Author Names
Zainab Khalid Khan, Syed Imran Ahmed, Aftab Ahmed Mirza Baig, and Waqas Ahmed Farooqui
Reviewer Name
Jordan Burnett, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background: Non-specific neck pain is the most prevailing musculoskeletal disorder which has a large socioeconomic burden worldwide. It is associated with poor posture and neck strain which may lead to pain and restricted mobility. Physical therapists treat such patients through several means. Post isometric relaxation and myofascial release therapy are used in clinical practice with little evidence to be firmed appropriately. So, this study was conducted to explore the effect of Post-isometric relaxation in comparison to myofascial release therapy for patients having non-specific neck pain. Methodology: Sixty patients were randomly allocated to Post isometric group and the Myofascial group. The treatment period was of 2 weeks. All the patients were evaluated using the Visual analogue scale (VAS), Neck disability index (NDI), Universal Goniometer, and WHO BREF Quality of life-100 in the 1st and 6th sessions. Recorded data was entered on SPSS 21. Data were examined using two-way repeated ANOVA to measure the variance of analysis (group x time). Results: Analysis of the baseline characteristics revealed that both groups were homogenous in terms of age and gender i.e. a total of 60 participants were included in this research study 30 in each group. Out of 60 patients, there were 20(33.3%) males and 40(66.7%) females with a mean age of 32.4(5.0) years. Participants in the Post Isometric group demonstrated significant improvements (p<0.025) in VAS, NDI, Cervical Extension, left side rotation ranges, and QoL (Social Domain) at the 2-week follow-up compared with those in the myofascial group. In addition, the myofascial group indicated significantly better improvement in the mean score of CROM (flexion and right and left side bending). Conclusion: The study demonstrated patients with nonspecifc neck pain can benefit from the post isometric relaxation with significant improvement in pain, disability, cervical ROM, and Quality of life compared with myofascial release therapy.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Cannot Determine, Not Reported, or Not Applicable
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- No
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- No
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Cannot Determine, Not Reported, or Not Applicable
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Cannot Determine, Not Reported, or Not Applicable
Key Finding #1
Post isometric relaxation (PIR) and myofascial release (MFR) are both helpful in decreasing pain, increasing cervical ROM, decreasing neck-related disability, and increasing quality of life (QOL) in patients with non-specific neck pain.
Key Finding #2
PIR showed more statistically significant effects than MFR in decreasing pain scores, improving cervical extension and bilateral rotation, and in increasing patients’ QOL in the social domain.
Key Finding #3
The findings in this article generally align with positive effects noted in prior studies investigating effectiveness of PIR, though others did not compare the effects of PIR on non-specific neck pain to the effects of MFR.
Please provide your summary of the paper
Authors investigated the effect of post isometric relaxation (PIR) and myofascial release (MFR) on pain, cervical range of motion (CROM), neck disability, and quality of life (QOL) in patients with non-specific neck pain (NSNP). PIR is a type of muscle energy technique that activates muscles and joint mechanoreceptors through isometric contraction of a muscle, stimulating Golgi tendon organs and leading to an inhibitory reflex allowing the muscle to relax. MFR is a technique directed at soft tissue through application of low load and long duration tension to restricted fascia, often with therapists’ hands or elbows. Participants were blinded to the intervention they received three times per week for two weeks, though both interventions included cryotherapy and isometric cervical strengthening in addition to either the PIR or MFR. The authors found that while both PIR and MFR improved CROM, decreased pain and disability, and increased quality of life (QOL) for patients with NSNP, PIR demonstrated greater and statistically significant effects. The study is limited in that the follow up was only two weeks so there was no analysis of long-term effects.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This paper demonstrates a comparison of two types of manual techniques that direct change through different mechanisms, which can be beneficial for identification of an optimal technique. When deciding between manual therapy techniques for patients with non-specific neck pain, this study reports that muscle energy techniques, specifically post isometric relaxation (PIR), can help decrease pain, increase range of motion, and increase quality of life. The effects were only measured after two weeks of treatment with six sessions total, so it is unclear what the long-term effects would be and if PIR would still be helpful with lower frequency; these data can be used to guide initial treatment and alongside clinical reasoning rather than as a long-term plan to follow to treat patients with non-specific neck pain.
