Efectividad de intervenciones fisioterápicas en el síndrome de dolor miofascial cervical en personas con lesión medular

Abstract

Cervical Myofascial Pain Syndrome is a chronic pain frequently spread, which is generated by various mechanisms that lead to the activation of Myofascial Trigger Points in people with spinal cord injuries. Different manual or electrical alternatives are often applied equally and without a protocol to treat this pain. The aim of this study is to compare the validity and the efficacy of the combination of manual versus electrical therapy modalities in a person with spinal cord injury and Cervical Myofascial Pain Syndrome. CONTENT Experimental crossed, randomized, controlled to simple blind study. The study was conducted in the “Service of Promotion of Personal Autonomy and Support to Independent Life” in the Centre of People with Disabilities in Palma de Mallorca between March 2015 and July 2016. The final study sample was composed of 25 people with spinal cord injury and Myofascial Pain Syndrome with active Myofascial Trigger Points in Scapular Elevator, Superiors Fibers Trapeze and Sternocleidomastoids. Manual therapy modalities (pressure release, massage and stretching) or electrical therapy modalities (ultrasound, laser and TENS) were used to treat them, both types combined with educational and global therapy. The differences were analysed after short-term (one week and a half) and long-term (three and a half months) study interventions of each group and between groups through non-parametric tests for samples related to a statistical significance of 0.05. The results of manual and electrical protocols show statistically significant short-term and long-term benefits (after the washout period), highlighting the results of manual therapy over electrical therapy. Both therapeutic combinations show long-term significant improvements in the following aspects: pain (Pressure Pain Threshold and Numerical Rating Scale), Cervical Range of Motion (flexion and rotations), Neck Disability Index, the global functionality (SCIM), quality of life (Fast-Espiditest), self-esteem (Rosenberg Scale), gained knowledge and increased physical activity. In addition, in the long term the manual combination shows important improvements that are not offered by the electrical combination in the global functionality (FIM), in disability (WHO-DAS) and in hopelessness (Beck Scale). Comparing both groups, manual therapy offers statistical advantages over long-term electrical therapy in pain (Numerical Rating Scale), in Neck Disability Index and in self-esteem (Rosenberg Scale). The quality of service questionnaire (SERVQHOS) shows a remarkable global average and it determined weaknesses in the external factors that affect the quality of service. CONCLUSIONS There are no available studies in which cervical myofascial pain has been treated in physical therapy by manual or electrical protocols in people with spinal cord injury, what makes difficult to contrast and discuss the results. More research should be done in this field, because this study shows that the electrical and manual physical therapy together with other physiotherapy measures achieve favorable results, despite the possible interrelations of central pain over peripheral. The combination of the studied therapies are effective alternatives to treat cervical myofascial pain. The studied participants show global results in favour of the quality of the treatment received.