Effect of Myofascial Release and Trigger Point Release among Osteoarthritis Knee Patients
Jibi Paul1, Selvabharathi. C2
1MPT, PhD, Professor, Faculty of Physiotherapy, Dr M.G.R. Educational and Research Institute University, Velappanchavadi, Chennai.
2Student, Faculty of Physiotherapy, Dr M.G.R. Educational and Research Institute University, Velappanchavadi, Chennai.
*Corresponding Author E-mail: physiojibi@gmail.com
ABSTRACT:
Background of the study: Osteoarthritis (OA) is the most widespread reason for knee joint pain and musculoskeletal disability. The knee is the most common site of OA. Osteoarthritis is the second most common rheumatologic problem. Objective: The purpose of this study was to investigate the effect of myofascial and trigger point release on quadriceps muscle pain and daily functional activities of patients with knee osteoarthritis. Methodology: This was quasi-experimental study done in ACS medical college and hospital, Chennai for 25 subjects. The patients with primary knee osteoarthritis were taken from both genders with age of 40 to 65. Patients with increased pain on resisted knee flexion, pain localized to the thigh and knee joint were included for the study. Patients with history of fracture of lower limb, secondary knee osteoarthritis, pain and tenderness located over the tibio-fibular joint, coagulation disorders and tumors were excluded. The duration of study will be 3 weeks. Visual analogue scale and knee injury and osteoarthritis outcome score questionnaire were used as outcome measures. Result: On comparing the mean value of the groups on KOOS score and VAS, it shows significant decreases in post mean values with P<0.0001. Conclusion: Myofascial release on quadriceps muscle is more effective to reduce the pain and improve the functional activities of Osteoarthritis knee patients.
KEYWORDS: Knee osteoarthritis, trigger point, Myofascial release technique, Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale.
INTRODUCTION:
Trigger point is a sensitive area in the muscle or connective tissue (fascia) that becomes painful when compressed. Pressing on a trigger point can cause referred pain and can help identify the external area in the body generating the pain.
Trigger points can also be a point from which pain radiates throughout the muscle and fascia causing myofascial pain syndromes. Trigger points are hyperirritable spots in skeletal muscles, when pressed, feel like tender ‘Knots’ or tight bands in the muscles3,4.
Myofascial release is a specialized physical and manual therapy. It is a safe and very effective hand on technique that involves applying gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore motion. OA is more common in women than men, but the prevalence increases dramatically with age. It is most frequent joint disease. It is a common disease of aged population and one of the leading causing of disability. The Quadriceps weakness commonly associated with osteoarthritis of the knee5.
The quadriceps weakness, commonly associated with osteoarthritis of the knee, is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis6,7.
The primary treatment goals for OA are to reduce and control pain, improve function, improve or maintain joint mobility, and reduce or prevent physical disability8.
OBJECTIVE:
This study was to find the effect of Myofascial release on reduction of pain and improve knee functional activities among patients with knee osteoarthritis.
METHODOLOGY:
This study is quasi-experimental design with pre-post comparative type. This study conducted at ACS Medical College Hospital, Velappanchavadi, Chennai- 77. Sample Size of the study was 25 Patients selected based on selection criteria. Sampling method used in this study was convenient sampling method to divide the sample in two groups. Treatment duration was given 3 weeks with 3 sessions in a week.
Inclusion criteria:
Both men and women, Age group of between 40-65 years, Pain and restricted knee flexion, Restricted movement due to pain, Joint instability, Weakness and thinning of thigh muscle, Morning stiffness, Primary OA, Bony tenderness.
Exclusion Criteria:
Any recent fractures in the knee joint, History of any recent knee surgeries, Rheumatoid arthritis, Impaired skin sensation, Any malignancy/infections, Metal implant in/around knee joint, Reynaud disease/ Peripheral knee joint, Secondary OA, Type 2 diabetes Obese patients.
Instrumentation:
Measurement Tools:
Visual Analogue Scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS)
Materials Used:
Couch
Outcome Measures:
Pain, Knee functional activities
Procedure:
25 patients were chosen based on inclusion and exclusion criteria. 25 subjects are consists of single group with primary OA knee Pre test taken and then Myofascial release on trigger point was given. Treatment followed by 3session in a week for 3 week. After the completion of treatment Post test was taken. Pretest and Post test were compared to know Myofascial and trigger point release is more effective or not.
Trigger Point:
Trigger point is a sensitive area in the muscle or connective tissue (fascia) that becomes painful when compressed. Pressing on a trigger point can cause referred pain and can help identify the external area in the body generating the pain. Trigger points can also be a point from which pain radiates throughout the muscle and fascia causing myofascial pain. Trigger points are hyperirritable spots in skeletal muscles, when pressed, feel like tender ‘Knots’ or tight bands in the muscles.
Myofascial release technique:
Trigger point can be identified by palpation at muscle hyper contracted area. Pain can be elicited at the trigger point and which may be referred to adjacent areas of the muscles, intern with severity of the condition. The pain secondary affect on muscle function and thereby joint range of motion also affected. Muscle function include movement in different direction, coordination of muscle, strength of muscle all affected. Myofascial release can reduce pain, improve flexibility of muscle and promote joint range of motion. This shows the importance of Myofascial release technique as significant concern.
Visual Analogue Scale [VAS]:
Measurement of visual analogue scale include 10 cm line with zero on one end representing no pain and 10 on the other end representing worst pain. The subjects are asked to indicate the level of pain on this scale to identify the severity of his or her pain9.
KOOS scale:
Knee damage and associated problems are related with knee injury and osteoarthritis outcome score (KOOS) is a knee specific instrument, developed to assess the patient’s opinion about. It holds 42 items in 5 separately scored subscales; pain, other symptoms, function in sport and recreation and knee related quality of life 10.
Fig 1: Myofascial Release on Quadricep Muscle
Data Analysis:
The collected data were tabulated and analyzed using inferential statistical Analysis. Paired t-test was adopted to find the statistical difference within the groups & Independent t-test (Student t-Test) was adopted to find the statistical difference between the groups.
The table-1 reveals the Mean, Standard Deviation (S.D), t-test, degree of freedom (df) and p-value of the VAS between (Group A) in pretest and posttest weeks.
The table 2 shows significant difference in VAS after myofascial release on the trigger point among patients of knee osteoarthritis with mean difference of 4.04 and P<0.0001
Table 1: Paired t test of VAS for myofascial release on the trigger point among patients with knee osteoarthritis
|
VAS |
Number of Pairs |
Mean Difference |
SD, SEM |
Df |
T |
P value |
Significant different (P < 0.05) |
|
Pre –Post
|
25 |
4.04 |
1.02 0.204 |
df=24 |
t=19.81 |
<0.0001 |
**** |
(***- P ≤ 0.001)
Graph 1: Graphical representation of VAS after myofascial release on the trigger point among patients with knee osteoarthritis.
Table 2: Paired t test for KOOS for myofascial release on the trigger point among patients with knee osteoarthritis.
|
KOOS |
Number of Pairs |
Mean Difference |
SD, SEM |
Df |
t |
P value |
Significant different (P < 0.05) |
|
Pre –Post |
25 |
47.48 |
8.456 1.691 |
df=24 |
t=28.07 |
<0.0001 |
**** |
The above table reveals the Mean, Standard Deviation (S.D), t-test, degree of freedom(df) and p-value of the KOOS score (Group A) in pretest and posttest weeks.
The above table 3 shows significant difference in KOOS after myofascial release on the trigger point among patients of knee osteoarthritis with mean difference of 47.48 and P<0.0001
Graph 2: Graphical representation of KOOS after myofascial release on the trigger point among patients with knee osteoarthritis.
RESULT:
On comparing the Mean values of Pretest & Posttest on VAS Score, it shows significant decrease in the post test Mean values shows 4.04 which has the Lower Mean value is more effective at P ≤ 0.001. Hence Null Hypothesis is rejected.
On comparing the Mean values Pretest & Posttest on KOOS score; it shows significant increase in the post test Mean values shows 47.48 which has the Higher Mean value is more effective at P ≤ 0.001. Hence Null Hypothesis is rejected.
On comparing Pretest and Posttest within VAS & KOOS Score shows highly significant difference in Mean values at P ≤ 0.001
DISCUSSION:
Results indicate that there is a significant improvement in reduce pain on quadriceps muscle and functional performance in patients with primary OA knee at the end of 3 weeks.
Adi Dor, Leonid Kalichman reported that occurrence of muscle trigger point may play a role in pain and disability of knee in OA. Further more studies required to provide clear cut information on causes of muscle trigger points11.
For statistical reveals the Pre-Post value of 25 pairs the mean difference was 4.04, the degree of freedom was 24 it proven the improvement shows in Pain and the mean difference was 47.48, the degree of freedom was 24 it proven the improvement shows in knee functional activity12.
The Myofascial trigger point release technique obtained successful outcomes as measured by significant improvement in functional activities and reduce pain after 9 sessions of intervention. There is significant difference in intensity of pain as per VAS score. OA knee is one of the conditions which can be treated by a wide variety of physiotherapy methods13.
In this study we found that Myofascial release technique were effective in reducing pain and disability and in improving functional activities of oa knee patients. It is still difficult to formulate all proof guidelines for the management of OA knee.
Various methods of treatment exists with own claims of success without any attempt to comparing the maximal effective method. The findings obtained in term of overall improvement pain, tenderness and frequency of pain demonstrate that at 2nd week the pain reduced to satisfactory level14.
ETHICAL CLEARANCE:
Ethical clearance has obtained from the Institution to conduct this study with reference number: IV C-042/PHSIO/IRB/2017-18 dated 08/01/2018.
CONFLICT OF INTEREST:
There was no conflict of interest to conduct this study.
CONCLUSION:
This study concluded that Myofascial pain and occurrence of muscle trigger points have great role in pain and disability of knee OA. The Trigger point and Myofascial release technique has proved, it has better effect on OA knee patients to improve their functions. The study fulfilled that Myofascial release can produce improvement in reducing pain and improve knee functional activities among OA knee patients.
LIMITATION:
Study duration was only 3 months, Study was performed only for age group 40-65 years. Small sample size was used in this study.
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Received on 05.04.2019 Modified on 14.05.2019
Accepted on 10.06.2019 © RJPT All right reserved
Research J. Pharm. and Tech. 2019; 12(11):5351-5354.
DOI: 10.5958/0974-360X.2019.00929.6