release technique is effective in unilateral

upper trapezius tender points.

Kumarasen ​et al.​ , (2012) stated that positional release therapy has been proposed as an

adjunct to conventional therapy to treat trapezitis.30 subjects were taken and divided

into group A and group B. Both groups were given ultrasound and isometric

exercise. In addition to this group A was given positional release technique. Giving

positional release technique along withultrasound and exercises improves the

cervical range of motion and relieves pain and enhancesquality of life in the patient

with trapezitis.

Ravish ​et al.​ , (2014) conducted this study to determine the effects of myofascial

releasetechnique and positional release therapy in trapezitis. 60 subjects with

unilateral trapeziusdivides into 2 groups. Group A receives myofascial trigger release

technique and LASER. Group B receives positional release technique with LASER.

Giving these techniques improves the cervical range of motion and relieves pain and

enhances quality of life in the patients with trapeztis. In both technique positional

release technique release technique shows significant effect in patient with unilateral

trapezitis.
Section B: Studies on effectiveness of stretching exercises technique in management of

the myofascial pain syndrome.

Ylinen ​et al​., (2007)​ conducted a study to compare the effects of manual therapy and

stretching exercises on neck pain and disability. 125 women with non-specific neck pain

weretaken. Patients were randomized into 2 groups. Group 1 received manual

therapy and group 2 performed stretching exercises. There was no significant

difference between groups. Both stretching exercise and manual therapy

considerably decrease neck pain and disability in womens with nonspecific neck

pain. The difference in effectiveness between the two treatment was minor.

Richa ​et al.​ , (2012) stated to evaluate the comparative effectiveness of muscle

energytechnique and static stretching on pain and active cervical range of motion in

subacutemechanical neck pain. 45 patients with subacute mechanical neck pain were

randomly assigned to receive muscle energy technique plus conventional

physiotherapy, Static stretching plusconventional exercise program and conventional

physiotherapy only. The study concluded that both the treatment techniques, muscle

energy technique and static stretching were effective in alleviating the mechanical

neck pain.
Juliano ​et al.​ , (2016) stated this study to combine stretching and strengthening exercises

inthe treatment of myofascial pain syndrome. 225 patient with myofascial pain were

included and divided into groups. In this study both stretching and strengthening

exercises were given for myofascial pain syndrome. In this study the combination of

both stretching and strengthening exercise shows significant effect in reduce pain

and disability in patient with myofascial pain syndrome.

Edwards ​et al.​ , (2017) conducted this to test the hypothesis that superficial dry needling

(SDN) together with active stretching is more effective than stretching alone, or no

treatment, in deactivating trigger points (TrPs) and reducing myofascial pain. Forty

patients with musculoskeletal pain, referred by GPs for physiotherapy, fulfilled

inclusion/ exclusion criteria for active TrPs. Subjects were randomised into three

groups: group 1(n = 14) received superficial dry needling (SDN) and active

stretching exercises (G1); group 2 (n = 13) received stretching exercises alone (G2);

and group 3 (n = 13) were no treatment controls (G3). Assessment was carried out

pre-intervention (M1, post-intervention (M2), and at a three-week follow up

(M3).Outcome measures were the Short Form McGill Pain Questionnaire (SFMPQ)

and Pressure Pain Threshold (PPT) of the primary TrP, using a Fischer algometer.
 SDN followed by active stretching is more effective than stretching alone in

deactivating TrPs (reducing their sensitivityto pressure), and more effective than no

treatment in reducing subjective pain. Stretching withoutprior deactivation may

increase TrP sensitivity

Section C: Studies on the the reliability and validity of visual analog scale in measuring

pain.

Bijur​et al​., (2012) ​conducted study to assess the reliability of the VAS for

measurement of acute pain. Intraclass correlation coefficients (ICCs) with 95%

confidence intervals (95% CIs) and a Bland-Altman analysis were used to assess

reliability of paired VASmeasurements obtained 1 minute apart every 30 minutes

over two hours.Reliability of the VASfor acute pain measurement as assessed by the

ICC appears to be high. Ninety percent of the pain ratings were reproducible within 9

mm. These data suggest that the VAS is sufficiently reliable to be used to assess

acute pain.
Boonstra ​et al.​ , (2008) ​conducted study to determine the reliability and concurrent validity

of a visual analogue scale (VAS) for disability as a single item instrument measuring

disability in chronic pain patients. The study population consisted of patients over 18

years of age, suffering from chronic musculoskeletal pain; 52 patients in the

reliability study,344 patients in the validity study. Main outcome measures were as

follows. The conclusion of the study was that the reliability of the VAS for disability

is moderate to good.

Gallagher et al.​ ,(2002)​, conducted the study to assess the validity and reliability of the

visual analog scale (VAS) in the measurement of acute abdominal pain, and to

identify the minimum clinically significant difference in VAS scores among patients

with acute abdominal pain. A prospective, observational cohort study of a

convenience sample of patients presenting to 2 urban EDs with the chief complaint

of acute abdominal pain was conducted. Reliability was assessed using the

intra-classcorrelation coefficient (ICC) between VAS scores taken 1 minute apart,

supplemented by a Bland-Altmananalysis. Reliability was high. VAS measures of

acute abdominal pain are valid and reliable. We concludethat the VAS is a

methodologically sound instrument for quantitative assessment of acute abdominal

pain and for detecting clinically important changes in such pain.

Section-D​:​Studies related to reliability and validity of neck disability index scale

Vernon H et al.,(1991) Conducted a study about the Neck Disability Index The alpha

coefficients were calculated from a pool of questionnaires completed by 52 such

subjects resulting in a total index alpha of 0.80, with all items having individual

alpha scores above 0.75. Concurrent validity was assessed in two ways. First, on a

smaller subset of 10 patients who completed a course of conservative care, the

percentage of change on NDI scores before and after treatment was compared to

visual analogue scale scores of percent of perceived improvement in activity levels.

These scores correlated at 0.60. Secondly, in a larger subset of 30 subjects, NDI

scores were compared to scores on the McGill Pain Questionnaire, with similar

moderately high correlations (0.69-0.70). While the sample size of some of the

analyses is somewhat small, this study demonstrated that the NDI achieved a high

degree of reliability and internal consistency.

Howard Vernon et al.,(2008) A study conducted about the Neck Disability Index:

State-of-the- Art, 1991-2008. The NDI is the most widely used and most strongly

validated instrument for assessing self-rated disability in patients with neck pain. It

has been used effectively in both clinical and research settings in the treatment of

this very common problem

MacDermid et al .,(2009​) Conducted about the measurement Properties of the Neck

Disability Index: A Systematic Review . The NDI has sufficient support and

usefulness to retain its current status as the most commonly used self-report measure

for neck pain.

Mark Chan Ci Ena et al.,(2009) studied that the Validity of the Neck Disability Index and

Neck Pain and Disability Scale for measuring disability associated with chronic,

non-traumatic neck pain. The purpose of this study was to evaluate the construct and

content validity of the Neck Disability Index (NDI) and the Neck Pain and Disability

Scale (NPAD) in patients with chronic, non-traumatic neck pain.

CHAPTER III

METHODOLOGY
3.1 Study setting

Study was conducted at out patient department of RVS College of Physiotherapy, Sulur.

3.2 Selection of subjects

20 subjects who fulfilled the inclution and exclution criteria were equally divided into two

groups by random sampling method.

Group A: Positional release technique

Group B:Stretching Exercise

3.3 Variables

3.3.1 Department variables

● Pain
● Disability

3.3.2 Independent variables

● Positional Release Therapy

● Stretching exercise

3.3 Measurement tools

ABLES LS

analog scale

lity disability index

3.4 Study design

Pre and post-test experimental design.

3.5 Duration of study

Duration of study was 1week.

3.6 Criteria for selection

Inclusion criteria

● Patient with myofascial pain in upper trapezius only.

● Age group between 20-30 years were included.

● Both the sexes were included in the study.

● Patient with neck pain due to upper trapezius trigger point in the age group of

20-40 years were included for this study.

 ● A total of 24 adults are expected to be accrued (8 in each group, normal, latent

and active) ages 18-65, without pain & those with continuous idiopathic

cervical pain of less than 3 months duration

Exclution criteria

● Degenerative disease of cervical spine

● Disc prolapsed of cervical region

● Osteoporosis

● Shoulder and shoulder girdle injury

● Spinal fractures

● Tumor of spine

● Tuberculosis of spine and shoulder

● Cardiac disease

● Pregnancy

● Sensory impairments

● Skin infection

3.8 Orientation to the patient

Before the collection of data, all the subjects were explained about the purpose of the study.

The investigator had given a detailed orientation about the various test procedures

such as visual analogue scale to measure pain and neck disability scale to measure

the neck disability.The concern and full cooperation of each participant was sought

after complete explanation of the condition and demonstration of the procedure

involved in the study.

3.9 Test administration

Visual analogue scale

0 1 2 3 4 5 6 7 8 9 10

No pain severe pain

Pain assessment is done by visual analogue scale. The visual analogue scale is a

subjective measure of pain. It consists of 10cm line with two end-points respecting ‘no pain’

and‘worst pain imaginable’. During the visit, patients asked to rate by placing a mark

on the linecorresponding to their current level of pain.

Neck disability index scale

Neck Disability Index score The NDI questionnaire is a 10 item questionnaire which

included feedback of the subjects regarding their pain, ability to do activities of daily
 living, ability to concentrate and presence of headaches. The scale consisted of

discrete categories within which each item was weighted and responses were

summed up and its percentage was taken. Vernon and Mior (1991) concluded from

their study that NDI had a high degree of reliability and internal consistency.

3.10 Treatment procedure

20 patients with myofascial pain syndrome of upper trapezius were randomly divided into

two groups;

Group A (positional release technique) and Group B (stretching exrecise).

Pre-treatment assessment was done. Both groups of patients recorded their pain on

VAS and disability measured by neck disability index and the treatment was given for both

group for 2 weeks.

TREATMENT PROCEDURE
Positional release technique:

Position of therapist:​ Therapist was sitting at the head side of the table.

Position of therapist: ​Supine lying and relaxed completely.

Technique of application: The affected area was palpated for tender points that may be

associated due to reffered pain .In case of multiple tendor point , first highest tendor

point was treated . the therapist was sitting at the head side of table and scapula of

the subject elevated by taking the shoulder or scapular superior and medial to the ear

, neck was rotated to the opposite side, extended and side bend to the same side to

treated .Selected tender point (TP) was palpated and patient was instructed to relax.

Then passively turning and release of muscle tension was done through either the

neck or shoulder movements. Pressure over the trigger point was applied by therapist

thumb and slightly released but maintained light contact over the TP to monitor the

response . This position was maintained for 90 seconds .It was hold longer . If

patient or active trigger point is felt a therapeutic pulse, tissue tension changes or

movement . After release subjects was put back to the neutral position. TP point was

rechecked and the procedure was repeated upto 70% improvement in pain level

and reduce tension noticed.

Stretching Exercise

Position of therapist: ​Walk standing position

Position of patient: ​Supine lying while neck set in three different positions depending on

the location of pain

● Flexion and lateral flexion to the opposite side.

● Flexion with rotation to the same side of pain.

● Flexion , with lateral flexion to the opposite side and rotation to the same side.

Technique of application:

Stretch forces was given by therapist and it was maintained so that subject must feel mild To

moderate pain during the stretch and should not have too much over pressure on

upper cervical spine. The stretch was maintained 30 seconds with 10 seconds resting

between each stretch and 15 stretches in each three direction were given per session.
 CHAPTER IV

DATA ANALYSIS AND RESULTS

4.1. Data analysis

This chapter deals with the systematic presentation of the analyzed data followed by the

interpretation of the data.

a)Paired‘t’ test

∑d
d= n

√
(∑d)2
∑d2 − n
s= n−1

t = d√s n

Where,

d – Difference between pre-test and post-test values

∑d
d= n
– Mean of difference between pre test and post test values

n – Total number of subjects

s – Standard deviation
 b) Un-paired t’ test

√
2 2
∑(x1− x1 ) +∑(x2− x2 )
s= n1 +n2 −2

x1− x2 n1 n2
T = S √ n1 +n2

Where, 2

S = Standard deviation

n1 = Number of subjects in Group A

n2 = Number of subjects in Group B

x1 = Mean of the difference in values between pre-test and post-test in Group-A

x2 = Mean of the difference in values between pre-test and post-test in

Group-B

Table I

The table shows mean value, mean difference, standard deviation, and paired ‘t’ value

between pre- test and post-test scores of pain among group A

Measurement Mean Mean Standard Paired ‘t’ value

difference deviation
Pre- test 8.1

4.1 1.101 11.767*

Post- test 4

In Group A for pain the calculated paired ‘t’ value is 11.767 and ‘t’ table value is 3.250 at 0.005

level. Since the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant

difference in pain following positional release technique in patients with myofascial pain

syndrome of upper trapezius.

Figure 1: Graphical representation of pre and post-test mean values of pain among

Table -2

The table shows mean value, mean difference, standard deviation, and paired ‘t’ value

between pre- test and post-test scores of pain among group B

Measurement Mean Mean Standard Paired ‘t’ value

difference deviation

Pre- test 7.5

2.5 0.527 14.99*

Post- test 5

In Group B for pain the calculated paired ‘t’ value is 14.99 and ‘t’ table value is 3.250 at 0.005

level. Since the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant

difference in pain following stretching technique in patients with myofascial pain syndrome

Figure 2: Graphical representation of pre and post-test mean values of pain among

Table 3
The table shows mean value, mean difference, standard deviation, and unpaired‘t’ value of pain

between group A and B

Groups Improvement Standard Un paired

deviation ‘t’Test
Mean Mean
Difference

Group -A 4.1
2.1 0.862 4.15
Group -B 2

In Group A and Group B for pain the calculated unpaired ‘t’ value is 4.15 and ‘t’ table value is

2.878 at 0.005 level. since the calculated ‘t’ value is less than ‘t’ table value, it shows that there

is significant difference between positional release technique and stretching in patients with

myofascial pain syndrome of upper trapezius.

Figure 3: Graphical representation of un-paired ‘t’ value of pain between Group A and

Group B.

Table -4

The table shows mean value, mean difference, standard deviation, and paired ‘t’ value

between pre- test and post-test scores of Neck disability index among group A

Measurement Mean Mean Standard Paired ‘t’ value

difference deviation

Pre- test 36.8

23 5.518 12.99*

Post- test 13.8

*0.005 level of significance.

In Group A for pain the calculated paired ‘t’ value is 12.99 and ‘t’ table value is 3.250 at 0.005

level. Since the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant
difference in range of motion following positional release technique in patients with myofascial

pain syndrome.posterior of upper trapezius.

Figure 4: Graphical representation of pre and post-test mean values of Neck disability

index among Group A

Table -5

The table shows mean value, mean difference, standard deviation, and paired ‘t’ value

between pre- test and post-test scores of neck disability index among group B

Measurement Mean Mean Standard Paired ‘t’ value

difference deviation

Pre- test 31.5

13 3.4 12.082*

Post- test 18.5

*0.005 level of significance.

 In Group A for pain the calculated paired ‘t’ value is 12.082 and ‘t’ table value is 3.250 at 0.005

level. Since the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant

differences in neck disability index following stretching in patient with myofascial pain

syndrome in upper trapezius.

Figure 5: Graphical representation of pre and post- test mean values of neck disability

index among group B

Table 6

The table shows mean value, mean difference, standard deviation, and unpaired‘t’ value of neck

disability index between group A and B

Groups Improvement Standard Un paired

deviation ‘t’Test
Mean Mean
Difference

Group -A 22.7
9.7 3.07 7.06
Group -B 13
In Group A and Group B for pain the calculated unpaired ‘t’ value is 7.06and ‘t’ table value is

2.878 at 0.005 level. since the calculated ‘t’ value is less than ‘t’ table value, it shows that there

is significant difference between positional release technique and stretching in patients with

myofascial pain syndrome of upper trapezius.

Figure 3: Graphical representation of un-paired ‘t’ value of pain between Group A and

Group B.

4.2 Results​:
20 subjects clinically diagnosed have myofascial pain syndrome of upper trapezius were

divided into two groups, Group A and Group B.Group A subjects were treated with

positional release technique, Group B subjects were treated with stretching

technique.

Analysis of Dependent variable pain in Group A:​The calculated paired ‘t’

value is 11.767 and ‘t’ table value is 3.250 at 0.005 level. Since the calculated ‘t’

value is more than ‘t’ table value, it shows that there is significant difference in pain

following positional release technique in patients with myofascial pain syndrome of

upper trapezius .

Analysis of Dependent variable pain in Group B:​The calculated paired ‘t’

value is 17.99 and ‘t’ table value is 3.250 at 0.005 level. Since the calculated ‘t’

value is more than ‘t’ table value, it shows that there is significant difference in pain

following stretching exercise in patients with myofascial pain syndrome of upper

trapezius.

Analysis of Dependent variable pain between Group A and Group B: ​The

calculated paired ‘t’ value is 17.99 and ‘t’ table value is 3.250 at 0.005 level. Since

the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant

difference between positional release technique and stretching exercise in

management of patients with myofascial pain syndrome of upper trapezius.

 Analysis of dependent variable neck disability index in group A:​The

calculated paired ‘t’ value is 12.99 and ‘t’ table value is 3.250 at 0.005 level. Since

the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant

difference in neck disability index following positional release technique in

management of patients with myofascial pain syndrome of upper trapezius.

Analysis of dependent variable neck disability index in groupB: ​The

calculated paired ‘t’ value is 12.082 and ‘t’ table value is 3.250 at 0.005 level. Since

the calculated ‘t’ value is more than ‘t’ table value, it shows that there is significant

difference in neck disability index following stretching exercise in management of

patients with myofascial pain syndrome of upper trapezius.

Analysis of Dependent variable neck disability index between Group A

and Group B: ​The calculated unpaired ‘t’ value is 7.06 and ‘t’ table value is 3.250

at 0.005 level. Since the calculated ‘t’ value is more than ‘t’ table value, it shows that

there is significant difference between positional release technique and stretching

exercise in management of patients with myofascial pain syndrome of upper

trapezius.
 CHAPTER V

DISCUSSION

Myofascial pain syndrome(MPS), the other common muscle pain syndrome is

associated with discrete taut bands of hardened muscle that contain regions of

exquisite muscle tenderness​(Robert​ et al., 2​ 005).

The aim of the study was to compare the effectiveness of Positional release

thechnique and stretching technique among myofascial pain syndrome of upper

trapezius patients. 20 myofascial pain syndrome of upper trapezius patients were

divided into two groups. Group A and Group B,10 patients in each group. Group

A was sstreated with Positional release technique and Group B was treated with

stretching.

The aim of the study was to compare the effectiveness of positional release

thechnique and stretching technique among myofascial pain syndrome of upper

trapezius patients. 20 myofascial pain syndrome of upper trapezius patients were

divided into two groups. Group A and Group B,10 patients in each group. Group

A was treated with positional release technique and Group B was treated with

stretching technique.
The present study demonstrated that the application of the PRT promotes a decrease

in pain and muscle tension in the upper trapezius, confirming the assumptions that

the PRT seems to relieve the muscle spasm and restore the appropriate painless

movement and the tissue flexibility . the relaxation of tensioned muscle fiber

promotes normalization of local vascularization and decreased pain, caused by

ischemia . The action of PRT on the nociceptive system can be exercised through the

relaxation of the surrounding tissues and the consequent improvement in the vascular

and interstitial movement. This can have an indirect effect on the removal of

chemical mediators of inflammation, the subsequent resolution of protective reflexes

of the myofascial structures can also contribute to a reduction of the release of more

nociceptive substances. The PRT also can act on the traumatic cycle and assist in the

resolution of facilitated segments of the central nervous system.

Stretching technique lengthening the muscle ,reduce the spasm and pain in

small muscles but less effect in large muscle compare the positional release

therapy.
 CHAPTER VI

CONCLUSION

A comparative study was concluded to investigate the effectiveness of

positional release technique and stretching technique in the management of pain

and myofascial pain syndrome of upper trapezius.

20 patients with myofascial pain syndrome of upper trapezius were included

in the study and divided into two groups, group A, group B, each group consist of

10 patients.
 Group A was treated with positional release technique technique and Group

B was treated with stretching technique. Pain was assessed before and after

intervention by visusal analogue scale and disability assessed before and after

intervention by neck disability index.

From the statistical results, it can be concluded that there is significance

reduction in pain and neck disability in both the groups. But when comparing the

mean values it was found that positional release technique is more effective than

stretching technique.

6.1 Limitations

The study was done with small samples

The study was limited to 40- 65 age groups

The study did not include follow up

 ANNEXURE-II

Table 7: pre and post-test values of pain in group A

S.NO PRE TEST POST TEST

1 9 5
 2 8 4

3 7 3

4 8 3

5 9 5

6 7 5

7 8 4

8 9 4

9 7 4

10 9 3

Table 8: pre and post-test values of pain in group B

S.NO PRE TEST POST TEST

8 6
1
2 7 4

3 6 3

4 8 6

5 7 4

6 8 5

7 9 7

8 10 8

9 5 3

10 7 4

Table:9 pre and post values of neck disability index in group A

 S.NO PRE TEST POST TEST

1 40 18

2 43 10

3 48 20

4 39 23

5 28 10

6 25 9

7 35 11

8 39 19

9 34 11

10 45 18

Table:10 pre and post values of neck disability index in Group B

S.NO PRE TEST POST TEST

1 40 22

2 20 11

3 22 13

4 29 12

5 29 20

6 33 22

7 31 15

8 33 19

9 34 20

10 44 31
Stretching exercise

Stretching any therapeutic maneuver designed to lengthen(elongate) pathologically

shortened soft tissue structures, thereby increasing the range of motion​(​Carolyn kisner

2013​)​.

CHAPTER II

REVIEW OF LITERATURE

Section A: Studies on effect of positional release technique in the management of

myofascial pain syndrome of upper trapezius.

Section B: Studies on effectiveness of stretching exercise technique in management of the

myofascial pain syndrome of upper trapezius.

Section C: Studies on reliability and validity of visual analogue scale in measuring pain

Section D: Studies related to reliability and of neck disability index scale

alogue Scale

Visual Analogue Scale attempt to represent measurement quantities in terms of a strainght

line placed horizontaly or vertically on paper. The endpoints of the line are labeled

withdescriptive or numeric terms to anchor the extremes of the scale and provide a

frame of reference for any point in the continuum between them​(​Susan 2014)​.

Neck disability index scale

Table:10 pre and post values of neck disability index in Group B

S.NO PRE TEST POST TEST

1 40 22

2 20 11

3 22 13

4 29 12

5 29 20

6 33 22

7 31 15

8 33 19

9 34 20

10 44 31