Effectiveness Of Positional Release Therapy In Treatment Of Trapezitis

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INTERNATIONAL JOURNAL OF PHARMACUTICAL SCIENCE AND HEALTH CARE ISSUE 2, VOLUME 1 (FEBRUARY 2012) ISSN: 2249-5738 Conclusion: Positional Release Therapy can be used as an adjunct with other conventional treatment methods for the relief of pain and trapezitis. Key Words: Positional Release Therapy, trapezitis, isometrics, Neck Disability Index, Visual Analog Scale. 1 Corresponding author Introduction Neck pain is the common problem in general population with prevalence between 10% to 15% 2. Population based surveys has shown lifetime prevalence of neck pain between 67% to 87% 3. On the other hand between 13% to 22% of the population in the industrialised society experience neck pain at any point of time 6 .Neck pain is thought to be multifactorial. Excessive physical strain may cause microtrauma in connective tissues. The cervical spine is the most intricate region of the spine and so are the muscles of this region.The principle muscle to carry the load is the trapezius 7 .The relative load percentage of maximum voluntary contraction [MVC] on the upper trapezius has been shown to increase linearly with the relative torque in the gleno humeral joint. Also in an optimal seated work posture,the upper trapezius staticload level is 2% to3% maximum voluntary contractions 5 . Upper trapezius is designated as postural muscle. Fibers of upper trapezius initiate rotation of the clavicle to prepare for elevation of the shoulder gridle. Any position which places trapezius in a shortened state for a period of time without rest may shorten the fibers and lead to dysfunction and restricted movements of neck.Long telephone conversations particularly those which elevate the shoulder to hold the phone,working from a chair set too low for the desk or computer terminal and elevation of the arm for painting,playing musical instruments particularly for extended period of time can all shorten trapezius fibers creating muscle spasm 9 . Physiotherapy is frequently the treatment of choice for persons with cervical spine related muscle spasm 10 . Physiotherapy include passive treatment such as massage, stretching etc along with various modalities like IFT ,TENS, US, heat application ,cryotherapy and active treatment such as exercise therapy in addition chiropractic techniques like positional release therapy [PRT] 11-14 . Positional release therapy is a gentle manual treatment for muscle pain and spasm which involve resetting muscle tone and enhancing circulation. The purpose of the study is to determine the effect of positional release therapy in the management of trapezitis. Methodology Subjects with neck pain and clinical diagnosis of unilateral upper trapezius spasm were screened after finding their suitability as per the inclusion and exclusion criteria and were requested to participate in the study. They were explained about the safety and simplicity of the procedure and information sheet was given and their informed consent was obtained. Durations of symptoms and the side affected were noted and initial evaluation for their pain profile using Visual Analogue Scale (VAS), Active Range Of Cervical Rotation (ARCR) and Active Range Of Lateral Flexion (ARLF) and Neck Disability Index (NDI) scoring were done. For recording the pain intensity by using visual analogue scale VAS, the subjects were asked to mark their intensity of pain on a 10 cm long line marked with numbers 0 to 10 where 0 symbolized no pain and 10 as maximum pain. Page 72
INTERNATIONAL JOURNAL OF PHARMACUTICAL SCIENCE AND HEALTH CARE ISSUE 2, VOLUME 1 (FEBRUARY 2012) ISSN: 2249-5738 To measure cervical lateral flexion the examiner centers the body of the goniometry over the subjects 7th cervical vertebra. The freely movable proximal goniometry arm hangs so that it is perpendicular to the floor. At the end of the lateral flexion ROM, the examiner maintains alignment of the proximal Goniometry arm and measurement was taken. To measure cervical rotation, the examiner stands at the back of the patient , who is seated in a low chair. The examiner Centers the Goniometry fulcrum on the top of the subjects’ head and aligns the proximal Goniometry arm parallel to an imaginary line between the subjects’ Acromion process. The examiner uses left hand to align the distal Goniometry arm with either the tip of the subject’s nose or the tip of the tongue depressor. At the end of the right cervical rotation the examiners left hand maintains alignment of the distal Goniometry arm with the tip of the subject’s nose or with the tip of the tongue depressor. The examiners right hand keeps the proximal arm aligned parallel to the imaginary line between the Acromion process.Neck disability index scoring for all the 10 items were done by asking the subject to mark their ability to perform each of the 10 activities. After this all the subjects were randomized into2 groups, Group A and Group B by using envelop method. Subjects in Group A received conventional treatment initially then added intervention of PRT was given. The subject was asked to lie supine and relax completely. The therapist sits at the head of the table and scapula of the subject was elevated by taking the shoulder or scapula superior and medial to the ear, neck was rotated to the opposite side, extended and side bent to the same side. Then fine tuning of the release is done through either the neck or shoulder. This position was held for 90secs. After the release, subject was put back to the normal position.(Figure-3) Both the groups were given ultrasound, the subject was made to sit in a well supported chair with pillow under the arm. The therapist stood near the affected side. Ultrasound was given with the intensity of 1.0Wcm2 and duration of 8min.(Figure-4) Then the subjects were given isometrics for the upper trapezius muscle and were advised to do the same as part of home exercise. Subjects were advised to avoid any strenuous activity with the affected side so as to prevent any stress to the affected side. NDI, VAS, ARCR and ARLF were done on the 7th day following the same procedure as done on the 1st day. Data Analysis and Results Visual analog scale (VAS), Cervical ROM (Active lateral flexion & rotation), Neck disability index questionnaire (NDI) was done between GROUP A (n=15) & GROUP B (n=15). The data collected were for the age group of 20-55 years. These data was used to calculate the mean of cervical ROM, VAS & NDI. The pre test & post test values were compared with in GROUP A & GROUP B. For group A mean for VAS pretest- 7.60, post test- 0.87 [S.D= Pretest- 1.12, post test- 0.92], p< 0.0001. Mean for NDI pretest- 18.87, post test- 1.47 [S.D pretest- 5.21, post test- 1.46] p
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Effectiveness Of Positional Release Therapy In Treatment Of Trapezitis

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