Kashyap R, Iqbal A, Alghadir AH Controlled intervention to compare the efficacies of manual pressure release and the muscle energy technique for treating mechanical neck pain due to upper trapezius trigger points. J Pain Res. 2018 Dec 12;11:3151-3160. doi: 10.2147/JPR.S172711. eCollection 2018. (Original study)

Purpose: This study aimed at comparing the clinical efficacies of two manual therapies to determine the most beneficial result-oriented physiotherapeutic approach for treating nonspecific neck pain due to myofascial trigger points (MTrPs).

Methods: This was a randomized, controlled pretest-posttest experimental study that compared manual pressure release (MPR), the muscle energy technique (MET), and a control condition. These techniques were compared using a convenience sample of 45 female participants with neck pain due to MTrPs (mean age±SD=21.49±3.66; age range=18-30 years). The visual analog scale, pressure pain threshold, Neck Disability Index Questionnaire, and a standardized measuring tape were used to assess the participants' neck pain, muscle tenderness, functional disability due to neck pain, and range of neck rotation, respectively, at baseline (day 0), day 1, and day 5 postintervention and at days 10 and 15 during follow-up. All groups were given postural advice and at-home neck exercises. Repeated-measures ANOVA and one-way ANOVA were used to analyze the data.

Results: The within-group analyses showed significant improvement (P<0.05) in all outcome measures at days 1 and 5 postintervention and at days 10 and 15 during the follow-up for all groups. The between-group analyses confirmed nonsignificant differences (P>0.05) between all groups for all variables.

Conclusion: MPR and the MET are equally effective for reducing pain and muscle tenderness and for improving neck disability and range of rotation in patients with nonspecific neck pain. Furthermore, advice promoting postural correction can be an adjunct to physiotherapeutic interventions for reducing neck pain and its symptoms. A combination of these manual therapies with postural advice might be a good treatment option for nonspecific pain in physiotherapy clinics.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

Neck pain is such a problematic chapter. This study does not change my practice much. Although manual therapy might slightly help some patients, I continue focusing on causative factors, position, exercise and other factors such as bruxism, which were not taken into account in this study.

Physician rater

Good to know the comparison of the 2 modalities.

Rehab Clinician (OT/PT) rater

This was a good study which elucidated the effectiveness of manual pressure technique and manual energy technique on painful upper trapezius trigger points. Lack of methodological rigor limits the internal and external validity of the study. Some aspects of the study need to be(re)considered while interpreting results. These include: a) conclusions drawn for combined approaches, b) low sample size and calculation, c) randomized versus convenient sample d) 51 versus 45 participants e) intention to treat analysis f) blind assessors g) standard and validated cervical range of motion assessment h)study site and authors collaboration.

Rehab Clinician (OT/PT) rater

This is a nice and interesting study; although, study participants were unusually homogeneous, ie. all young females and of a small size (n=45). One also needs to exercise caution over the reliable and valid detection of so called 'myofascial trigger points', latent or otherwise. The results suggested that positive outcomes were non-technique dependent, when a comparison was made between direct inhibition of trigger points and muscle energy technique.

Rehab Clinician (OT/PT) rater

Interpretation of the results of this study should be considered within the context of the variability in diagnostic criteria used to determine the presence of trigger points, and the lack of a gold standard in diagnosis.
Comments from PAIN+ CPN subscribers

Ms. Monica Noy (1/29/2019 9:09 AM)

The premise of pain due to myofascial trigger points is implausible. There is a lack of evidence for the concept of trigger points and, by defining them as the cause of neck pain ignores the neuroscience of pain. The conclusion seems reasonable for an outcome study and does not mention trigger points.