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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 33-36

Comparison of effectiveness of electrical stimulation, myofascial release, and conventional physiotherapy over acupuncture points (GB21, SI14) on upper trapezius in female basketball players


1 Professor & HOD, Ujjain College of Physiotherapy, Ujjain, Madhya Pradesh, India
2 Professor, Ujjain College of Physiotherapy, Ujjain, Madhya Pradesh, India
3 Post Graduate Student, Ujjain College of Physiotherapy, Ujjain, Madhya Pradesh, India
4 Department of Dentistry, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, India

Date of Submission20-Oct-2021
Date of Decision13-May-2022
Date of Acceptance14-Jun-2022
Date of Web Publication22-Jul-2022

Correspondence Address:
Dr. Ananya Bhargava
A-30/10, Vasant Vihar, Ujjain - 456 010, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pjiap.pjiap_29_21

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  Abstract 


AIM: The aim of the study is to compare the effectiveness of electrical stimulation, myofascial release (MFR), and conventional physiotherapy over acupuncture points (GB21, SI14) on the upper trapezius in female basketball players.
METHODOLOGY: The study included 30 patients with unilateral myofascial trigger points (MTrPs) present on acupuncture points GB2l (midway between shoulder and vertebral column) and SI14 (3 cm lateral to lower border of spinous process of first thoracic vertebra) on the upper trapezius, between the age group of 18 and 30 years. The patients were allotted alternatively to Group A, Group B, and Group C, respectively. Preparticipation evaluation was done. Group A received electrical stimulation with exercise, Group B received MFR with exercise, and Group C received cold pack with exercise. Posttreatment evaluation is conducted on the 7th day of treatment.
RESULTS: The results showed that Group B has significant decrease in pain and increase in lateral bending of the cervical spine to the opposite side at posttest values as compared to Group A and Group C.
CONCLUSION: All three groups have got beneficial effects in reducing pain intensity and increasing lateral bending of the cervical spine to the opposite side. Group B shows more significant effect in decrease in pain and increase in lateral bending of the cervical spine to the opposite side in female basketball players with MTrP over acupoints GB21, SI14 on the upper trapezius.

Keywords: Acupuncture point, electrical stimulation, GB21, myofascial release, SI14


How to cite this article:
Jha S, Bajpai S, Mishra R, Brahm V, Bhargava A. Comparison of effectiveness of electrical stimulation, myofascial release, and conventional physiotherapy over acupuncture points (GB21, SI14) on upper trapezius in female basketball players. Physiother - J Indian Assoc Physiother 2022;16:33-6

How to cite this URL:
Jha S, Bajpai S, Mishra R, Brahm V, Bhargava A. Comparison of effectiveness of electrical stimulation, myofascial release, and conventional physiotherapy over acupuncture points (GB21, SI14) on upper trapezius in female basketball players. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2022 Nov 30];16:33-6. Available from: https://www.pjiap.org/text.asp?2022/16/1/33/351860




  Introduction Top


Neck pain is a common problem in the general population with a prevalence between 10% and 15%. Population-based surveys have shown a lifetime prevalence of neck pain between 67% and 87%.[1]

Myofascial trigger point (MTrP) is the most tender spot in taut band of the skeletal muscle fibers and is characterized by a specific pattern of referred pain and local twitch responses.[2]

The systematic practice of team sports at an elite level, such as basketball, requiring overhead, or repetitive upper extremity movements, is often associated with higher risk for injury.

The shoulder and scapula regions including the upper trapezius muscle are the most common areas developing myofascial pain syndrome among overhead sport activities. MTrPs are characterized by the presence of palpable taut band or spot within skeletal muscle; the local inflammation caused by MTrPs can negatively affect surrounding soft tissues, resulting in impairment of entire muscle and surrounding fascia. The presence of MTrPs is therefore considered to be the first sign of overloading of the muscle.[3]

The MTrP in the trapezius is most commonly found at the midpoint of upper border of the muscle.[4]

Muscle spasms occur early after injury; this feels like tightness in the muscle and is sometimes painful. When basic injury is not treated, spasm causes formation knots of muscle knots called trigger points (TrPs).[1],[5]

The purpose of our study was to see the effect of electrical muscle stimulation (EMS), myofascial release (MFR), and cold pack with exercise over acupoints on the upper trapezius instead of TrPs in female basketball players and to compare the effect of EMS, MFR, and cold pack with exercise over acupoints GB21, SI14 on the upper trapezius.


  Methodology Top


Source of data

Madhav College Ground, Ujjain; Mahananda Ground, Ujjain.

Sample size

Thirty.

Patients were divided into three groups:

  • Group A includes ten patients receiving electrical stimulation with exercise
  • Group B includes ten patients receiving MFR with exercise
  • Group C includes ten patients receiving cold pack with exercise.


Study duration

July 2019 to December 2019.

Inclusion criteria

  • Age: 18–30-year-old females (basketball players)
  • Pain from the last 1 month
  • Limitation in neck movement due to pain
  • Unilateral muscle spasm with TrPs on acupoints GB21, SI14.
  • Training workload of at least 20 h/week
  • Active MTrPs in dominant trapezius muscle
  • Willingness to participate.


Exclusion criteria

  • History of referred pain due to cervical pathology
  • Dermatitis, wound over the upper back/neck region
  • Degenerative cervical spine
  • Upper limb pain, trauma history
  • History cervical or shoulder surgery
  • Administration of sedatives, analgesics, and other medication
  • Sensory disturbance present in the upper trapezius.


Materials used

  • EMS
  • Cold pack.


Procedure

The study included 30 patients with unilateral MTrPs present on acupuncture points GB2l (midway between shoulder and vertebral column) and SI14 (3 cm lateral to lower border of spinous process of first thoracic vertebra) in the upper trapezius, between the age of 18 and 30 years with permission from the institute, and informed consent was obtained for the performance of this study. Demographic data were collected from the participants. The patients were allotted alternatively to Group A, Group B, and Group C, respectively, that is, first patient to Group A, second to Group B, and third to Group C, and so on.

Each subject was asked to point to the most painful areas of the upper trapezius region and to determine the area of possible TrPs that matches with acupoints (GB21 and SI14). Examiner then palpates the region of the upper trapezius and marked all points that matched inclusion criteria with nonpermanent marker.

Preparticipation evaluation form consisted of chief complaint, history, and range of motion (ROM) of the lateral side cervical flexion by using a goniometer chart. Each subject was allowed to ask questions to the examiner regarding the study. Then, the participant was asked to mark a visual analog scale (VAS) with the average pain intensity for their pain over the past 24 h. Posttreatment evaluation is conducted on the 7th day of treatment.

Intervention

Group A

Participants were asked to expose the affected part and removed artificial material before applying of EMS. The patient should be seated erect on chair with arms hang freely. Then, mark the TrPs that match with acupoints GB21 and SI14. Muscle stimulator machine having faradic current of systemic, surged biphasic pulses of duration 0.1–1 min with a frequency of 50 Hz is given for 15 min.

Group B

Participants were asked to expose the affected part and removed artificial material, before applying MFR technique. The therapist should stand to the side and behind the patient, close to the muscle to be treated. The therapists forearm or lateral aspect of the palm glides slowly medially toward the base of the neck or scapula, while maintaining a firm pressure. As glide is given, the subject should equally side bending and turning the head away from the side being treated while maintain erect sitting posture. MFR has to be given for 5 min included three palmer glides.

Group C

Participant should be seated erect on chair with the arm hanging freely. Cold pack was given over the upper trapezius in the sitting position for 20 min.

Exercises

All participants in three groups were instructed for shoulder girdle exercises including scapular protraction, retraction, elevation, and depression, as well as active neck exercises including cervical flexion, extension, right and left rotation, and side flexion. All exercises are given for 10 repetitions and 5 s hold.

Variables

  1. Dependent variables: VAS, ROM of lateral side flexion
  2. Independent variables: Electrical stimulation, MFR, cold pack exercises.


Instrumentation

Goniometer.

Outcome measures

Pain, cervical flexion ROM.


  Results Top


Analysis was done using SPSS software version 22 (IBM Corporation, Armonk, NY, USA). Descriptive analysis was used to calculate mean and standard deviation. Paired t-test was used for intergroup analysis. Independent t-test was used for intragroup analysis for all group variables. The level of significance was set at 95%. When the comparison was made on the VAS and cervical side flexion ROM on day 1 and day 7, they show significant improvement in pain in all three groups [Table 1] and [Table 2]. However, there is more significant improvement in outcome measures in Group B compared to Group A and Group C. The results showed that Group B has significant decrease in pain and increase in lateral bending of the cervical spine to the opposite side at posttest values compared to Group A and Group C [Table 3] and [Table 4].
Table 1: Mean score of pre -and post-visual analog scale of groups

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Table 2: Mean score pre-and post-range of motion of groups

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Table 3: Comparison of posttest visual analog scale between groups

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Table 4: Comparison of posttest range of motion between groups

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  Discussion Top


The study was designed to compare the effectiveness of EMS, MFR, and conventional physiotherapy acupuncture points Gb21 and SI14 on the upper trapezius in female basketball players. This comparative study of seven sessions of electrical stimulation, MFR, and conventional physiotherapy in combination with shoulder girdle exercises led to the findings that MFR has shown statistically significant decrease in pain and improvement in the lateral bending of the cervical spine to the opposite side than EMS and conventional physiotherapy After analysis of baseline data and posttreatment scores, it reveals significant improvement (P < 0.05) in Group B after seven treatment sessions. The possible mechanism is that MFR is a soft tissue mobilization technique, and MFR involves specifically guided low-load long-duration mechanical forces to manipulate the myofascial complex, intended to restore optimal length, decrease pain, and improve function. Myofascial utilizes the manual traction and prolonged stretching of fascia and muscle to break down the adhesions, thus helping to decrease pain and increase flexibility and thereby increase ROM. When Myofascial Release is used on the TrPs, local chemistry changes due to blanching of nodules occurs which is followed by hyperemia. This flushes out the muscle inflammatory exudates and pain metabolites, breaks down the scar tissue, desensitizes the nerve endings, and reduces muscle tone.

This study was in accordance with Chaudhary et al.[6] who compared the effectiveness of MFR technique versus cold pack in relieving pain and improving cervical ROM and pressure pain threshold in the upper trapezius spasm patients and found that the MFR and cold pack along with exercises are effective interventions in upper trapezius muscle spasm. However, MFR shows greater effectiveness as compared with cold pack and exercises in the treatment of upper trapezius spasm.

This study was inconsistent with Mishra et al.[7] who compared the effect of active release technique (ART) and MFR on the upper trapezius muscle spasm on pain and cervical ROM and found that both techniques are effective in the alleviation of symptoms and associated disability in the upper trapezius muscle spasm, and ART gave better results as compared to MFR.


  Conclusion Top


This study provided evidence to support the use of electrical stimulation, MFR, and cold pack along with exercise over acupoints GB2l and SI14 on the trapezius. This study concluded by stating that all three groups have got beneficial effects in reducing pain intensity and increasing lateral bending of the cervical spine to the opposite side, and Group B shows more significant effect in decrease in pain and increase in lateral bending of the cervical spine to the opposite side in female basketball players with MTrPs at acupoints GB2l and SI14 on the upper trapezius.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumaresan A, Deepthi G, Anandh V, Prathap S. Effectiveness of positional release therapy in treatment of trapezitis. Int J Pharm Sci Health Care 2012;1:71-81.  Back to cited text no. 1
    
2.
Hong Zern C. Myofascial trigger points: Pathophysiology and correlation with acupuncture points. Acupunct Med 2000;18:41-7.  Back to cited text no. 2
    
3.
Matsubara T, Arai PY, Shiro Y, Shimo K, Nishihara M, Sato J, Ushida T. Comparative effects of acupressure at local and distal acupuncture points on pain condition and autonomic function in female with chronic neck pain. Evid Based Complement Altern Med 2011;1:1-6.  Back to cited text no. 3
    
4.
Chaudhary ES, Shah N, Vyas N, Khuman R, Chavda D, Nambi G. Comparative study of myofascial release and cold pack in upper trapezius spasm. Int J Health Sci Res 2013;3:20-7.  Back to cited text no. 4
    
5.
Manheim CJ. The Myofascial Release Manual. 4th. Edition Charleston, SC: Slack Incorporated; 2008.  Back to cited text no. 5
    
6.
Chaudhary ES, Shah N, Vyas N. Comparative study of myofascial release and cold pack the upper trapezius spasms. Int J Health Sci Res 2013;3:20-7.  Back to cited text no. 6
    
7.
Mishra D, Prakash R, Mehta J, Dhaduk A. Comparative study of active release technique in treatment of patient with upper trapezius spasm. J Clin Diagn Res 2018;12:YC01-4.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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