Muscle Energy Techniques and Trigger Point Therapy in Asymptomatic Persons With Latent Trigger Point
Muscle Energy Techniques and Trigger Point Therapy in Asymptomatic Persons With Latent Trigger Point
The main objective of this study is to evaluate the effectiveness of therapy which will be a
 combination of Muscle Energy Technique (MET) and Trigger Point Therapy (TPT), performed
 bilaterally on the upper trapezius muscle in the group of asymptomatic persons with latent
 trigger point. The study will show whether one-time therapy has an impact on: mobility of the
 cervical spine, biophysical parameters (muscle tone, stiffness and elasticity) of soft
 tissues and pressure pain threshold of upper trapezius muscle. An additional goal will be to
 compare the effectiveness of the three treatments used: combination of MET with TPT, single
 MET and single TPT.

 Research hypotheses:

 -  The combination of MET with TPT will increase the angular ranges of basic cervical spine
 movements immediately after the therapy and these effects will persist the second day
 after the intervention.

 -  The combination of MET with TPT will increase the elasticity and reduce muscle tone and
 stiffness in the area of the upper trapezius immediately after the therapy, and these
 effects will persist the second day after the intervention.

 -  The combination of MET with TPT will increase the pressure pain threshold of upper
 trapezius muscle immediately after the therapy, and this effect will persist the second
 day after the intervention.

 -  The combination of MET with TPT will be more effective than single MET and single TPT
 methods.

 Muscle Energy Techniques (MET) can be defined as a group of soft tissue manipulation methods.
 They are a multi-task techniques that can be performed to improve the function of the
 musculoskeletal system and reduce pain. METs are used by clinicians who treat various
 myofascial and joint dysfunctions as well as a form of prevention and protection of the
 musculoskeletal system.

 Trigger point therapy (TPT) uses manual techniques such as ischemic compression (IC),
 positional release (PR), dry needling and soft tissue manipulations [TP1]. Their main purpose
 is to reduce or eliminate the symptoms generated by myofascial trigger points (TrPs), which
 are defined as severely irritated areas within the hypertonic muscle fiber band or the fascia
 itself. Latent TrPs are described as those that do not generate symptoms on their own.
 However, they can cause refered pain at the time of provocation, i.e. pressure at the place
 of their occurrence.

 In the scientific literature there are no reports on the assessment of the combination of MET
 with TPT
The randomized study will focus on assessing the effectiveness of 3 different
 physiotherapeutic interventions. The physiotherapist with 10 years of professional experience
 will be responsible for performing all diagnostic procedures and therapeutic interventions.

 Diagnosis of latent trigger point will be performed on subjects in the supine position. The
 therapist using a pincer grip will perform palpation in the area of the entire upper
 trapezius muscle. Testing for the presence of trigger point can be considered positive when
 it is noted: 1) the presence of a detectable strained band in the muscle, 2) the presence of
 an excessively sensitive area in the strained muscle band, 3) the response of local vibration
 caused by compression of the strained band, 4) occurrence of characteristic transferred
 symptoms (pain radiating to the posterior-lateral side of the neck, and/or mastoid process of
 the temporal bone, and/or the temporal bone area, and/or the angle of the jaw) as a result of
 compression of the hypersensitive muscle band. The test will be performed on both sides of
 this muscle.

 The following measurement methods are planned to be used:

 1. Electrogoniometry of the cervical spine. A Penny & Giles strain tensometric
 electrogoniometer will be used. Using this device, the angular values of cervical spine
 movements will be examined. The SG150 two-plane sensor and the Q110 single-plane sensor
 will be used. The lower edge of the upper sensor will be attached around the occipital
 tuberosity, while the upper edge of the lower sensor on the C7 spinous process. The
 examined person will be in a sitting position. Double-sided tape from Biometrics will be
 used to stick the electrogoniometer sensors. For the measurements of each movement, the
 subject will perform 3 repetitions. Then the mean value will be calculated, which will
 be the result.

 2. Myotonometry. In order to examine the biophysical parameters of soft tissues a MyotonPRO
 will be used.

 Measurements will be made on the upper part of the trapezius muscle at the point located
 in the middle of the segment between the C7 spinous process and the shoulder angle of
 the acromion. During measurements, the subject will be lying down.

 3. Pressure pain threshold (PPT). The Wagner Instruments Algometer will be used to assess
 the subjective parameter - pressure pain threshold of first discomfort. The place of
 measurement will be the point located on the upper trapezius muscle in the middle of the
 segment between the C7 spinous process and the shoulder angle of the acromion. The
 subject will be lying down on his back. Pressure from the algometer sensor will be
 applied from above and perpendicular to the examined muscle. Three measurements will be
 taken alternately for both sides of the upper trapezius. The mean value will be
 calculated, which will be the results for the right and left sides of the examined
 muscle.

 The order of measurements will be: 1) myotometry, 2) pressure pain threshold test, 3)
 cervical spine electrogoniometry.

 Participation in the study will be voluntary, free and fully anonymous. The participant will
 be able to opt out of the study at any stage. All planned therapeutic and measurement methods
 are non-invasive and safe. They do not threaten the health and life of the respondents.
Inclusion Criteria:

 -  right-handed people

 -  amateur practicing symmetrical sports (eg. swimming, running, cycling, gym, roller
 skates)

 -  asymptomatic subjects (without pain symptoms of the cervical spine and shoulder
 girdle)

 -  occurrence of latent trigger point of the upper trapezius muscle

 Exclusion Criteria:

 -  age above 21 years

 -  no latent trigger point on the upper trapezius muscle

 -  pain in the cervical spine or shoulder girdle

 -  any neurological symptoms in the upper limb

 -  previous operations in the cervical spine or shoulder girdle

 -  practicing asymmetrical sports

 -  professional sports