Short- and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: a randomized controlled trial

J Manipulative Physiol Ther. 2013 Jun;36(5):300-9. doi: 10.1016/j.jmpt.2013.04.008. Epub 2013 Jun 12.


Objective: The purpose of this study was to investigate effects of different manual techniques on cervical ranges of motion and pressure pain sensitivity in subjects with latent trigger point of the upper trapezius muscle.

Methods: One hundred seventeen volunteers, with a unilateral latent trigger point on upper trapezius due to computer work, were randomly divided into 5 groups: ischemic compression (IC) group (n=24); passive stretching group (n=23); muscle energy technique group (n=23); and 2 control groups, wait-and-see group (n=25) and placebo group (n=22). Cervical spine range of movement was measured using a cervical range of motion instrument as well as pressure pain sensitivity by means of an algometer and a visual analog scale. Outcomes were assessed pretreatment, immediately, and 24 hours after the intervention and 1 week later by a blind researcher. A 4×5 mixed repeated-measures analysis of variance was used to examine the effects of the intervention and Cohen d coefficient was used.

Results: A group-by-time interaction was detected in all variables (P<.01), except contralateral rotation. The immediate effect sizes of the contralateral flexion, ipsilateral rotation, and pressure pain threshold were large for 3 experimental groups. Nevertheless, after 24 hours and 1 week, only IC group maintained the effect size.

Conclusions: Manual techniques on upper trapezius with latent trigger point seemed to improve the cervical range of motion and the pressure pain sensitivity. These effects persist after 1 week in the IC group.

Keywords: Articular; Pain Perception; Pain Threshold; Physical Therapy Modalities; Range of Motion; Trigger Points.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cervical Vertebrae / physiology*
  • Female
  • Humans
  • Male
  • Manipulation, Chiropractic / methods*
  • Middle Aged
  • Muscle, Skeletal / physiology*
  • Musculoskeletal Manipulations / methods*
  • Myofascial Pain Syndromes / therapy*
  • Pain Measurement
  • Pain Threshold
  • Pressure
  • Range of Motion, Articular / physiology*
  • Treatment Outcome