INTRODUCTION

1
 INTRODUCTION

The trapezius muscle is a large superficial back muscle that resembles a trapezoid. It
extends from the external protuberance of the occipital bone to the lower thoracic
vertebrae and laterally to the spine of the scapula. The trapezius has upper, middle, and
lower groups of fibres. Trapezius is a large diamond shaped muscle that moves the
scapula and supports the arm and neck. Its origin is from the occipital bone of the
ligamentum nuchae and its insertion is on the outer third of the clavicle.1

FIG: 1.1 TRAPEZIUS MUSCLE

The ventral rami of C3, C4 innervates the sensory function of the trapezius. Cranial
nerve XI innervates the motor function of the trapezius.1
The function of the trapezius is to stabilize and move the scapula. The upper fibers can
elevate and upwardly rotate the scapula and extend the neck. The middle fibers adduct
(retract) the scapula. The lower fibres depress and aid the upper fibres in upwardly
rotating the scapula. These motions allow for the scapula to rotate against

2
the levator scapulae and the rhomboid muscles. This rotation is important, in
conjunction with the deltoid muscle, for throwing objects.1

The trapezius is a muscle made up of particularly long muscle fibers that span a large
width of the upper back. Functionally, this allows the trapezius to assist in mainly
postural attributes, allowing and supporting the spinal column to remain erect when
the person is standing. The trapezius is one of the broadest and most superficial (closest
to the skin) muscles of the upper back and trunk, meaning upon dissection of a cadaver
it is often used as a landmark because it is encountered first. This muscle is triangular,
broad, and thin and covers the upper back of the shoulders and neck. Its attachment
points consist of the spinous process of C7-T12 of the spine, ligamentum nuchae,
scapulae, clavicles, and ribs. The trapezius muscle is mainly postural but is also used
for active movements such as side bending and turning the head, elevating and
depressing the shoulders, and internally rotating the arm. The trapezius elevates,
depresses, and retracts the scapula. The descending muscle fibers of the trapezius
muscle internally rotate the arms. The transverse muscle fibers retract the scapulae,
and the ascending muscle fibers medially rotate the scapulae.1

Trapezitis is an inflammatory pain arising from the trapezius muscle causing a severe
neck spasm. This muscle lies at the back of the neck and helps in shrugging movement
of the Shoulder along with upward movement of the head.2

The upper trapezius is that part of the trapezius muscle extending from the occiput to
the lateral third of the clavicle and acromion process of the scapula. A strain of this
muscle results in pain in posterolateral region of the neck.2

Bad posture is frequently incrimate as the cause of trapezitis. Watching television or

working on a computer with an awkward posture or even use of a thick pillow can
cause neck spasm. The stress that gives rise to this condition is often a combination of
tension on, and contraction of, the muscle. Stretching sideways to reach for an object
while holding the head tilted in the opposite direction that rolled under a desk or sitting
in the front seat of a car reaching can cause such an attack. A typical

3
example may be someone on the floor reaching to recover an object to recover an
object from the back seat.2

FIG: 1.2 CAUSES OF UPPER TRAPEZITIS

FIG: 1.3 SIGNS AND SYMPTOMS OF UPPER TRAPEZITIS

4
Myofascial release is a soft tissue mobilization technique, defined as “the facilitation
of mechanical, neural and psycho physiological adaptive potential as interfaced via the
myofacial system.[8] By MFR there is a change in the viscosity of the ground substance
to a more fluid state which eliminates the fascia’s excessive pressure on the pain
sensitive structure and restores proper alignment. This technique acts as a catalyst in
the reduction of trapezius spasm.3

FIG: 1.4 MYOFASCIAL TRIGGER POINT RELEASE THERAPY

5
The use of cold or cryotherapy for medicinal purposes in the form of ice and snow has
been used since the time of Hippocrates. The application of ice in osteopathic is most
commonly recommended for patients presenting with musculoskeletal injury.
Cryotherapy decreases tissue blood flow by causing vasoconstriction, reduces tissue
metabolism, oxygen utilization, inflammation and muscle spasm. Common methods
of cold application are ice pack, vapo-coolant spray, ice massage, cold whirlpool. By
application of cold pack reduces temperature to a depth of 2 to 4 cm, which reduces
activation of nociceptors and painful nerve conduction velocity.3

FIG 1.5 COLD PACK IN UPPER TRAPEZITIS

6
Exercises: Shoulder girdle exercises including scapular protraction, retraction,
elevation and depression. Active Neck exercises including cervical flexion, extension,
right and left rotation and side flexion.3

FIG 1.6 SHOULDER GIRDLE EXERCISE

FIG1.7 NECK EXERCISE

7
The Numeric Pain Rating Scale (NPRS) is a one-dimensional measure of pain intensity
in adults, including those with chronic Pain. The Numerical Pain Rating Scale is an
11- point scale for patient self-reporting of pain. It is based solely on the Ability to
perform activities of daily living (ADLS) and can be used for adults and children 10
years old or older. The numerical pain rating scale should not be more than 7.4

Rating Pain Level

0 No pain

1-3 Mild Pain

( nagging, annoying, interfering little with ADLs)
4-6 Moderate Pain ( interference significantly with ADLs)

7-10 Severe Pain( disabling, unable to perform ADLs)

Reliability

High test- retest reliability has been observed in both literate and illiterate patients with
rheumatoid arthritis (r 0.96 and 0.95, !! respectively) before and after medical
consultation.4

Validity

For construct validity, the NPRS was shown to highly correlated with the VAS
inpatients with rheumatic and other chronic pain conditions (pain > 6 months) ;
correlations range from 0.86 to 0.95.4

8
NEED OF THE
STUDY

9
 NEED OF STUDY

To determine Comparative study between Myofascial release v/s Cold pack along with
sh. girdle exercise and neck exercise in patient’s with upper Trapezitis.

10
 AIM &
OBEJECTIVES
OF THE STUDY

11
 AIM OF STUDY

The aim of this study is to compare the effectiveness of Myofascial release and Cold
pack along with sh. girdle exercise and neck exercise in patient’s with upper Trapezitis.

OBJECTIVES OF THE STUDY

1. To determine the effectiveness of Myofascial release along with sh. girdle exercise
and neck exercise in patient’s with upper trapezitis.
2. To determine the effectiveness of cold pack along with sh. girdle exercise and neck
exercise in patient’s with upper trapezitis.
3. To compare the effectiveness of myofascial release and cold pack along with sh.
girdle exercise and neck exercise in patient’s with upper trapezitis.

12
 RESEARCH HYPOTHESIS

1. NULL HYPOTHESIS [ H0 ] :

There will be no significant improvement in the effectiveness of myofascial release

and cold pack along with sh. girdle exercise and neck exercise in patient’s with upper
trapezitis.

2. EXPERIMENTAL HYPOTHESIS [ H1] :

There will be significant improvement in the effectiveness of myofascial release and

cold pack along with sh. girdle exercise and neck exercise in patient’s with upper
trapezitis.

13
LITERATURE
REVIEW

14
 REVIEW OF LITRATURE

➢ Ekta S. Chaudhary, Nehal Shah. (nov.2013)

This study provided evidence to support

the use of MFR and cold pack along with shoulder girdle exercises in the short term
management of upper trapezitis. MFR along with exercises was more effective than
that of cold pack along with exercises and exercises alone in pain alleviation and
improving pressure pain threshold and opposite side cervical side flexion ROM in
patients with upper trapezitis because of stretching effect on muscle and stimulation of
nociceptive endings connected to A- delta fibres.3

➢ Edwards J et al.,(2005)
Analyzed various structural abnormalities that contribute to the
perpetuation of myofascial trigger point activity and the pain arising from it. These
postural habits that are likely to be carried out both frequently and unconsciously are
adopted during the course of sitting, standing or sleeping. They are entirely
independent of any structural abnormalities that may be present. Correcting them is a
necessary contribution to treatment, as failure to do so is liable to lead to persistence
of the pain.5

➢ Wheeler AH et al. (2004)

Concluded that myofascial pain disorders are characterized by the presence of tender,
firm nodules called trigger points. Within each trigger point is a hyperirritable spot, the
‘taut-band’, which is composed of hyper contracted extrafusal muscle fibers. Palpation
of spot within the trigger point provokes radiating, aching-type pain into localized
reference zones. Mechanical, thermal and chemical treatments, which neuro-
physiologically or physically denervate the neural loop of the trigger point, can result
in reducing pain and temporary resolution of muscular over contraction.6

15
 ➢ Hong CZ, et al., (2002)

Clarified the mechanism of Myofascial trigger point. He said

that there are multiple Myofascial trigger points loci in an Myofascial trigger points
region. An Myofascial trigger points locus contains a sensory component (sensitive
locus) and a motor component (active locus). A sensitive locus is the site from which
pain, referred pain and local twitch response can be elicited by needle stimulation.7

➢ Chu J and Schwartz I, et al., (2002)

Proposed that needling methods such as

acupuncture, primarily effect pain relief in myofascial pain through a local mechanism,
elicitation of muscle twitches. Twitch elicitation has been observed to be essential to
obtain myofascial pain relief associated with the needling methods of automated and
electrical twitch obtaining intramuscular stimulation.8

➢ Hanten WP, et al., (2001)

Concluded that Myofascial trigger points are found among

patients who have neck and upper back pain. The purpose of this study was to
determine the effectiveness of a home program of ischemic pressure followed by
sustained stretching for the treatment of myofascial trigger points. The results of the
study indicated that clinicians can treat myofascial trigger points through monitoring
ahome program of ischemic pressure and stretching.9

➢ Hsueh TC, et al., (1997)

The immediate effectiveness of electrotherapy on myofascial

trigger points of upper trapezius muscle with sixty patients (25 males and
35 females).The effectiveness of treatment was assessed by conducting three
measurements on each muscle before and immediately after treatment: subjective pain
intensity (PI) with a visual analog scale, pressure pain threshold (PT) with algometry,
and range of motion(ROM) with a goniometer of upper trapezius muscle. It was
concluded that electrical nerve stimulation is more effective for immediate relief of
myofascial trigger point pain than EMS.10
16
➢ Han SC, Harrison P, et al., (1997)

Concluded that Myofascial pain syndrome is a

common condition often resulting in referral to a pain clinic. The incidence of
Myofascial pain syndrome with associated trigger points appears to vary between 30%
and 85% of people presenting to pain clinics, and the condition is more prevalent in
women than in men. Patients complain of regional persistent pain, ranging in intensity
and most frequently found in the head, neck, shoulders, extremities, and low back. The
definitive pathogenesisof Myofascial pain syndrome is currently unknown, and no
single diagnostic method is consistently positive.11

➢ AM J Phy Med Rehabil (2016 Sep.)

The aim of this study was to compare the

effectiveness of transcutaneous electrical nerve stimulation and interferential therapy
both in combination with hot pack, Myofascial release, active range of motion exercise
, and a home exercise program on myofascial pain syndrome patient with upper
trapezius myofascial trigger point.12

➢ Mayuri Parab, Nilima Bedekar (Aug.2020)

Myofascial release, as well as cryo-stretching,

were effective in reducing pain. The myofascial release showed immediate greater
improvement in cervical lateral flexion range of motion as compared to cryo-
stretching.13

17
 MATERIALS
AND
METHODOLOGY

18
 MATERIAL AND METHODS

This chapter deals with the methods used for the study. It also includes the data on
sample size, the source of data, inclusion criteria, exclusion criteria, study design,
instrumentation needed and the interventions given.

RESEARCH DESIGN

Experimental pre-test & post-test design was used to carry out this study.

SAMPLE AND SAMPLING TECHNIQUE

A quota sample of 20 subjects was chosen to take part in the study regarding the upper
trapezitis pain relief. The subjects were chosen from inpatient department of various
hospitals. The subjects were those who fulfilled the inclusion criteria and were ready
to take the treatment on the daily basis; they were divided into 2 groups namely Group
A & Group B. The group consisted of 11 males and 9 females. Having a mean age of
(group A) and mean age (group B).

SAMPLING METHOD: Convenient Sampling

STUDY DURATION: 2 weeks

19
 SAMPLE SIZE

20 subjects were chosen to participate in this study and they were divided into 2 groups
with 10 subjects each.

Group A Group B

Treatment given by MFR Treatment given by Cold pack

followed by shoulder girdle followed by shoulder girdle
exercise and neck exercise. exercise and neck exercise

INSTRUMENTATION:

• Cold pack
• Pen
• Pencil
• Paper
• Laptop
• Chair
• Pillow
• Towel
• Consent form
• Data collection form

20
INCLUSION CRITERIA
• Myofascial Trigger point in upper Trapezius
• Age between 20 to 40 years
• Both Male and Female subjects
• Palpable tender spot in the upper Trapezius muscles.

EXCLUSION CRITERIA
• Resent surgery or open wounds in the neck region
• Recent fractures in the back or neck
• Skin disease and lesions in the area of trapezius
• Any sensory disturbances in the trapezius region
• Individual with neurological symptoms in upper trapezius
• Cardiovascular patient fitted with Pace makers
• Degenerative cervical spine
• Shoulder pathology
• Clotting disorder

21
 PROTOCOL

Sample of convenience of 20 subjects those who fulfilled the inclusion criteria were
only allowed to take part in this study. The subjects were divided randomly into 2
groups i.e., Myofascial release + shoulder girdle and neck exercise (group A) and Cold
pack + shoulder girdle and neck exercise (group B). All the subjects were attended
individually.

Firstly, demographic data was collected and after that the patients were assessed with
numerical pain rating scale. Assessment of the Group A was taken and they were
treated for 6 days for 2 weeks & similarly assessment of Group B was taken and they
were treated for 6 days for 2 weeks. After the treatment i.e. after 2 weeks they were
again assessed.

22
 PROCEDURE

Various subjects were approached and were thoroughly explained about the procedure,
the potential benefit and risk factors. From those subjects – the ones who agreed and
those who fell in the criteria for selection were selected with their consent.

Total 20 subjects were selected which were then divided into 2 groups randomly with
each 10 subjects. The subjects were then evaluated for the pre-test measures i.e. NPRS
scale for better clarity & result at the end of the study. The duration of the treatment
differed group wise – the subjects in group A were treated 6 days in a week for 2 weeks
and the subjects in group B were treated for 6 days in a week for 2 weeks.3

In Group A:
Firstly, the subjects were assessed with Pre-test measures & after that they were
treated with myofascial trigger point release technique for 10 minutes along with
shoulder girdle and neck exercise for 5 minutes with a hold for 30 seconds- at the end
of the treatment. This has to be done for 6 days in a week for 2 weeks. After the
completion of the treatment, they were again assessed with post-test measures.3

In Group B:
Firstly, the subjects were assessed with pre-test measures & after that they were
treated with cold pack for 10 minutes along with shoulder girdle and neck exercise for
5 minutes with a hold of 30 seconds- at the end of the treatment. After the completion
of the treatment, they were again assessed with post-test measures.3

23
 DATA ACQUISITION

Based upon the individual the treatment data was collected and was recorded in the
data collection forms. After that the recorded data was sent for the final analysis.

FIG: 4.1 MATERIALS USED FOR TREATMENT

FIG: 4.2 COLD PACK

24
FIG: 4.3 A VIEW OF APPLYING SHOULDER GIRDLE
EXERCISE

FIG: 4.4 A VIEW OF APPLIYING NECK EXERCISE

25
RESULTS

26
 RESULT

Paired and Unpaired T test were used to analyse and compare the scores. The scores
are: the score before intervention and score after intervention (1month of therapy) for
both groups respectively. Total and individual scores of both the two occasions were
compared with each other and a significance level of p<0.05 was fixed.14

27
This chapter deals with the results of data analysis of the PRE scores (pre intervention
scores) and POST scores (scores obtained after two week of intervention) and there by
interpreting there effect in the subjects.

Paired and Unpaired t-test was used to compare the performance of the subjects after
the subjects received their treatment using NPRS. The analysis of POST NPRS showed
a significant improvement after Myofascial release technique Along with shoulder
girdle and neck exercise. Post NPRS calculations [X2 = 2.9 SD2 = 1.3] as compared
to Pre NPRS calculations [X1 = 5.5 SD1 = 1.02] with T value = 4.98.14

The analysis of POST NPRS showed a significant improvement after cold pack along
with shoulder girdle and neck exercise. The Post NPRS calculations [X2 = 3.3 SD2=
1.26] as compared to Pre NPRS calculations [X1 = 6.3 SD1 = 0.78] with T value =
6.41.14

The Post NPRS scores were more significant in both the groups as compared to the
Pre NPRS scores.

Thus, an overall analysis of score show maximally improved occurred with Myofascial
release technique Along with shoulder girdle and neck exercise with T value = 4.98
for NPRS scores as compared to cold pack along with shoulder girdle and neck
exercises T value = 6.41 for NPRS scorer.14 Myofascial release technique along with
shoulder girdle and neck exercises Showed marked improvement in the ability of the
subject.

28
TABLE: 5.1 COMPARISONS OF AGE IN GROUP A AND
GROUP B

Variables Group A Group B

Age in year 21.7 ± 1.61 21.9 ± 1.51

GRAPH: 5.1 COMPARISONS OF AGE IN GROUP A AND

GROUP B

AGE IN
21.9
5

21.9

21.8
5

21.8 AGE IN

21.
7

21.6
5
GROUP GROUP

29
 TABLE: 5.2 GENDER RATIO IN GROUP A

SR.NO Group A Total (10)

1 Male 5
2 Female 5

GRAPH : 5.2 GENDER RATIO IN GROUP A

Gender Ratio in

50 50

Male

30
 TABLE: 5.3 GENDER RATIO IN GROUP B

SR.NO Group B Total (10)

1 Male 6
2 Female 4

GRAPH: 6.3 GENDER RATIO IN GROUP B

Gender Ratio in

40

60

Male

31
TABLE: 5.4 COMPARISON OF GENDER WISE DISTRIBUTION
BETWEEN GROUP A AND GROUP B

SR.NO Gender Group A Group B

1 Male 5 6
2 Female 5 4

GRAPH: 5.4 COMPARISON OF GENDER WISE DISTRIBUTION

BETWEEN GROUP A AND GROUP B

4
MALE
3
FEMAL

0
GROUP GROUP

32
TABLE: 5.5 MEAN AND SD OF PRE AND POST NPRS IN
GROUP A

Variable Group A
Pre NPRS 5.5 ± 1.02
Post NPRS 2.9 ± 1.3

GRAPH: 5.5 MEAN AND SD OF PRE AND POST NPRS IN

GROUP A

Mean value of NPRS in Group A

PRE-NPRS POST-NPRS

35%

65%

33
TABLE: 5.6 MEAN AND SD OF PRE AND POST NPRS IN
GROUP B

Variable Group B
Pre NPRS 6.3 ± 0.78
Post NPRS 3.3 ± 1.26

GRAPH:5.6 MEAN AND SD OF PRE AND POST NPRS IN

GROUP B

Mean values of NPRS in

Group B

34

66

34
 TABLE: 5.7 MEAN AND SD OF PRE AND POST NPRS
BETWEEN GROUP A AND GROUP B

Variable Group A Group B

Pre NPRS 5.5 ± 1.02 6.3 ± 0.78
Post NPRS 2.9 ± 1.3 3.3 ± 1.26

GRAPH: 6.7 MEAN AND SD OF PRE AND POST NPRS

BETWEEN GROUP A AND GROUP B

4 PRE-
NPRS
3

0
GROUP GROUP

35
 TABLE: 5.8 COMPARISON OF T VALUES AND P VALUES
OBTAINED FROM GROUP A AND GROUP B

Variable Group A Group B

T Value 4.98 6.41
P value 0.000048 0.00001

GRAPH: 5.8 COMPARISON OF T VALUES AND P VALUES

OBTAINED FROM GROUP A AND GROUP B

3 T

0
GROUP GROUP

36
Key Words

Group A : Myofascial trigger point release along with Shoulder girdle and neck
exercise

Group B: Cold pack along with Shoulder girdle and neck exercise

MFTPR: Myofascial Trigger Point Release

NPRS: Numerical Pain Rating Scale

37
DISCUSSION

38
 DISCUSSION

The upper trapezitis pain and their improvement has been studied for over many years;
however comparatively little work has been conducted to study the effect of
Myofascial Trigger Point Release with Shoulder girdle and Neck Exercise v/s Cold
pack with Shoulder girdle and Neck Exercise for reducing upper trapezitis pain. The
assessment was taken by NPRS score is commonly used for the identification for upper
trapezitis pain.

Ekta S. Chaudhary, Nehal Shah. (Nov.2013): This study provided evidence to support
the use of MFR and cold pack along with shoulder girdle exercises in the short-term
management of upper trapezitis. MFR along with exercises was more effective than
that of cold pack along with exercises and exercises alone in pain alleviation and
improving pressure pain threshold and opposite side cervical side flexion ROM in
patients with upper trapezitis because of stretching effect on muscle and stimulation
of nociceptive endings connected to A- delta fibres.3

Hantan WP, et al., (2001): Conducted study which concludes that Myofascial trigger
points are found among patients who have neck and upper back pain. The purpose of
this study was to determine the effectiveness of a home program of ischemic pressure
followed by sustained stretching for the treatment of myofascial trigger points. The
results of the study indicated that clinicians can treat myofascial trigger points
through monitoring a home program of ischemic pressure and stretching.9

39
 RELEVANCE TO THE CLINICAL PRACTICE

Myofascial trigger point release and Cold pack along with Shoulder girdle and Neck
Exercise should be given to reduce the pain in upper trapezius. Among the subjects
who took the treatments - some subjects still felt the pain along with restricted range
of motion in cervical region even after taking the therapy. While many of them with
upper trapezitis pain recovered from Myofascial trigger point release. Thus,
Myofascial Trigger Point Release showed significant decrease in pain and
improvement in range of motion and also helped in improving the strength of the
muscles.

40
 LIMITATION OF THE STUDY

• Smaller sample size

• Shorter duration of time

• Number of sessions could be increased

41
CONCLUSION

42
 CONCLUSION

The research showed that Myofascial Release along with Shoulder girdle and Neck
Exercise reduce the upper Trapezitis as compared to the Cold pack along with Shoulder
girdle and Neck Exercise. Also it improves the strength of the muscles and provide
relaxation and also reduce the pain in upper trapezius. Furthermore, no adverse effect
of any increase in pain intensity was reported. The study concluded that the subjects
treated with Myofascial Release along with Shoulder girdle and Neck Exercise showed
an additional benefit as compared to the Cold pack along with Shoulder girdle and
Neck Exercise.

43
 FUTURE STUDY

Future researches are needed in this field which could involve a larger sample group
by involving other muscle groups, combining other treatments and by using many
different parameters. Also, Myofascial Trigger Point Release and Cold pack could be
given as a combined treatment.

44
 SUMMARY

Upper trapezitis pain rehabilitation relates to the best type of training approaches for
better recovery. A sample of convenience of 20 subjects suffering with upper trapezitis
and fulfilling the inclusion criteria took part in the study. The subjects were divided
into two groups i.e. Myofascial Trigger Point Release and Cold pack subjects in both
the groups were assessed based on NPRS scale. Myofascial trigger point release
therapy was given for 6 days a week for 2 week and Cold pack was given 6 days a
week for 2 week.
After the data analysis- the results obtained reveal that the subjects were benefited and
showed a maximum improvement from receiving Myofascial Trigger point release as
compared to the subjects receiving Cold pack as a treatment.

45
 BIBILIOGRAPHY

1. Ourieff J, Scheckel B, Agarawal A- anatomy, Back, Trapezius.

2. Shweta R. Rakholiya*1, and Vaibhavi ved2; effect of ischemic compression on upper

trapezitis.

3. Ekta S. Chaudhary1*@, Nehal shah2*, Neeta Vyas2**, Ratan khuman1*, Dhara chavda1**,
Gopal Nambi1**- Comperative study of myofascial Release and cold pack in upper
Trapezius spasm.

4. Orthopedic physical assessment – David J. Magee sixth edition.

5. EDWARDS J; The importance of postural habits in perpetuating myofascial trigger

point pain; Acupuncture Medicine ; Jun, 2005; 23(2): 77-82

6. WHEELER AH; Myofascial pain disorder; theory to therapy ; Drugs; 2004; 64(10;
45-62.

7. HONG CZ; New trends in myofascial pain syndrome; Zhonghua Yi Xue Za Zhi
(Taipei); Nov, 2002;65(11) : 501-512.

8. CHU J SCHWARTZ I ; The muscle twitch in myofascial pain relief ; effects of

acupuncture and other needing methods, electromyography clinical Neurophysiology;
Jul – Aug, 2002; 42(5), 307-11

9. HANTEN WP , OLSON SL , BUTTS NL, NOWICKI AL; effectiveness of a home

program of ischamic pressure followed by sustained stretch pressure followed by
sustained stretch for treatment of myofascial trigger point ; physical Therapy; APR, 2001 :
81(4): 1059-60

46
10. Hsueh Tc et al (1997): The immediate effectiveness of electrical nerve stimulation and
electrical muscle stimulation on myofascial trigger point.

11. HAN SC , HARRISON P ; Myofascial pain syndrome and trigger point management
; Reg anaesthiology; Jan – Feb, 1997, 22(1) ; 89 – 101

12. AM J Phys Med Rehabil, 2016 sep: Comparison of the effectiveness of

Transcutaneous electrical nerve stimulation and Interferential Therapy on the upper
Trapezius in Myofascial pain syndrome: A Randomized Controlled study.

13. Mayuri parab , Nilima Bedekar, Ashok Shyam, Parag Sancheti – Immediate effect of
myofascial release and cryo – stretching in management of upper trapezius trigger
point – A comparative study.

14. Mahajan’s methods in Biostatistics for Medical students and Research 8th edition.

47
 CONSENT

Madhav University,
Aburoad (Rajasthan)
Title of Study:

A Comparative study between Myofascial release v/s Cold pack along with Shoulder
girdle exercise and Neck exercise in patient’s with upper Trapezitis.

You are invited to participate in the study based on assumption that you fulfil our
criteria and you do not have any problem that might affect your participation in the
study. Prior to participation an investigator will take the medical history which could
make you ineligible to participate.

You are invited to participate in a study which will measure your Upper Trepezitis pain
score followed by type of feedback; Myofascial release along with Shoulder girdle and
Neck exercise and Cold pack along with Shoulder girdle and Neck exercise will be
given to perform for 6 day per 2 week and 6 day per week for 2 week and your
participation is required throughout the period of 2 week.

You will be assigned a subject number so that your name will not be associated with
any of the findings of the study. The risk of participation in this study is nil/minimal.
Your participation in the study is voluntary.

If you have any question regarding this study please feel free to contact: Dr. Priyanka Pujara

48
 CONSENT FORM

I ................................................................................................................................ v
olunteer to participate study entitled " A Comparative Study between Myofascial
release v/s Cold pack along with Shoulder girdle and Neck exercise in patient’s
with upper Trapezitis” being carried out by Asha dabhi , Madhav university,
Aburoad (Rajasthan) . I have had to chance ask question and was answered to my
satisfaction.

…………………… …………………

Student signature: Patient Signature:

: Dr. Priyanka Pujara

Madhav university,

Aburoad (Rajasthan)

49
 EVALUATION FORM

1. Name:

2. Date of Birth:

3. Age:

4. Gender:

5. Occupation:

6. Phone number:

7. Address:

8. Pain scale:

• Pre-test pain:
• Post-test pain:

9. Is there pain for more than one month: Yes/No

50
 NUMERICAL PAIN RATING SCALE

The Numeric Pain Rating Scale (NPRS) is a one-dimensional measure of pain intensity in
adults, including those with chronic Pain. The Numerical Pain Rating Scale is an 11- point
scale for patient self-reporting of pain. It is based solely on the Ability to perform activities of
daily living (ADLS) and can be used for adults and children 10 years old or older. The
numerical pain rating scale should not be more than 7.

Rating Pain level

0 No pain

Mild pain (nagging, annoying, interfering

1-3
little with ADLs)
Moderate pain (interferes significantly
4-6
with little with ADLs)
Sever pain ( disabling; unable to perform
7-10
ADLs)

51
 DATA COLLECTION FORM

1. NAME:

2. AGE:

3. GENDER:

4. DATE OF BIRTH

5. ADDRESS:

6. PHONE:

7. OCCUPATION:

PRE-NPRS POST-NPRS

52
1st week Myofascial release Shoulder girdle and
technique Neck exercise
Day 1 10 MIN 5 MIN
Day 2 10 MIN 5 MIN
Day 3 10 MIN 5 MIN

2nd week Myofascial release Shoulder girdle and

technique Neck exercise
Day 1 10 MIN 5 MIN
Day 2 10 MIN 5 MIN
Day 3 10 MIN 5 MIN

1st week Cold pack Shoulder girdle and

Neck exercise
Day 1 10 MIN 5 MIN
Day 2 10 MIN 5 MIN
Day 3 10 MIN 5 MIN

2nd week Cold pack Shoulder girdle and

Neck exercise
Day 1 10 MIN 5 MIN
Day 2 10 MIN 5 MIN
Day 3 10 MIN 5 MIN

53
 GROUP A

PRE POST
SR.NO. NAME AGE SEX
NPRS NPRS

1 Patel Ramesh 20 Male 5 3

2 Mali Rahul 25 Male 6 4

3 Patel Niyati 22 Female 6 3

4 Purohit Khushi 21 Female 4 1

5 Rajput Abhishek 22 Male 5 2

6 Patel Prinsi 22 Female 7 4

7 Mali Harsh 21 Male 7 5

8 Barot Priyansi 20 Female 5 2

9 Gelot Sanja 24 Female 4 1

10 Vyas Dhruv 20 Male 6 4

54
 GROUP B

PRE POST
SR.NO. NAME AGE SEX
NPRS NPRS
1 Patel Kunj 22 Male 6 5

2 Chaudhary Aditya 22 Male 7 4

3 Khatri Jiya 21 Female 6 2

4 Patel Jagruti 22 Female 5 3

5 Umakar Maitry 22 Female 7 4

6 Rathod Hitesh 20 Male 6 2

7 Makvana Mukesh 24 Male 7 4

8 Darji Nilesh 25 Male 5 1

9 Patel Bhoomika 21 Female 7 5

10 Rathva Sanjay 20 Male 7 3

55
RAW DATA ANALYSIS SHEET

Formula for T Test:

Formula for standard deviation:

Formula for Mean

56