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The Effects of Upper Trapezius Muscle Energy Technique on Pain, Muscle Tension, and Cervical Range of Motion Using the MyotonPRO

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A52-A54. doi: Subito , type of study: clinical trial

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

cervical spine [210]
clinical trial [612]
MET [449]
muscle energy technique [157]
range of motion [80]

Abstract:

Statement of Significance: Medical students are prone to neck/upper back pain related to computer use and poor posture while studying. Muscle energy technique (MET) is thought to reduce muscle tension and pain. The MyotonPRO measures properties of muscle including tone and stiffness. A previous study showed a reduction of pain scores in upper trapezius tender points after counterstrain treatment, but without reduction in stiffness or tone; this study examined the ability of MET to reduce muscle stiffness, tone, and pain. Research Methods: Twenty-four medical students (fourteen females and ten males) were evaluated and treated by a board-certified osteopathic physician. Osteopathic medical students (OMS) were recruited using a survey posted on social media platforms (GroupMe, Facebook, etc.). Inclusion criteria included being an OMS with shoulder and/or neck pain or discomfort. Subjective ratings of pain in the upper trapezius (from 1 to 10) and range of motion (ROM) of the neck in both sidebending and rotation were recorded for both the treatment side and control side before and after treatment. A blinded student investigator also measured muscle data using the MyotonPRO bilaterally before and after MET was applied. The participants chose the side to be treated with MET for the upper trapezius muscle regardless of the side with the highest pain rating. Treatment of the upper trapezius with MET consisted of the physician providing resistance to the temporal side of the head and ipsilateral shoulder while the participant tried to side bend their neck towards the ipsilateral side. Changes in the subjective pain scores, Myoton-measured muscle parameters, and sidebending and rotation range of motion measurements before and after treatment were analyzed using paired t-tests in SPSS statistical software. Data Analysis/Results: After analysis of the collected data, there was a statistically significant (p=0.033) difference of 5.8 newtons per meter (N/m) between pre-treatment and post-treatment measurements for muscle stiffness. There was also a statistically significant (p=0.001) difference of 0.4 hertz (Hz) between pre-treatment and post-treatment measurements for muscle tone. There was no significant difference observed between stiffness (p=0.30) or tone (p=0.15) on the non-treatment (control) side. The analysis also indicated that there was a significant difference in pre-treatment and post-treatment pain scores on both the treatment (p<0.001) and non-treatment (p=0.014) sides. P-values were calculated by running Wilcoxon signed-rank test. Spearman’s rank correlation coefficient was also calculated for the changes in stiffness and pain score for both sides; no significant correlation between pain score change and stiffness change was found for either the treatment (r = -0.24) or non-treatment side (r = 0.31). No subjects were excluded from the final statistical analysis. Conclusion: This study highlights the complexity of the relationship between muscle tension and pain. The use of MET for the upper trapezius reduced muscle tone and stiffness on the treatment side, but not on the control side. While there was a statistically significant decrease in pain on both sides, it was markedly more reduced on the treatment side. MET engages the golgi tendon organ reflex, but it also engages reciprocal inhibition thus explaining a lesser, though still noteworthy, effect on the contralateral side. Moreover, MET does not guarantee pinpoint accuracy, thus while the position does favor the upper trapezius, there will be spillover to additional cervical muscles. This is likely why we also observed a smaller effect, bilaterally, in increased cervical ROM. The upper trapezius, which bore the focus of the technique, exhibited a decrease in tension, but the overall cervical ROM is likely a composite of all regional muscles. These additional muscles, even if mildly reduced in tension, could collectively sum to an overall increase in ROM. Our previous study on Counterstrain showed decreased pain but no decrease in muscle tension. We postulated, after our Counterstrain study, that MET would more directly inhibit muscle tension because of its mechanism, and our results bore that conclusion out. Our present analysis shows that there was no significant relationship between the changes in these two variables. The control side did not have a significant decrease in muscle tension but did show a significant decrease in pain. The treatment side did achieve significant reductions in muscle tension and pain but failed to show a correlation between them. This study, while demonstrating the efficacy of MET on the upper trapezius for neck and upper back pain, casts doubt on this long-held assumption that pain and muscle tension are related phenomena.


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