INTRODUCTION:

Trapezius pain is a classic stress pain and it is the most common musculoskeletal disorder. It is usually caused by placing too much stress or strain over the trapezius muscle. It is more common in people working on a computer or driving for long distance. Pain and stiffness due to Trapezitis is episodic and last for 3 to 5 days. Neck pain is very commonly site of traumatic and Non-traumatic musculoskeletal pain¹.Roughly two thirds of the general population have neck pain at some time in their lives and the prevalence is highest in middle age².

Most patients who complain of neck pain or shoulder pain will be invariably showing the pain to be at slope between the base of the neck and the shoulder, in the region of upper trapezius. (The percentage of Indian population to be affected with neck pain depends on the work environment and posture that is acquired all day long. The Ratio of prevalence in males and females in India is 1:10. and 3-5% of the population is affected worldwide^3,4. Roughly two thirds of the general population have neck pain at some time in their lives and the prevalence is highest in middle age⁵. Work related neck pain are common problems in office workers, especially among those who are intensive computer users with long duration sitting job. Prolonged computer use is a potential risk of stress and strain on the musculoskeletal structures of the neck and upper extremity, due to repetitive work and non-neutral work postures^6,7. Professionals working at desks and computers, or individuals who drive for a long period of time are more prone for this condition as the upper trapezius muscle becomes painful and spasmodic. Limitation of range of motion along with neck pain and a feeling of stiffness may be experienced by the person which is precipitated or aggravated by neck movements^8,9. Neck pain prevalence varies widely on different studies with a mean point prevalence of 13% (range 5.9%-38.7%) and mean lifetime prevalence of 50% (range 14.2% - 71.0%). Trapezitis pain occurs for when person does neck extension, it is occurred due to faulty posture during walking, watching time, prolonged use of phone¹⁰. Trapezitis is mainly due to fatigue, stress, tension, forward neck posture, sitting for prolonged period of time. Post isometric relaxation is based on the active work of the patient and therapist who exerts an optimal resistance. PIR is a muscle energy technique used to relax and lengthen a hypertonic and shortened muscle. This gentle stretching technique is typically used on postural muscles. Due to gravity these muscles often become short and tight and can lead to muscle imbalances. This can lead to limitation of range of motion and cause joint restrictions. When trapezius muscle become shortened they can restrict ROM in the head, neck and shoulder and often become painful. By using the PIR technique the therapist can relax and lengthen the muscle to increase the passive and active ROM and decrease the pain. Thus the study is important role for improving the restricted range of motion and lead a better life.

Physiotherapy is frequently the treatment of choice for persons with cervical spine related muscle spasm¹¹. Physiotherapy include passive treatment such as massage, stretching etc along with various modalities like IFT, TENS, US, heat application, cryotherapy and active treatment such as exercise therapy in addition chiropractic techniques like positional release therapy [PRT]^12,13,14,15.

1. Neck pain is the common problem in general population with prevalence between 10% to 15%.

2. Population based surveys has shown lifetime prevalence of neck pain between 67% to 87%.

3. On the other hand between 13% to 22% of the population in the industrialised society experience neck pain at any point of time¹⁸.

Neck pain is thought to be multifactorial. Physical strain may cause microtrauma in connective tissues. The cervical spine is most intricate region of the spine and so are the muscles of this region. The principle to carry the load is the trapezius¹⁹. Upper trapezius is designated as postural muscle. Fibers of upper trapezius initiate of the clavicle to prepare for elevation of the shoulder gridle. Any position which trapezius in a shortened state for a period of time without rest may shorten the fibers lead to dysfunction and restricted movements of neck. Long telephone conversations those which elevate the shoulder to hold the phone, working from a chair set too for the desk or computer terminal and elevation of the arm for painting, playing musical particularly for extended period of time can all shorten trapezius fibres creating spasm²⁰. The relative load percentage of maximum voluntary [MVC] on the upper trapezius has been shown to increase linearly with the torque in the gleno humeral joint. Also in an optimal seated work posture, the upper staticload level is 2% to3% maximum voluntary contractions²¹. About two thirds of people will experience neck pain at some time^22,23. About 15% of hospital-based physiotherapy in the UK, and 30% of chiropractic referrals in Canada are for neck pain^24,25. In the Netherlands, neck pain accounts for up to 2% of general practitioner consultations²⁶. Neck pain usually resolves within days or weeks, but can recur or become chronic. In some industries, neck-related disorders account for as much time off work as low back pain.²⁷.

OBJECTIVE OF THE STUDY:

To determine the effect of post isometric relaxation in reducing the pain and improving the functional range of motion among the patient with trapezitis.

METHODOLOGY:

A convenient sample of 20 subjects selected from the study, any person from 25 to 40 years complaining of pain in the side of the neck and shoulder in unilateral and bilateral for last 3 days.subjects to males and females were screened as in acute stage patient with painful trapezius muscle and restricted range of motion in shoulder elevation movements. The participants were asked to fill the questionnaire from trapezius muscle pain symptoms and intensity and severity of pain experienced.

STUDY DESIGN:

Experimental study:

INCLUSION CRITERIA:

· Subjects age group: 25 - 40years

· Subjects involved: both genders.

· Subjects those who are willing to participate.

· Subjects who diagnosed with trapezitis

· Unilateral and bilateral trapezitis

EXCLUSION CRITERIA:

a) Patients under medications

b) Subjects those who are not willing to participate.

c) Psychological problems.

d) Orthopaedic problems.

e) Any other cervical instability and other degenerative disorder

f) Recent surgery in and around shoulder and cervical region

g) Cervical radiculopathy

h) Skin disease and infection

i) Thoracic outlet syndrome

MATERIALS REQUIRED:

Goniometer, Inch tape

PROCEDURE:

The subjects those who are selected has been got with the consent form. The nature of the study was clearly explained to the subjects. The PIR technique begins by placing the muscle in a stretched position. Then minimal resistance is exerted. Then for muscle release, relaxation and gentle stretch. At this point, relieving of pain in both the muscle itself and at tender insertion points is done.

Group A received with therapeutic ultrasound with the frequency of 3Mhz, with continuous mode and an intensity of 0.1-1.5 W/cm2 for a duration of 5 min was given with the patient position back rest, stretching followed by elastic resistance band exercises: Elastic resistance band shrugs, lateral raise, Back pull down exercise and Upright row¹⁶.

Group B received the same traditional physical therapy program in addition to the post isometric relaxation technique (PIR) for the upper fibers of the trapezius muscle. PIR technique was applied from supine lying position and the patients with the head free position from the plinth and it is held by the therapist’s hand and while the therapist is sitting on a stool at the treatment table head. The position of head was arranged so that the stretched muscle is in the lengthened position, and the therapist applied isometric resistance to the action of the tight muscle and held for 7 seconds with gentle muscle contraction to avoid the risk of increasing the muscle tone, while breathing in withhold this breath during contraction, then the patient is asked to breathe and relax for 3 seconds, then they applied static stretching in the opposite direction for 30 sec. for each muscle bilaterally, this procedure is repeated three times. Post isometric relaxation technique was applied on upper fibers of trapezius, while the head and neck of individual were flexed and the side bent away from the side which is being treated to just short of the restriction barrier with stabilization of the shoulder with one hand and the ipsilateral mastoid process with the other hand¹⁷. Patient is asked to take the stabilized shoulder toward the ear, and the ear toward the shoulder against resistance from both sides and to breathe in and hold his breath for 7 seconds. Then the patient was asked to breathe out, relax for 3 seconds and the shoulder was stretched caudally for 30 seconds. This exercise was repeated 3 times for each time and the starting position is just short of new restriction barrier for both of the muscles. All the patients is treated for three sessions per week for four weeks in a month.

RESULTS:

The data was obtained and tabulated statistically analyzed using SPSS Package, Due to nature of outcome measures are pain and disability for pre and post intervention measured parametric statistical tests, dependent t sample test and unpaired t test were used to interpretation of data.

Table.1 Pre Interventions (NPRS Scale)

STATISTICAL MEASUREMENTS	GROUP A	GROUP B
MEAN	8.6	8.3
STANDARD DEVIATION	0.51	0.82

Fig.1 Pre Intervention (Numerical Pain Rating Scale)

Table.2 Pre Intervention (Neck Disability index)

STATISTICAL MEASUREMENTS	GROUP A	GROUP B
MEAN	34.2	34.1
STANDARD DEVIATION	3.58	3.41

Fig.2 Pre Intervention (Neck Disability IndexScale)

Table. 3 Post Intervention (NPRS Scale)

STATISTICAL MEASUREMENTS	GROUP A	GROUP B
Mean	6.5	1.1
Standard deviation	1.08	0.56

Fig.3 Comparison of Numerical pain rating scale in both groups.

Table.4 Post Intervention (Neck Disability index)

STATISTICAL MEASUREMENTS	GROUP A	GROUP B
Mean	21.8	5.2
Standard deviation	2.97	1.61

Fig.4 Comparison of Neck disability index scalefor both groups.

DISSCUSSION:

The present controlled trial was conducted to study the effectiveness of Post Isometric Relaxation techinque and conventional therapy in the treatment of trapezitius. In terms od reduction of pain using NPRS, neck disability index, the results from present study supported alternative hypothesis which stated that there will be a significant difference in terms of pain reduction using NPRS, Neck disability Index scle with Post Isometric Relaxation added with conventional therapy

The improvement in functional ability has been found to be significant in all the subjects. Both the study and the control groups were found to be effective in improving the functional ability, but when the two groups were compared for reduction in the neck disability scores, the Group A was found to be more significant with reduction in neck disability index scores, than the Group B

In this study, the age group of the participants was in the range of 20-40years. Prevalence is highest in middle age. Fischer stated that neck pain is more common at approximately 50 years of age. The findings of this study cannot be correlated with the author’s statement. Sample of the present study consisted of 10 males and 10 females i.e. 50% were males and 50% were females. Many authors have stated that females are more prone to neck pain than men. The findings of this study can be correlated with the author’s statement. In the present study both A and B groups which suggest that the groups were same and no significant change in pre-intervention phase.

Pain will be decreased by experimental group with observation of Numerical pain rating scale17-18. The two tailed p-value is less than 0.0001 by conventional criteria, this difference is considered to be extremely statistically significant. The results shows that the post intervention phase NPRS scale 95% confidential interval and t value is 14.81, standard error of difference 0.313.the two tailed p value is less than 0.0001 by conventional criteria this difference is considered to be extremely statistically significant

CONCLUSION:

Trapezius pain is the classic stress pain and it is the most common musculoskeletal disorder. It is usually caused by placing too much stress or strain over the trapezius muscle. The office workers were mostly affected to the neck and trapezius muscle pain, due to highly susceptible to overuse. Trapezius muscles help with the function of neck rotation, side bending and extension. Tightness in the muscles can decrease the range of motion of the neck. The decrease in motion can negatively affect the mobility of the cervical joints. Limited range of motion creates an increase in soft tissue tightness, with an ensuing pain-spasm cycle which can be difficult to break. Physiotherapy techniques like post isometric relaxation technique has been proposed as an adjunct to conventional therapy to treat trapezitis. The Post isometric relaxation technique to improves the cervical range of motion and relieves pain and enhances quality of life in the patient with trapezitis.

ETHICAL CONSIDERATION:

This study was approved by the Research Committee Institutional Scientific Review Board in the college university and study start-up at the site. Great care will be taken to fully explain the study to the patients before fully informed consent is taken.

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Received on 17.04.2019 Modified on 25.05.2019

Research J. Pharm. and Tech. 2019; 12(10):4836-4840.

DOI: 10.5958/0974-360X.2019.00837.0