Muscle Energy Technique on Hamstring Muscle for Trigger Points of Muscle of Mastication

Temporomandibular Disorder Clinical Trial

Official title:

Effect of Muscle Energy Technique on Hamstring Muscle for the Trigger Points of Muscle of Mastication

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05971953
• Other study ID #: REC/01649Naureena Binte Sayed
• Status: Recruiting
• Phase: N/A
• Start date: August 30, 2023
• Est. completion date: April 28, 2024

Study information

• Verified date: August 2023
• Source: Riphah International University
• Contact: KINZA ANWAR, MS-OMPT
• Phone: +92-3239735427
• Email: kinza.anwar[@]riphah.edu.pk
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this randomized controlled trial is to find the effect of muscle energy technique for trigger points of muscle of mastication for reducing pain , improving mouth opening and jaw functional limitations.

Description:

The primary muscles of mastication (chewing food) are the temporalis, medial pterygoid, lateral pterygoid, and masseter muscles. The masticatory muscles are divided into elevator and depressor groups. The collective term 'hamstrings' refers to four muscles- semimembranosus (SM), semitendinosus (ST), biceps femoris long head (BFlh) and biceps femoris short head (BFsh). The hamstring muscles are the major flexors of the knee and also aid hip extension. Trigger point is classically defined as a hyperirritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Latent trigger points located in the muscles can interfere with muscular movement patterns, cause cramps, and reduce muscle strength. Active MTrPs can be associated with a reduced range of motion through muscle dysfunction and muscle weakness, causing orefacial pain, MTrPs in the masticatory muscles may restrict active maximum mouth opening (MMO).

It is possible that stretching the hamstring muscles may activate the dorsal periaqueductal grey area of the midbrain [PAG], and activate descending inhibitory control pathways. It is known that descending projections from the PAG to the medulla have collateral branches that terminate in various areas including the upper cervical spinal cord. Convergence of the nociceptive afferents from the receptive fields of cervical roots C1-C3 and those of the trigeminal nerve, which include the masseter muscle, occurs in the nucleus caudalis. If hamstring muscle stretching is capable of activating the PAG, then decreased sensitivity should affect a greater number of muscles, including the remaining masticatory muscles.

Muscle energy technique (MET) is a manual technique developed by osteopaths that is now used in many different manual therapy professions. It is claimed to be effective for a variety of purposes, including lengthening a shortened or contractured muscle, strengthening muscles, as a lymphatic or venous pump to aid the drainage of fluid or blood, and increasing the range of motion (ROM) of a restricted joint. MET may influence pain mechanisms and promote hypoalgesia.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 42
• Est. completion date: April 28, 2024
• Est. primary completion date: March 10, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 25 Years to 50 Years

Eligibility

Inclusion Criteria:

1. Age group 25 to 50 years..

2. Diagnosis of trps using the diagnostic criteria:

• Presence of palpable taut band in a skeletal muscle.

• Presence of hypersensitive tendor spot in a taut band

• Spontaneous response of the typical referred pain pattern.

• A local twitch response provided by snapping palpation of taut band.

• Reproduction of the typical referred pain pattern of Trp in response to compression.

3. Reduced mouth opening < 40nm

Exclusion Criteria:

• Diagnosis of fibromyalgia.

• History of whiplash injury

• History of any surgery in the cranio cervical region

• Having under gone any myofacial pain therapy

• No lower extremity or low back pathology.

Related Conditions & MeSH terms

• Myofascial Pain Syndromes
• Temporomandibular Disorder
• Temporomandibular Joint Disorders
• Temporomandibular Joint Dysfunction Syndrome
• Trigger Point Pain, Myofascial

Intervention

Other:
• Muscle Energy Technique
They would be receiving treatment as follow: The patient is instructed to gently attempt to push down on the practitioner's shoulder with the leg against the practitioner's resistance( 75% of his and her available strength). After the relaxation, the muscle is lengthened more aggressively beyond the barrier and held for up to 15 seconds. Frequency: 10 reps for 4 times/week for 2 consecutive weeks. Intensity: moderate intensity (pain free) Time: 20 mins
• Conventional PT
They would be receiving conventional treatment as follow: including hot pack for 10 mins ischemic compression for 60 seconds .Frequency: 5 reps with 60 sec hold for 4 times/week for 2 weeks Intensity: moderate-high intensity (depending on pain tolerance) Time: 10 mins

Locations

Country	Name	City	State
Pakistan	Railway General Hospital	Rawalpindi	Punjab

Sponsors (1)

Lead Sponsor	Collaborator
Riphah International University

Country where clinical trial is conducted

Pakistan, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Visual Analog Scale VAS	The visual analog scale for pain is a straight line with one end meaning no pain and the other end meaning the worst pain imaginable. A patient marks a point on the line that matches the amount of pain he or she feels.	2 weeks
Secondary	Inch Tape	A measuring tape is a flexible tool used for measuring. It is marked in centimeters and inches.	2 weeks
Secondary	Jaw Functional Limitation Scale	The JFLS-20 is an organ-specific instrument comprising 3 constructs for assessing functional status of the masticatory system; the 3 scales exhibit properties that are ideal for both research and patient evaluation in patient groups with a range of functional limitations of the jaw.	2 weeks