STUDY ON THE EFFECTIVENESS OF MYOFASCIAL RELEASE ON

SMARTPHONE USERS WITH NECK PAIN

INTRODUCTION

Neck pain is defined as pain located in the anatomical region of the neck with
or without radiation to the head, trunk, and upper limbs. The pain perceived
anywhere in the posterior region of the cervical spine from the superior
nuchal line to the first thoracic spinous process (Misailidou 2010)

The awkward postures adopted by smart phone users can adversely affect the
soft tissues. Smart phone users typically bend their neck slightly forward
when reading and writing text messages. They also sometimes bend or twist
their neck sideways and put their upper body and legs in awkward position.
These postures put uneven pressure on the soft tissues around the spine that
can lead to discomfort ( Rose Boucaut 2009 )

Community based studies worldwide reported annual prevalence of neck

pain ranging from 15 to 44%. Globally one-year prevalence of neck pain
related disability has been reported ranging from 7% to 11%. Prevalence of
neck pain among office workers is higher than in the general community.
Globally, one-year prevalence of neck pain among administrative workers has
been reported between 15%to 34.4%.( Dr.Surendrababu Darivemula 2015 )

Neck pain is defined as pain between the superior nuchal lie an imaginary
transverse line through the tip of the first thoracic spinous process and
laterally by sagittal plane tangential to lateral borders of neck. Individuals
with neck pain lack an identifiable patho-anatomic cause for their symptoms
are usually neck pain may be associated with degenerative processes or
pathology identified during diagnostic imaging, the tissue that is causing a
patients’s neck pain is most often unknown (Rachael lowe 2021 )

Mechanical neck pain is recognized as the most common form of the neck
pain. The pain can be felt locally in the neck, ands also in the arms or
shoulders. The condition can also be worsened by resting the head in one
place for a significant period of time. Those with mechanical neck pain can
experience the constriction of head mobility, as well as muscle spasm and
tightness. Mechanical neck pain can also cause headache.
Neck pain is a musuloskeletal disorder that is extremely that is extremely
common in the general population. Upper trapezius and the levator scapulae
are the most common postural muscles that tend to get shorten leading to
restriction neck mobility. If this group of muscles is treated it may provide
with best results. Neck pain in the sensation of discomfort in the neck area.
Neck pain can result from disorders of any of the structures of neck including
cervical vertebra and inter vertebral discs, nerves, muscles, blood vessels,
esophagus, larynx,trachea, lymphatic organs, thyroid glands, or parathyroid
glands. Neck pain arises from numerous different conditions and is
sometimes referred to as cervical pain.

Pain in the neck is one of the more debilitating musculoskeletal problems.

Complaints of neck can be influenced by emotional, psychological, social,
and cultural factors unique to the patients.

A large majority of the world 3 to 4 billion smartphone users are putting their
necks at risk every time they send a text, according to new research involving
the University of South Australia 779 Thai university students who use
smartphone with 32% reporting the neck, 26% shoulder pain, 20% upper back
pain and 19% wrist and hand pain.

Musculoskeletal disorders were more common among students with higher

smartphone use (More than fewhours a day) and those who smoked and did
little exercise. Female phone users also experienced for more musculoskeletal
disorders than men 71% compared to 28%. Researchers from Khonkaen
university video recorded 30 smart phone users in Thailand aged between 18-
25 years who spend up to 8 hours a day on their phones.

1.1 Statement of the study

A study on the effectiveness of myofascial release on smartphone

users with neck pain.

1.2 Need of study

 The reason of the studywas aimed to introduce myofascial release
method to decrease pain and improving the range of motion in neck
pain subjects. This study also serves as an initial step in research
process that would create awareness among physiotherapist that
myofascial release can be used to decrease pain and improving ROM.

1.3 Objective of the study

The objective of the study of effectiveness of myofascial release

on smartphone users with neck pain.

1.4 Hypothesis

It is hypothesized that they may be significant difference in

decreasing pain and improve the ROM following myofascial release on the
neck pain among the smart phone users.
It is hypothesized that there may be no significant difference in
decreasing pain and improve the ROM following myofascial on the neck pain
among the smart phone users.

1.5 Operational definition

1.5.1 Pain

Pain is defined as unpleasant and emotional experience associated with

or without actual tissue damage. Pain sensation is described in many ways
like sharp, pricking, electrical dull ache, shooting, cutting, stabbing etc.

1.5.2 Neck pain

Neck pain is a sensation of discomfort in the neck pain area. Neck

pain defined as experienced from the bass of the skull to the upper part of
back and shoulder blade. Neck pain commonly causes disability and
works less.
(Bet et al., 2005)

1.5.3 Myofascial release

Myofascial release is a form of soft tissue therapy used to treat

somatic dysfunction and resulting pain and restriction of motion. This is
accomplished by relaxing contracted muscles, increasing circulation,
 increasing venous and lymphatic drainage and stimulating the stretch
reflex of muscles and overlying fascia (Gieseckeetal,2004)

1.5.4 Visual analogue scale

The VAS is a form of patient perception outcome assessment that

has been described as “generally relevant, vaild, responsive and safe”.
With the VAS patients are asked to place a mark on a hortizontal line,
10cm in length to indicate the severity of pain. The left end of the line
represents no pain, and the right end represents ever or unbreakable pain (
Susan Sullivan 2006)

1.5.5 Range of motion

Range of motion is the measurement of movement around a

specific joint or body part. In order for joint to have full range of motion it
must have good flexibility. Flexibility is the range of motion around a
joint and can refer to ligaments, tendons, muscles, bones and joint.

REVIEW OF LITERATURE:

Section A: Studies on the effectiveness of myofascial release on neck pain

Section B: Studies related to the reliability of the goniometer
Section C: Studies related to the reliability of the VAS
Section D: Studies on impact of trigger point in neck pain

Section A: Studies on the effectiveness of myofascial release on neck pain.

Sonia Pawaria eta l., (2015) comparative study on the effectiveness of
myofascial release and muscle stretching on pain, disability and cervical ROM in patient
with myofascial release was effective in reduction of pain, functional status and improve
ROM

Rodeiguez-Hugluet M et al., (2018) has done a study on the efficacy of myofascial

release therapy for improving pressure pain threshold and pain in patients with mechanical
neck pain. 41 patients neck pain was included in this study. It was concluded that
myofascial release therapy could be better than a multimodal patient program for the short
term improvement of pain an pressure pain threshold in patients with neck pain.

Hasan et al., (2016) investigated the impacts of myofascial release technique on pain,
disability, the maximum contraction of isometric extensor muscles of neck and
pressure pain threshold in the patients with nonspecific neck pain compared with
control group. Patients randomly divided into two groups control group and
myofascial release therapy group. The treatment was performed for 4 sessions and
each session for 20 minutes. The study was concluded that the myofascial release is
one of the effective manual therapy techniques in reducing pain and disability in
patients with non specific neck pain.

Peeyoosha et al., (2014) conducted a study to determine the effect of gross myofascial
release on upper limb and neck in subjects with mechanical neck pain in order to
reduce pain and improve the functional abilities. 15 patients with mechanical neck
pain along with referred pain to unilateral upper limb were included for the study.
The subjects showed significant reduction in pain and improvement in functional
activities.

Paolo et al., (2010) conducted a study to show the effectiveness of myofascial release
therapy on non specific neck pain and back pain patients. The study also shows that
US screening can be useful tool to assess the dysfunctional alteration of organ
mobility in relation to their fascial layers in people with non specific neck pain and
back pain before and after treatment. MFT are effective manual technique to area
of impaired sliding fascial mobility and to improve pain perception over short term
duration in people with non specific neck pain

Sahreen Anwar et al., (2024) the effectiveness of myofascial release technique along
with congnitive behavioral therapy on pain craniovertebral angle and neck
disability in university students with chronic neck pain and forward head posture. A
total of sixty-six eligible participants with chronic neck pain and head posture were
randomized into the myofascial release therapy (MRT) group (n=33)and MRT and
cognitive behaviour therapy (CBT) group (n=33). Clinical outcomes included neck
pain measured using the numerical pain rating scale, neck disability measured
through the neck disability index, and forward head posture measured through the
 cranial vertebral angle. The outcomes were assessed at baseline and the four and
eight weeks after the intervention. Both groups showed significant improvement in
pain intensity, CVA, and neck disability after the intervention. However, the CBT
group was demonstrated greater improvements than the MRT group. The difference
in outcomes between the groups was statistically significant. Myofascial release
therapy combined with CBT is an effective treatment method for patients with
chronic neck pain and forward head posture.

Shazia Neelam et al., (2022) trapezitis is the most common musculoskeletal disorder
caused by the inflammation of the trapezitis muscle which leads to muscle spasm
and pain in the neck. The prevalence of musculoskeletal disorders among
smartphone users ranges from 1% to 67.8%. The prevalence of neck pain in young
adults among smart phone users in the past 12 months was 47.4%. Smartphone
usage for prolonged periods of time causes repetitive strain of muscles.
Physiotherapists utilise a wide range of interventions in the management of
trapezitis including myofascial release technique and muscle energy technique. The
purpose of the study is to compare the effects of myofascial release technique and
muscle energy technique on pain and physical function among smart phone users
with trapezitis.

Kholoud T. Alsiwed et al., (2021) neck pain caused by repetitive stress injury
resulting from prolonged neck flexion among smartphone users. The association of
neck disability with various behaviours during the use of smartphones is still
unclear in the literature . Therefore, we aimed to estimate the frequency of such
factors and evaluate whether they contribute to text neck.

S.Islam et al., (2023) the effect of a postural awareness program neck pain among long
time smart phone users. The purpose of the study is to genetrate and anayze the
effect of a postural awareness program on neck pain in long time smartphone user
students and the characteristics of the relationship between pre and post neck pain
intensity level, pre and post test neck muscles weakness, and the pre and post neck
disability index (NDI).

Section B: Studies related to the reliability of the goniometer.

 Edmund(1980) study on the modified triaxialgoniometer was designed based
on the gyroscopic concept. The device is capable of measuring the joint three
dimensional angular motion corresponding to a specific set of Eulerian angles.
Since the angular measurement by this device is not sequence dependent, it is
convenient to provide unique motion patterns of the joints from one position to
another. The joint rotational axes are oriented based on identified bony landmarks
which provide a convenient visualization of the anatomical motion involved. The
error caused by the exoskeletal attachment of the instrument can be theoretically
corrected. Considering all factors in joint functional evaluation, the triaxial
goniometry is useful and effective method to provide simple real time three
dimensional angular motion measurement.

Gajdosik (1987) clinical measurement of range of motion is a fundamental evaluation

procedure with ubiquitous application in physical therapy. Objective measurement of
ROM and correct interpretation of the measurement results can have a substantial impact
on the development of the scientific basics of therapeutic interventions. The purpose of the
article is to review the related literature on the and body regions, passive versus active
measurements, intratester versus intertester measurements, reliability and validity of
goniometric measurements of the extremities. Special emphasis is placed on how the
reliability of goniometry is influenced by instrumentation and procedures, differences
among joint actions and different patient types. Our discussions of validity encourages
objective interpretation of the meaning of ROM measu conclude that clinicans should
adopt standardized methods of testing and should interpret and report goniometric results
as ROM measurements only, not as measurements of factors that may affect ROM.

J.Goodwin (1991) this investigation compared the reliability and interchangeable use
of three currently available goniometers – a universal goniometer, a fluid goniometer, and
an electrogoniometer. Three consecutive readings of the active range of movement of the
right elbow joint were taken from each of 23 healthy female volunteers; three experienced
observers each used each type of goniometer on two occasions. A balanced experimental
design was used to eliminate order effects with respects to subjects, tester, or goniometer,
and rigid protocol was employed to reduce error due to diurnal or methodological
variations. The results show that there are significant difference between the goniometers
used, the testers, and the replications. Significant interaction effects also exits between the
goniometers and the occasion, the goniometers and the testers, and the testers replications.
The data suggest that the interchangeable use of different types of goniometer in a clinical
setting is inadvisable.

Norkin et al., (1998) study on stated that the most common instruments to use to
measure joint positions and the motion in the clinical setting are the universal goniometry.
Typically, the design includes a body and two thin extensions called arms a stationary and
moving arm.

McDermid (1999) conduced a comparative study on measurement of rotation ROM is

frequently performed during shoulder evaluation. The purpose of the study was to
determine the intra-tester reliability of goniometry measurement of passive rotation ROM
of the shoulder. Two experienced PTs performed the testing in a randomized block design.
They were blinded to all clinical information and to their goniometry readings. Passive
rotation ROM of the shoulder was assessed in 34 patients with a variety of shoulder
pathologies. Patients were placed in supine position with the arm abducted approximately
0 degree to 30 degree. A standard goniometry, placed along the joint axis by the therapist,
was red by an independent assistant. Intraclass coefficients (ICCs) and their associated
95% confidence intervals were calculated. Intra therapist ICCS (0.88 and 0.93) and inter
therapist ICCs (0.85 and 0.93) and inter therapist ICCs (0.85 and 0.80) were high. These
findings suggest that reliable measurement of passive lateral rotation ROM of the shoulder
can be obtained from patients with shoulder pathology using standard goniometer and by
placing the patient in a supine position.

James W Youdas et al., (1997) to determine normal valves for cervical active range
of motion (AROM) obtained with a “ cervical range of motion “ (CROM) instrument on
healthy subjects whose ages spanned 9 decades.

Kolber et al., (2012) they conducted a study of validity of active shoulder mobility
using a goniometry in 30 asymtomatic participants in a blinded repeated measures design.
Their results supports the use of goniometry and inclinometer for measuring mobility
measurements.

Law EY et al., (2013) conducted a study to investigate reliability and validity of

electronic CROM. Goniometer in measurement of cervical spine mobility in adults
with and without neck pain.
Section C: Studies related to the reliability of the VAS.

Huskisson (1974) stated that pain intensity can be measure by visual analogue scale. A
10cm line marked with numbers 0 to 10 can be used where 0 symbolizes no pain
and 10 is marked pain. Subject is asked to marked to his or her on this line as per
the severity.

Paul et al., (1988) stated that, clinical application of VAS provides a simple technique
for measuring subjective experience and it had been established as valid and
reliable in a range of clinic and research applications and VAS are one of the most
frequent used measurement scales of pain in health care research and practice.

Boonstra et al., (2008) conducted study to determine the reliability and concurrent
validity of the VAS for disability as a single item instrument measuring disability in
chronic pain patients. The study population consisted or patient over 18 year of
age, suffering from chronic musculoskeletal pain; 52 patients in their liability
study, 344 patients in the validity study. Main outcome measures were as follows.
The conclusions of the study was the reliability of the VAS for disability is
moderate to good.

Bijur et al., (2012) conducted study to assess the reliability of the VAS for
measurement of acute pain. Intra class correlation coefficients (ICCs) with 95%
confidence intervals (95%/ CI) and a bland – Altman analysis were used to assess
reliability of pared VAS measurements obtained 1 minute apart every 30 minutes
over two hours. Reliability of the VAS for acute pain measurement as assessed by
the ICC appears to be high. Ninety of the pain ratings were reproducible within 9
mm; these data suggest that the VAS is sufficiently reliable to be used to assess
acute pain.

Sujin Hwang et al., (2013) several muscles surroundings neck are vital not only neck
motion, but for upper extremities motions as well. Neck pain would affect neck and
shoulder disability. The Neck disability Index (NDI), Shoulder Pain and Disability
Index (SPADI), and visual analogue scale (VAS) are increasingly used to evaluate
treatment effectiveness after chronic neck pain. The purpose of the this study was
to analyze the correction of neck pain, shoulder pain, and quality of life in patients
with chronic pain.
Anna MacDowall et al., (2017) The visual analog scale (VAS) is frequently used to
measure treatment outcome in patients with cervical spine disorders. The minimum
clinically important difference (MCID) is the smallest change in a score that has
clinical importance to the patient.

Section:D Studies on impact of trigger point on neck pain.

Borghouts (1997) Neck pain occur frequently in the western societies in the
majority of the cases, no specific causes can identified. In order to gain insight into
the clinical course and prognostic factors of nonspecific neck pain, systematic
review was conducted. A characterized literature search was carried out to identify
observation studies on no specific neck pain and randomized clinical trials on
conservative treatment of nonspecific neckpain. 2 reviewers scored independently,
the methodological quality of all identified publications, using a standardized set of
13 criteria which were divided into few categories to determine the prognosis
perstudy, on overall outcome measures was calculated. Only seven of 23 studies
scored 50% or more of the 13 items, including a generally poor quality of method.
Most information regarding the clinical courses available for the group of patients
with complaints for more than 6 months, who are treated in a secondary care or on
occupational setting. In a group of patients, 46% had less pain, with a range of 22-
79% and generally improvement that ranged between 37 and 95%. The reduction in
the use of analgesics ranged between 32 and 80% (37% medium).

Fernandey(2005) The myofascial pain syndrome is thought by some authors the main
cause of headacheand neck pain. MPS is characterized by myofascial trigger
points. However, there are not many controlled studies tht have analyzed the effect
of the manual therapies in their treatment was investigated in four studies; a
combination of various manual therapies was investigated in two studies and
manual therapy combined with other physical medicine modality was investigated
in two triads. The principal conclusion of the review is that there have been very
few randomized controlled trials that analyze treatment of MPS using the manual
therapy. The second conclusion is that hypothesis that manual therapies have
specific efficacy, beyond placebo, in the management of MPS is either supported of
MPS is either supported not rejected by research to data. Controlled trials are
 needed to investigate whether manual therapy as an effect beyond placebo on
myofascial triggers point management.

Luke D. Rickarts (2006) Myofasical pain syndrome associated with active

myofascial trigger point is a common diagnosis in patients presenting with
symptoms of neuromusculoskeletal pain. The literature details dozens of proposed
treatments interventions uses to treat myofascial trigger points. However, reliable
evidence for the intra-and inter- effectiveness for many of these treatments appears
deficient.

C Fernandez-de-las-penas the presence of myofascial trigger points in the upper

trapezius, sternocleidomastoid, temporalis and suboccipital muslces
between unilateral migraine subjects and healthy controls, and the
differences in the presence of Trps between the symptomatic side and the
non symptomatic side in migraine subjects. We assess the the difference in
the presence of both forward head posture and active neck mobility between
migraine subjects and healthy controls and the relationship between
migraine subjects and healthy controls and relationship between FHP and
neck mobility. 20 subjects with unilateral migraine without side shift and 20
matched controls participated. TrPs were identified when there was a
hypersensible tender spot in a palpable taut band, local twitch response
elicted by the snapping palpation of the tautband and reproduction of the
referred pain typical of each TrP. Side view pictures were taken in both
sitting and standing positions to measure the craniovertebral angle. The
cervical goniometer was employed to measure neck mobility.

Lucas et al., (2009) this generally well conducted study examined the reliability of
physical examination in the diagnosis of the myofascial trigger points.The
authors concluded that on the basis of the limited number of poor-quality
studies available, physical examination could not be recommended as are
reliable test for diagnosis of the trigger points, 9 studies were included in
the review (n=393 range 6 to 124). None of the studies full field all of the
quality criteria. None of the studies reported inter examiner reliability for
diagnosis of active triggers point in the symptomatic patients; and six
studies did not report blinding of observes the range of the reliability
 estimate were; taut band K=-0.008 to 0.75 (5 studies) tenderness K=0.22 to
1.0(3 studies). Reproduction of familiar pain K=0.57 TO 1.0 (2 studies);
referred pain K=-0.13 to 0.80(4 studies); and jump sign K=0.07 to 0.71 (2
studies) on the basis of the basis of the limited number of poor quality
studies available, physical examination could not be recommended as a
reliable test for diagnosis of trigger point.

Daniel Cury Ribeiro et al., (2018) Neck and shoulder disorders may be linked in
the presence of myofascial trigger points (MTrPs). These disorders can
significantly impact a person’s activities of daily living and ability to work.
MTrPs can be involved with pain sensitization, contributing to acute or
chronic neck pain and shoulder musculoskeletal disorders. The aim of this
reviews was to synthesise evidence on the prevalence of active and latent
MTrPs in subjects with neck and shoulder disorders.

Ahmad H. Alghadir et al., (2020) Myofascial pain syndrome thought to be main

cause of neck pain and shoulder muscle tenderness in the working
population, is characterized by myofascial trigger point (MTrPs). This study
aimed to examine the immediate and short-term effect of the combination
of two therapeutic techniques for improving neck pain and muscle
tenderness in male patients with upper trapezius active MTrPs. This study
was a pretest-post test single blinded randomized controlled trial.60 male
subjects with mechanical neck pain due to upper trapezius active MTrPs
were recruited and randomly allocated into group A, which received muscle
energy technique (MET) and ischemic compression technique (ICT) along
with conventional intervention; group B, which received all the
interventions of group A except ICT; and group C, which received
conventional treatment only. Pain intensity and pressure pain threshold
(PPT) were assessed by a visual analog scale (VAS) and pressure threshold
meter, respectively.

Maria Jose Guzman-Pavon et al., (2020) Myofascial pain syndrome is one the
primary causes of health care visits. In recent years, physical exercise
program have been developed for the treatment of myofascial trigger points,
 but their effect on different outcomes has been clarified. Thus, this study
aimed to assess the effect of physical exercise program on myofascial
trigger points.

III METHODOLOGY

3.1 Study setting

Study will be conducted in outpatient department of RVS college of

Physiotherapy, Sulur, Coimbatore .
3.2 Selection of Subject:

10 neck pain patients with restricted ROM among phone users

were randomly selected .
3.3 Variables.

3.3.1 Dependent variables:

 Pain

 ROM

 Neck ability

3.3.2 Independent variable:

 Myofascial release technique

3.4 Measurement tools:

Variables Tools

Pain Visual Analogue Scale

Neck Ability Neck disability index (NDI)
3.5 Study design

The study designed as pre and post experimental study.

3.6 Duration of study

The treatment duration was about 10 days.

3.7 Criteria for Selection

3.7.1 Inclusion criteria:

 Subject with age 18-35 years old

 Both males and females

 Neck pain along with trigger points

3.7.2 Exclusion criteria:

 Cervical radiculopathy
  Cervical myelopathy

 Torticollis

 Spinal cord injury patients

 Kyphosis

 Meningitis

 Cervical rib

 Cervical tumor

 Rheumatoid arthritis

 Infection in neck region

3.8 Orientation to the subjects

Before collection of the data, all subject were explained about the

purpose of the study. A detailed orientation to the various test

procedures such as VAS and goniometry was given. The concern and full
cooperation of each participant was sought after complete explanation of the
condition and demonstration of the involved in the study.

3.9 Materials used

 Data collection sheet

 Evaluation chart

 Chair

 Pillow

 Goniometer

 Couch

 Vaseline
3.10 Measurement procedure

3.10.1 Visual analogue scale

The Visual analogue Scale (VAS) is a subjective measure of

pain. It consists of a 10cm line with two end -points

representing “no pain” and “worst pain imaginable”. During

the visit, patients were asked to rate their pain by placing a

mark on the corresponding to their current level of pain.

3.10.2 Neck Disability Index (NDI)

Neck Disability Index (NDI) is a 10 item questions that measures a patient’s neck pain

related disability, it was first published in 1991 by DR. Howard Vernon and Oswetry Low

back Pain Disability Questionnaire. The NDI was reviewed in 2008 by the same

author.The 10 Questions of NDI include activities of daily living, such as: personal care,

lifting, reading, work, driving, sleeping, recreational activities, pain intensity,

concentration and headache.

A study of the psychosocial, physical and workplace features of female office workers

found that those with neck pain and disability can be differentiated from those with no

disability using the Neck Disability Index.

 Disability
NDI Score
No disability
0-4
Mild disability
5-14
Moderate disability
15-24
Severe disability
25-34
Complete disability
35-50