Comparative Study of Immediate Effects of Intra Muscular Manual Therapy Vs Percutaneous Electrical Nerve Stimulation in the Treatment of Myofascial Trigger Point in Trapezius Muscle.

Trigger Point is a dysfunction that occurs at the point where a nerve enters a muscle. Trigger Points result in muscles which have been traumatized by accidents, sports, occupational stress, and overuse. Once a Trigger Point develops, it can remain for life unless properly treated. The Trigger Point restricts motion of the muscles and decreases circulation, depriving the muscle of nutrients and oxygen and resulting in a collection of metabolic waste that cannot be properly filtered away. These wastes excite pain nerve endings and can also damage them.The decrease of nutrients to the muscle increases spasm and inflammation. Pain is now being caused by mechanical (pressure) and chemical (waste product) stimulation. This nasty cycle continues until treatment occurs. Additionally, Trigger Points create shortened muscles which often compress nearby nerves. This compression irritates the nerve and distorts the nerve signal transmissions. This can lead to irregular sensations such as numbness, tingling, and burning1. Intra muscular manual therapy(IMMT) is a skilled intervention used by physical therapists that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments2. Percutaneous electrical nerve stimulation (PENS) refers to applying electrical stimulation through small needles which penetrate the skin. Studies have shown effects of hypoalgesia when TENS is applied using an electro acupuncture approach, in which needles are used as electrodes to avoid skin impedence3-5.Patients having trigger point in Trapezius muscle were allotted in two groups A and B by simple random sampling with chit method. GROUP A –20 patients were treated by Intramuscular Manual Therapy and in GROUP B -20 patients were treated by PENS. Both the groups received treatment for 10 mins and subjects were assessed pre and post treatment in Ultrasonography where size of the active trigger point and muscle width were recorded. Patients were given Vitamin C tablet ( Celin 500mg)prior to the treatment. Pain was assessed by Pressure Algometer, Goniometer and subjectively by NPRS .Data was analyzed statistically. Statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean ± SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5 % level of significance. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two groups, Non-parametric setting for Qualitative data analysis. The paired t-test is used to test the null hypothesis that the average of the differences between a series of paired observations is zero. The size of the trigger point which appeared as hypoechoic area in Ultra Sonography and muscle width has increased immediately after the treatment due to the local effects of the needling in both the groups. Clinically patients reported feeling of heaviness immediately after the treatment but feeling of well being reported more in PENS compare to IMMT. Immediate depletion of pain recorded in Pressure Algometer.