The Effect Of Stretching Exercise on Pectoralis Minor Myofascial Latent Trigger Points

NCT02699294 | Completed

• 1 other identifier: 34910702
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

This randomised-controlled trial investigates whether a single intervention of manual pressure release combined with stretching exercise has an effect on muscle length, pain perception threshold, and respiratory function in subjects with latent myofascial trigger point in the pectoralis minor muscle or not. First quarter of the participants will receive a single intervention of manual pressure release combined with contract-relax PNF stretching exercise of pectoralis minor muscle, second quarter of the participants will receive a single intervention of manual pressure release combined with Z stretching exercise of pectoralis minor muscle while, only a single intervention of manual pressure release will be applied to third quarter of the participants and final quarter of them will not receive any intervention.

Conditions

Myofascial Trigger Point Pain

Keywords

Pain Threshold; Pectoralis Minor; Proprioceptive Neuromuscular Facilitation (PNF) Stretching; Physiotherapy; Rehabilitation

Outcome Measures

Primary Outcomes (1)

• Change from Baseline Pectoralis minor index (PMI) to 24 hours follow-up

  The PMI will be calculated by dividing the resting muscle length measurement by the subject height in centimeters and multiplying by 100. The test-retest reliability for PMI measurement is 0.94 (95 % Confidence Interval (CI): 0.81-0.98).

  Baseline, immediately after intervention, and 24 hours follow-up

Secondary Outcomes (9)

• Pectoralis minor length

  Baseline, immediately after intervention, and 24 hours follow-up

• Pain pressure threshold of pectoralis minor muscle myofascial latent trigger point site

  Baseline, immediately after intervention, and 24 hours follow-up

• Rounded shoulder posture measure

  Baseline, immediately after intervention, and 24 hours follow-up

• The Forced Vital Capacity (FVC)

  Baseline and 24 hours follow-up

• Forced Expiratory Volume in 1 second (FEV1)

  Baseline and 24 hours follow-up

Other Outcomes (3)

• Visual Analogue Scale (VAS)

  Baseline

• Disability arm shoulder hand questionnaire (DASH)

  Baseline

• Short-Form 12

  Baseline

Study Arms (4)

Contract-relax PNF stretch

EXPERIMENTAL

A contract-relax PNF stretching techniques of the pectoralis minor muscle including latent trigger points will be applied by Group 1 after a single intervention of manual pressure release will be performed according to the techniques describe by Simons et al. (1999).

Other: Manual pressure release; Other: Contract-relax PNF stretch

Z-stretch

EXPERIMENTAL

The Z- stretch of the pectoralis minor muscle including latent trigger points will be applied by Group 2 after a single intervention of manual pressure release will be performed according to the techniques describe by Simons et al. (1999).

Other: Manual pressure release; Other: Z-stretch

Manual pressure release

EXPERIMENTAL

The single intervention of manual pressure release will be only applied to Group 3 according to the techniques describe by Simons et al. (1999).

Other: Manual pressure release

Control

NO INTERVENTION

This is a control group.

Interventions

Manual pressure release OTHER

Subjects will be positioned supine on a treatment plinth and will be encouraged to relax as much as possible before pressure is applied. A slow pressure to myofascial latent trigger point will be applied directly over the marked pectoralis minor muscle myofascial latent trigger point site until a moderate but tolerable pain value of 7 out of 10 (0= no pain, 10= severe pain) is reported. Constant pressure will be sustained for 90 seconds if the subjects report that the pain is decreased to a value of 3, the pressure will be increased to restore perceived pain to the value of 7. Then, tissue resistance (barrier) in pectoralis minor muscle will be controlled.

Contract-relax PNF stretch; Manual pressure release; Z-stretch

Contract-relax PNF stretch OTHER

Subjects will be in a sitting position with hands being clasped behind the head. The pectoralis minor muscle will be passively and slowly stretched until a strong but tolerable stretch discomfort intensity level of 4 out of 10 (0= no pain, 10= severe pain) is reported. Passive stretch will be sustained for 10 seconds followed by 6 seconds of maximal voluntary isometric contraction of the pectoralis minor muscle. Then, subjects will be instructed to relax for further 4 seconds. Subjects will maintain newly active stretched position of pectoralis minor muscle for 10 seconds with a strong but tolerable stretch discomfort intensity level of 4 out of 10. The procedure will be repeated four times with 30 seconds of rest between two successive trials.

Contract-relax PNF stretch

Z-stretch OTHER

Subjects will be positioned supine with knee bent on a treatment plinth, and the legs will be rotated to the opposite direction of the arm to be stretched placing a stabilizing distal tension on the ribs. Then, the subjects will be slowly brought the arm in a circular motion overhead pausing at the points of tightness, maintaining close contact to the treatment table until a strong but tolerable stretch discomfort intensity level of 4 out of 10 (0= no pain, 10= severe pain) is reported. Self-stretch of pectoralis minor muscle, including myofascial latent trigger points will be sustained for 30 seconds. The procedure will be repeated four times with 30 seconds of rest between two successive trials.

Z-stretch

Eligibility Criteria

• Age: 18 Years - 35 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Subjects diagnosed with at least one latent myofascial trigger point in the pectoralis minor muscle

You may not qualify if:

• Presence of active trigger points in the pectoralis minor muscle
• Any orthopaedic problems pertaining to the spine-shoulder complex (e.g., fractures, arthrosis, listhesis, sprains, strains) within the last six months
• Surgery on the spine-shoulder complex before the study
• Neurological impairment in the upper extremities
• Receiving the treatment for myofascial pain within the last three months
• Receiving anti-inflammatory and pain relief medication in the past 24 hours

Sponsors & Collaborators

• Istanbul University: lead

Study Sites (1)

Istanbul University

Istanbul, Turkey (Türkiye)

Location

Related Publications (12)

• Trampas A, Kitsios A, Sykaras E, Symeonidis S, Lazarou L. Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Phys Ther Sport. 2010 Aug;11(3):91-8. doi: 10.1016/j.ptsp.2010.02.003. Epub 2010 May 5.

  PMID: 20673857 BACKGROUND

• Borstad JD. Measurement of pectoralis minor muscle length: validation and clinical application. J Orthop Sports Phys Ther. 2008 Apr;38(4):169-74. doi: 10.2519/jospt.2008.2723. Epub 2007 Nov 21.

  PMID: 18434665 BACKGROUND

• Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 2013 Aug;17(8):353. doi: 10.1007/s11916-013-0353-8.

  PMID: 23801006 BACKGROUND

• Halbertsma JP, van Bolhuis AI, Goeken LN. Sport stretching: effect on passive muscle stiffness of short hamstrings. Arch Phys Med Rehabil. 1996 Jul;77(7):688-92. doi: 10.1016/s0003-9993(96)90009-x.

  PMID: 8669996 BACKGROUND

• Hanten WP, Olson SL, Butts NL, Nowicki AL. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000 Oct;80(10):997-1003.

  PMID: 11002435 BACKGROUND

• Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elbow Surg. 2006 May-Jun;15(3):324-30. doi: 10.1016/j.jse.2005.08.011.

  PMID: 16679233 BACKGROUND

• Park G, Kim CW, Park SB, Kim MJ, Jang SH. Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Rehabil Med. 2011 Jun;35(3):412-7. doi: 10.5535/arm.2011.35.3.412. Epub 2011 Jun 30.

  PMID: 22506152 BACKGROUND

• Lee JH, Cynn HS, Yoon TL, Ko CH, Choi WJ, Choi SA, Choi BS. The effect of scapular posterior tilt exercise, pectoralis minor stretching, and shoulder brace on scapular alignment and muscles activity in subjects with round-shoulder posture. J Electromyogr Kinesiol. 2015 Feb;25(1):107-14. doi: 10.1016/j.jelekin.2014.10.010. Epub 2014 Oct 28.

  PMID: 25467545 BACKGROUND

• Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996 Mar;34(3):220-33. doi: 10.1097/00005650-199603000-00003.

  PMID: 8628042 BACKGROUND

• Wong CK, Coleman D, diPersia V, Song J, Wright D. The effects of manual treatment on rounded-shoulder posture, and associated muscle strength. J Bodyw Mov Ther. 2010 Oct;14(4):326-33. doi: 10.1016/j.jbmt.2009.05.001. Epub 2009 Jun 26.

  PMID: 20850039 BACKGROUND

• Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983 May;16(1):87-101. doi: 10.1016/0304-3959(83)90088-X.

  PMID: 6602967 BACKGROUND

• Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996 Jun;29(6):602-8. doi: 10.1002/(SICI)1097-0274(199606)29:63.0.CO;2-L.

  PMID: 8773720 BACKGROUND

Related Links

• Simons et al., 1999

MeSH Terms

Conditions

Myofascial Pain Syndromes

Condition Hierarchy (Ancestors)

Muscular Diseases; Musculoskeletal Diseases

Study Officials

• Tansu Birinci, PT

  Research Assistant

  PRINCIPAL INVESTIGATOR

• Ebru Kaya Mutlu, PhD, PT

  Lecturer

  STUDY DIRECTOR

• Rustem Mustafaoglu, MSc, PT

  Research Assistant

  PRINCIPAL INVESTIGATOR

• Arzu Razak Ozdincler, Prof. Dr

  Professor

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research assistant

Study Record Dates

• First Submitted: November 16, 2015
• First Posted: March 4, 2016
• Study Start: April 1, 2017
• Primary Completion: May 16, 2017
• Study Completion: July 11, 2017
• Last Updated: July 13, 2017

Record last verified: 2017-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)