Speakers - 2026

Title: Comparative study of intramuscular manual therapy, percutaneous electrical nerve stimulation and TENS on myofascial trigger points of trapezius muscle

Abstract

Background: A myofascial trigger point is defined as a hypersensitivity point in a tight band of skeletal muscle that is painful when contracted, stretched, or stimulated and which inflicts pain at a distance from the point. Tight bands are found on either side of contraction knot that are stretched due to pulling effect of the knot in muscle fibers.

Methods: Subjects from Physiotherapy Out Patient Department of a tertiary care center in Pune city,India  were selected by convenience sampling method.  90 Patients satisfying inclusion and exclusion criteria were considered for this study. All the patients were divided randomly into 3 groups, 30 in each group. Patients were treated with Intermuscular manual therapy (IMMT), Percutaneous electrical nerve stimulation (PENS) and TENS respectively. A clear explanation of the study was given to them and informed consent were obtained, duly signed, from them who were ready and agreed to participate. The. Each group was given assigned treatment   alternate days for 10 mins, 3 sessions for 3 weeks. Vitamin C supplement was recommended prior to the treatment for the patients who were treated with Intramuscular Manual Therapy and PENS. Pre and post interventions were recorded in Ultrasonography (size of the trigger point and width of the upper fibers of trapezius muscle) , NPRS, Goniometer, Pressure Algometer and Neck Disability Index which were analyzed statistically.

Results: Pain mitigation was seen in all three groups. However, proclivity for percentage of Improvement in Cervical Range of Motions (left Cervical Rotation, Right Cervical Rotation, Right Cervical Lateral Flection and Left Cervical Lateral Flection) irrespective of sides in which the Myofascial Trigger points were nestled, were recorded less than 50%. This is probably because of Kinesiophobia.

Conclusion: The study demonstrated amelioration of pain and disability in patients treated with IMMT, PENS and TENS. Ultrasonography images of trigger point size and upper fiber of Trapezius muscle thickness showed abated in all groups. Painful experience was interpreted as threatening, it has created notion that activity may cause more pain and re/injury. Hence ramification reflected in restriction of neck movements despite of decrease in pain.

What will the audience take away from presentation:

• Algophobia, or the fear of pain, is the reason for Kinesiophobia, the rational behind decrease in neck range of motion in spite of no cervical pain.
• Intra Muscular Manual therapy can be considered as the first line of treatment for myofascial trigger points in muscles.
• Ultrasonography may be a preferred objective outcome measure for the diagnosis of size of myofascial trigger point and muscle width.
• Increase in Hypoechoic area in ultrasonography image after the intervention with intra muscular manual therapy or percutaneous electrical nerve stimulation in muscles  is due to the accumulation of interstitial fluid around the sarcomeres which may illustrate as increase in the size of trigger point.