Estudio comparativo de la efectividad de diferentes abordajes en los puntos gatillo cervicales presentes en los músculos angular de la escápula y trapecio fibras superiores

  1. Amanda Grávalos Gasull
Supervised by:
  1. Antonio Gamundí Gamundí Director

Defence university: Universitat de les Illes Balears

Year of defence: 2017

Committee:
  1. Julián Jesús González González Chair
  2. Olga Velasco Roldán Secretary
  3. David Sanz Rivas Committee member

Type: Thesis

Abstract

Introduction Daily activities together with the sport expose the locomotor apparatus to variable traumatic injuries, where the structures most affected are the soft tissues. Cervical pain is a multifactorial phenomenon that affects approximately 70% of the population throughout life, and is the second most frequent cause of consultation to the physician specialist of the locomotor system with the consequent health expenditure destined both for diagnosis and treatment. Myofascial Pain Syndrome (MPS) can be defined as musculoskeletal pain, with no inflammatory response, localized, that generates dysfunction and no specific cause of onset. The MPS always counts on the presence of Trigger Points (TP). Neck pain is defined as localized pain at the cervical level, with symptomatology associated or not with the upper extremities. The manifestations of cervical pain can range from the occipital to the beginning of the dorsal spine, associated with joint wear or soft tissue dysfunction. Develop of the research The techniques most used for the treatment of neck pain associated with a MPS depend, above all, on the availability of the service and the training of the therapists. Therefore, the hypothesis of this Doctoral Thesis is the confirmation of the effectiveness of the different techniques protocolized for mechanical neck pain with myofascial pain, as well as to determine what of these techniques is less painful and implies a lower economic cost for the Health System. Based on this hypothesis, the main objective of the present study is the comparison of the results obtained to evaluate the best approach of the patient with muscular neck pain, at short and medium term. The study was carried out in the Rehabilitation Service of the Hospital Son Llàtzer of Palma de Mallorca, and it was started after a medical diagnosis of mechanical neck pain of the patients who went on an outpatient basis to the Service. We included 112 subjects who, after their evaluation and diagnosis, were randomized to one of four study groups: Deep Dry Needling, where the needle penetrates to the TP; Superficial Dry Needling, where the puncture does not reach the TP; Pressure Release, in which it exerts a manual pressure on the TPs of study; and Shockwaves, treated by extracorporeal therapy. The muscles evaluated were the upper trapezius fibres and the elevator scapula muscle, considering those with the highest number of active trigger points in the neck pain. The study variables were divided into two groups: a) quantitative, formed by algometry, goniometry, and assessment of balance and maximum muscle contraction; and b) qualitative, which were the numerical scale of pain and the SF-12 quality of life test. The results of this Doctoral Thesis led to the confirmation that in all the treatments under study, the patients showed a statistically significant improvement on the variables of perception of pain, mobility and pressure pain. Patients treated by Dry Needling techniques specifically improved the balance above the rest of the applied techniques. Patients treated with Pressure Release were the study subjects who showed a statistically significant increase of the maximum muscle contraction with respect to their initial situation but the only one in which there was a worsening in their Emotional Role. Conclusions As a conclusion of this research, it can be confirmed that the choice of the therapeutic technique would be determined by the specific symptomatology of each patient and by those particular variables to be improved, and not by the application of general therapy.