The Effect of Combination of Extracorporeal Shock Wave Therapy and Muscle Energy Technique on Active Trigger Points of Upper Trapezius Muscle

Objective: to demonstrate the effectiveness of combination of radial extracorporeal shock wave therapy and muscle energy technique on pain, range of motion, and neck function of the individuals with active trigger points of upper trapezius muscle. Method: Fifty-four (54) participants with active TrPs of upper trapezius muscle were participated and randomly divided into three groups. Group A (N=18) received muscle energy technique only, group B (N=18) received radial extracorporeal shock wave therapy only, and group C (N=18) received both muscle energy technique and radial extracorporeal shock wave therapy. The visual analogue scale, pressure pain threshold, neck disability index questionnaire and range of active contra lateral flexion measured before and after each intervention. The participants treated for three sessions in a one-week period with at least a two-day break between each session. Results: All three intervention groups showed a decreasing in pain (P < 0.001), increasing pressure pain threshold (P < 0.001), and contra lateral flexion (P <0.001) and also improving of the neck function (P < 0.001). Combination group showed more significant improvement than the other two groups in pressure pain threshold (P < 0.001). No significant differences were found between three groups in regards to the visual analogue scale, neck disability index, and contra lateral flexion (P > 0.05). Conclusion:  This study concluded that all three-interventions used in this study were effective in the treatment of upper trapezius TrPs however, combination group showed more significant difference in term of pressure pain threshold. Therefore, this study concludes that combination group is superior to only muscle energy technique group and only radial extracorporeal shock wave therapy in improving the pressure pain threshold in individuals with upper trapezius TrPs.