Effect of Hamstrings Triggers Point Ischaemic Compression on Hip Range - Research Proposal Example

The immediate effect of hamstrings triggers point Ischaemic compression on hip range of motion By Name of school (university) City Date Abstract Purpose: The purpose of this study is to investigate the immediate effect on hip of range motion (ROM), after a single intervention of trigger point Ischemic compression release on active or latent hamstring myofascial trigger points. Background: A myofascial trigger point is an area on the skeletal muscle or in the fascia of the muscle that has increased irritability. If the spot is compressed, it experiences pain and tenderness. Active trigger points usually become painful and irritable both in rest and in activity. Latent trigger points become painful only in activity and when the spot is palpated. Ischemic compression to a trigger point involves the stretching of the affected muscle to the point of discomfort. Method: The subjects in the study are 20 to30 healthy volunteers who are aged between 18 and 45 years old who have either active or latent trigger points. They were thoroughly screened to ensure that no other pathologies were present. Therefore criterion for exclusion was patients who had local pathologies. The criterion for inclusion was individuals with thigh pain at the posterior part after pressure is applied Design: A pilot randomised control trial. Data collection: Range of motion was measured hours before the test at the hip and scales of visual analogue completed to check hamstring pain at rest and also in activity. Data analysis: interclass correlation coefficients, Sigma plot, ANOVA and Microsoft Excel. Intervention: A screening process to establish suitability and the presence of active and latent MTrPs in the hamstring muscle. Participants were then to be randomly allocated to an intervention group (TrP Ischemic compression technique), sham (ultrasound intervention) group and control group (no therapy). Summary A myofascial trigger point is an area on the skeletal muscle or in the fascia of the muscle that has increased irritability. If the spot is compressed, it experiences pain and tenderness. Active trigger points usually become painful and irritable both in rest and in activity. Latent trigger points become painful only in activity and when the spot is palpated. These spots form scarring of the tissue because the muscle becomes less flexible. This is caused by straining of the muscle. (Dommerholt & Huijbregts,2011,Pg. 207). Myofascial release is a technique that is used to stretch the fascia or the muscle. One of the techniques of myofascial release is the ischemic compression. The purpose of these techniques is to aid in the increase of the Range of Motion or to help in the decrease of the pain by breaking the adhesions in the fascia or muscle. Ischemic compression to a trigger point involves the stretching of the affected muscle to the point of discomfort. The process involves pressing the trigger point using the thumb to evoke a sustained pressure with pain that is tolerable. As the pain or discomfort increases, the pressure is also increased by using the thumb (or finger) from the other hand. If the tenderness of the trigger point does not stop, the procedure is usually repeated, along with active range of motion and a hot pack. This paper is supposed to show that the ischemic compressions on the hamstring myofascial trigger point increase the Range of Motion on the hip and it also helps in reduction of pain. Proposed investigation Title: The immediate effects of hamstrings trigger point Ischaemic compression on hip range of motion Aims: The primary aim of this study is to investigate the immediate effect on hip range of motion (ROM), after a single intervention of trigger point Ischemic compression release on active or latent hamstrings myofascial trigger points . The secondary aim is to assess aspects of the methodological design quality, identify limitations and propose areas for improvement in future research Background Myofascial release techniques have been used since the 19th century, even though there is no literature that proves the exact origin of this technique. However, this technique was used at around 1940’s in some research programs that were investigating the different pain syndromes. By 1970s, the knowledge of myofascial triggers and their relations in causing pain and reducing the Range of motion had already come to light. A myofascial trigger point is an area on the skeletal muscle or in the fascia of the muscle that has increased irritability. If the spot is compressed, it experiences pain and tenderness. Active trigger points usually become painful and irritable both in rest and in activity (Dixon, 2007, pg.43). Latent trigger points become painful only in activity and when the spot is palpated. These spots form scarring of the tissue because the muscle becomes less flexible. This is caused by straining of the muscle. When the muscles are restricted in flexibility, then the Range of Motion is restricted and this causes pain. If not treated, the myofascial trigger points develop. Myofascial release is a technique that is used to stretch the fascia or the muscle (Kostopoulos & Rizopoulos, 2001, pg.51). One of the techniques of myofascial release is the ischemic compression. The purpose of these techniques is to aid in the increase of the Range of Motion or to help in the decrease of the pain by breaking the adhesions in the fascia or muscle. Ischemic compression is to a trigger point involves the stretching of the affected muscle to the point of discomfort. (Chaitow & Fritz, 2007,pg.35). Ischemia is a term that means the absence of blood supply, associated with irritation of the tissue and congestion. The aim of the ischemic compression is to increase the occlusion of blood deliberately to an area, so that when released, the specific area gets blood resurgence. This process allows the washing off of waste products in the area, supply the area with enough oxygen and aid the healing of the tissue. (Whyte & Gerwin, 2005,pg.46) The process involves pressing the trigger point using the thumb to evoke a sustained pressure with pain that is tolerable. (Muscolino, 2009,pg.61). As the pain or discomfort increases, the pressure is also increased by using the thumb (or finger) from the other hand. If the tenderness of the trigger point does not stop, the procedure is usually repeated, along with active range of motion and a hot pack. The compression of the trigger point causes tenderness (local), a twitch or referred pain. There is a lot of evidence supporting the use of the myofascial release techniques like ischemic compressions to normalize or improve the Range of Movement after either a single or multiple application of the therapy (George et. al, 2006,pg.55). The studies also show that there is no relation between myofascial release techniques and muscular performance; therefore the therapies do not affect the performance of the muscles. The methods of diagnosing hamstring injury include ultrasound and magnetic resonance imaging (Pedowitz, et.al, 2008,pg.72) Ultrasound is a good method, though its limitation is how it depends highly on a clinician or physician that uses it. Magnetic resonance is the best even in grading (Bahr & Engebretsen, 2011, pg.67) the extent of the injury though it is very expensive. Another simple way most physicians have used is by palpating the injured area. Critique of current literature Despite the logic explanations, there are controversies surrounding the issue of trigger points and their therapies like ischemic compression. There have been critics who seriously questioned the existence of triggers and even their modes of treatment. There is a book written by Quinter, Cohen and Bove who disregard the issue of trigger points arguing that the concept of trigger points in muscles and soft tissues is flawed and that the treatment that has been established (myofascial release) has the same effects as the placebo effects. (Quinter, et.al, 2014, pg.71) They believed that all the evidence found over the years is flawed critically in all ways and that the evidences all lead to points not related to trigger points. They also criticize how people in general treat the theory behind trigger points like the facts have been established, while they are not, according to them. They believed strongly that the pain does not originate from the muscles, but the pain comes from nerve fibres that have been inflamed or from structures that are deeper that yield tenderness and referred pain. However, in their book, they do not discuss this point further. Despite the negative critics, a lot of people support the idea of trigger points causing muscle pain and the use if ischemic compression to aid in healing of the muscle. Many agree that the therapies for triggers are not a lie. Although the therapy may not provide healing for all kinds of pain, it is important to understand that the processes are quick and effective in most cases, even in a hamstring myofascial trigger point. Plan: subjects, equipments 20-30 participants that are healthy and aged between 18 and 45 years will be recruited for the study. The participants should have either active or latent trigger points. Questionnaires will be given to them and physical examination performed to fulfil the criteria for inclusion and exclusion. The participants that will be accepted must have pain of the hamstring whose onset is gradual and also they should produce pain upon pressure to their trigger points. They should also have a good understanding of English-both spoken and written and they must attend all sessions for the study. The criterion for exclusion will be if there are pathologies that are external to the study. The presence of a tear in the hamstring will also be used as a criterion for exclusion using magnetic resonance imaging to view the tissues. If one is an alcoholic, or is undergoing injection treatment like infectious diseases, or has a cognitive disease or has no ability to give symptoms of pain upon application of pressure to the trigger points, then the individual is excluded from the study. Equipments: The hip Range of Motion will be measured by using the Goniometer. The hamstrings will be viewed by the MRI machine. The ischemic compressions will be performed by hand or by the algometer. The ultrasound machine will be used for the second group. Methods First, the myofascial trigger points will be assessed using the Simon’s criteria which involves trigger points in bands (taut), patterns of referred pain, visible twitching or palpations-as seen in lateral myofascial trigger points triggered by touch of the bands which are the most sensitive and the restrictions of bending of the hamstring muscles (Chaitow & Crenshaw, 2006,pg.66) The participants will be divided in to three groups of therapy to check which one is more effective-the first group will be given the ischemic compression technique, the second group will receive the ultrasound therapy and the last group will be the control group meaning they will not receive any treatment or therapy. The ischemic technique will be administered using the algometer, and as the pain decreases, the pressure will be increased. This will take 30seconds. Ultrasound will be performed on the second group sing the ultrasound machine. The values for the goniometer will be taken at the hamstring of each individual before and immediately after the treatment. All this will be done by one examiner. The degree intensity of compression where the subject or patient feels pain or discomfort other that the expected sense of pressure (Wise, 2015, pg.80).  This is referred to as PPT. Before application of the ischemic compression, the PPT will be measured using a Wagner pressure algometer and record the heaviness or intensity of compression at which the subject experiences pain or discomfort. Therefore, the subjects in this research study will undergo treatment in order to get the effectiveness of the therapies used to address the myofascial trigger points. Plans to avoid research issues There are a few common errors made during a research process for many reasons. I have analysed a few of them so as to plan ahead and minimizes mistakes and issues during the study. The first one is specification of the population (White, 2009, pg.65).  This occurs by selecting a population that is not appropriate where data can be obtained. It can be done even by excluding important individuals who can contribute to the study. Another one is selection or the recruitment of subject. The error from selection is the error of sampling for subjects that are chosen by methods that are not profitable. For example, researchers conducting a study in a busy area like the town centres have a tendency to choose subjects that are closest and can easily agree, yet the subjects should be random. Another mistake is in non responsiveness. This error is present when samples and subjects are different from the sample that was selected originally. Some may be unreachable through telephone therefore we will require that all participants attend all sessions to maximize feedback. Another error is the error of measurement which originates from the process of measuring data collected. This shows the difference that may exist between the data from the study through the participants and the information the researcher wants. Therefore, extreme care will be taken to ensure that the mistakes are very minimal. Also, proper study will be taken to ensure plagiarism is not involved in any literature during the study by studying and researching extensively. Justification Subject 20-30 participants that are healthy and aged between 18 and 45 years will be recruited for the study. The participants should have either active or latent trigger points. This number will be enough to provide the necessary information and the number is not expensive to use and maintain. Staff The plan is to use only one researcher (me). However, in diagnosing, regular hospital staff will be used from the hospital since they are trained to use the equipments. Therefore the ultrasound, goniometer and agiometer will be used by the clinicians in those departments. Equipment The equipment used will be the goniometer (to measure hip Range of Motion), algometer (to measure the PPT and also to perform the ischemic compression) and the ultrasound-both for diagnosis and for the second group that will use ultrasound as a form of intervention. Due to its high cost, we may not use the magnetic resonance imaging to diagnose hamstring injury in the subjects; therefore the equipment above will be used for the study. The information and data that will be obtained from this study is to show how fast and effective the treatment of using ischemic compression is on hamstring myofascial trigger points. This information will be very useful to both osteopaths and in osteopathic research. This technique is very simple to perform and is not costly at all. The use of algometer may increase cost but it is more effective and it can be used in osteopathic research. It will also show that it is the most effective method in all of the myofascial release techniques. Gantt chart Task Name 1St Quarter 2nd Quarter 3rd Quarter 4th Quarter Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May literature review recruitment data collection data analysis Write-up research presentation References 1. Bahr, R., & Engebretsen, L. 2011. Handbook of Sports Medicine and Science, Sports Injury Prevention. New York, NY, John Wiley & Sons. 2. Brier, S. R. 1999. Primary care orthopedics. St. Louis, Mosby. 3. Chaitow, L. 2008. Naturopathic physical medicine: theory and practice for manual therapists and naturopaths. Edinburgh, Churchill Livingstone/Elsevier. 4. Chaitow, L., & Crenshaw, K. 2006. Muscle energy techniques: with accompanying DVD. Edinburgh, Churchill Livingstone Elsevier. 5. Chaitow, L., & Fritz, S. 2006. A massage therapists guide to understanding, locating and treating myofascial trigger points. Edinburgh ; New York, Churchill Livingstone/Elsevier. 6. Chaitow, L., & Fritz, S. 2007. A massage therapists guide to lower back and pelvic pain. 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