Int J Physiother.

Vol 5(4), 141-144, August (2018) ISSN: 2348 - 8336

ORIGINAL ARTICLE
EFFECT OF STRAIN COUNTER STRAIN TECHNIQUE AND
IJPHY
STRETCHING IN TREATMENT OF PATIENTS WITH UPPER
TRAPEZIUS TENDERNESS IN NECK PAIN
Jibi Paul
*1

²Pradeep Balakrishnan

ABSTRACT
Background: Neck pain is a common disorder with a reported six-month prevalence rate of 54%. Strain/counter-strain
technique and stretching are passive positional intervention aimed at relieving musculoskeletal pain and related dys-
function. The study aimed to find the effect of strain counter strain technique and to stretch on tenderness over upper
trapezium of neck and neck function.
Methods: This is an experimental study with comparative pre-post study design. The subjects for the study selected
from KPJ University College, Nilai, Malaysia. The study conducted in the Physiotherapy department of the University
College. Total 70 with 53 female and 17 male patients were selected for this study as per sample size calculation. Thir-
ty-five (35) samples were allocated to each group. Purposive sampling method adapted to select the samples. The study
samples selected based on inclusion and exclusion criteria included exhibits with a tender point over upper trapezius.
Dependant‘t’ test was used to find the outcome of the study.
Results: Paired t-test on the visual analogue scale (VAS) and Neck Disability Index (NDI) among stretching group
found significant (P< .0001) improvement in the outcome with a mean difference of 3.23 and 12.2 respectively. A paired
t-test on VAS and NDI among strain counter strain group found significant (P<.0001) improvement in the outcome
with a mean difference of 3.829 and 22.686 respectively.
Conclusion: This study concluded that both stretching and strain counter strain technique could reduce pain in the
upper trapezius of the neck and improve neck function among the patients.
Keywords: Stretching, strain counter strain, neck pain, visual analogue scale, Neck Disability Index.

Received 02nd March 2018, accepted 18th June 2018, published 09th August 2018

10.15621/ijphy/2018/v5i4/175695

www.ijphy.org

CORRESPONDING AUTHOR
*1
Dr. Jibi Paul, MPT, PhD,
Professor in Faculty of Physiotherapy,
²Lecturer in Physiotherapy, School of Health Dr. M.G.R. Educational and Research Institute,
Sciences, KPJ Healthcare University College, Nilai, Chennai, India.
Malaysia. E-Mail: [email protected]
This article is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License.
Copyright © 2018 Author(s) retain the copyright of this article.

Int J Physiother 2018; 5(4) Page | 141

INTRODUCTION Study Materials/Measurement Tools:
Neck pain is very common among officers specifically on Personal assessment form, Couch, Informed consent,
computer workers with a prevalence rate of more than 50% VAS (Visual Analogue Scale): This is a valid and reliable
[1-3]. Strain/counter-strain technique is applied passively tool to evaluate pain intensity among subjects suffering
on muscles to reduce pain and increase joint functions in from musculoskeletal ailments [11].
different regions of the body tender points [4].
Neck disability index scoring interpretation: Raw Score
Strain/counter strain is found effective to decrease hyper- Relative Impairment; 0-4 none, 5-14 mild, 15-24 moderate,
sensitivity of muscular tissues on palpation thereby sub- 25-34 severe, > 35 complete.
jects can perform muscle strengthening programs to im-
Intervention:
prove functions5. Many subjects with fibromyalgia have
reported the effects of stretching and strain counter strain Both techniques were performed on alternate days for two
technique on pain and function of different joints [6]. weeks. Stretching done actively 3 times. Each time hold for
30 seconds followed by 10 seconds rest. Neck Disability In-
Pathomechanism of neck pain in most of the cases are
dex, a reliable and valid tool used to collect the data from
not identified in individuals, therefore, it is referred to as
the samples [12,13].
non-specific [7]. There are many factors contributing to
non-specific neck pain, trigger point (TrP) is one of which Stretching Procedure:
has a scientific emphasis on that, stretching improve the Stretching as performed in sitting position with feet com-
flexibility of muscles thereby can increase the range of fortably placed on the ground. The neck is bend to forward
movement for the joints and can reduce neck pain [8-10]. and sideways slowly in a pain-free range of movement and
Effect of myofascial release on pain was reported by Si- rotate to opposite side, apply an inferior pressure on same
mons et al. in 1999. Break down the strategy of the pain- side shoulder. Hold this stretching for 30 seconds and re-
spasm-pain cycle can affect the treatment of muscle pain. lease gradually to return position then repeat it for three
McHugh et al. 1992, has reported the effect of passive sus- times.
tained stretching to promote muscle relaxation and reduc- Data collection: All subjects were physically examined by
tion of pain in tight muscles. The manual technique Strain the physiotherapist to screen for the presence of palpable
counter-strain is useful in the reduction of pain and pro- tender points over upper trapezius. The pre-intervention
moting muscle relaxation has been stated by Kisner C,1990. process took approximately 5 minutes.
The concepts behind the treatment of sustained stretching Following the physical examination, the subjects were
and strain couter strain techniques are different, but both moved to a separate assessment cubicle where initial VAS
can promote muscle relaxation and reduce muscle pain score and neck disability index data was collected. The ob-
by the break down the pain-spasm-pain cycle. The phys- tained data was documented as a pre and post-test score.
iological effect of these techniques include an autogenic Strain counter strain Procedure:
inhibition of tendon reflex and induce muscle relaxation. Strain counter-strain technique can perform in the upright
This improves the viscoelasticity of shortened muscles and sitting position. Locate tender points in upper trapezius
surrounding tissues. The comparative effect of sustained muscle and apply pressure till get the sensation of pain af-
stretching and strain counter strain technique is still con- ter that perform neck ipsilateral side flexion with contra-
troversial. The objective of this study is to find out the effect lateral rotation, the shoulder in the same side need to be
of strain counter strain over sustained stretching technique maintained abducted position.
on neck pain and function.
Statistical Analysis: From the dependent variables, sum-
METHODOLOGY mary measures were evaluated and analyzed the differenc-
This is an experimental study with subjects selected from es. Descriptive data analysis of demographic data. Depen-
all students and staff of KPJ University College, Nilai, Ma- dent ‘t’ test used to find the effect of stretching and strain
laysia. Study setting as did in the Physiotherapy depart- counter strain on the reduction of neck pain and neck
ment of the University College. Purposive sampling meth- function among the patients. The study was considered as
od adapted to select the samples. Subjects selected based significant with P <0.05.
on inclusion and exclusion criteria. RESULTS
Inclusion criteria: Both genders with age Group between Descriptive data analysis: Total 70 patients participated in
18 to 50yrs, subjects who exhibit a tender point over upper the study with 53 females and 17 males and range of age 18
trapezius, Unilateral and Bilateral tender points were in- to 43 years (Table 1).
cluded for the study.
Table 1: Descriptive data analysis of Group A and Group
Exclusion criteria: Subjects with the traumatic and neuro-
logical condition, Subjects with an open wound, subjects Group Sex Frequency Age group
which don’t sign the informed consent were excluded from Strain Counter Strain F 32
the study. Technique- Group A M 3
19-40

Sample size and allocation: Total 70 patients were select- Stretching Technique F 21
ed for this study as per sample size calculation. Thirty-five 18-43
Group B M 14
(35) samples were allocated to each group. Total 70

Int J Physiother 2018; 5(4) Page | 142

 Table 2: Paired t test within the Group A counter strain technique has proved a significant effect on
Paired Samples Test
pain (P < 0.001), Albert Atienza (2006) [14].
Paired Differences Strain counter-strain technique can reduce pain thereby
95% Confidence Sig.
increase the function of the neck. Reduced pain in muscu-
Group A Std. Std. Interval of the t df (2- lature can increase the range of movement of the neck. A
Mean Devia- Error Difference
tion Mean
tailed)
reduction of pain and an increase in neck function of 50%-
Lower Upper 100% occurred in 19 of 20 patients immediately after SCS
PRE VAS therapy. The partial improvement was maintained for six
STRETCH
- 3.229 1.573 .266 2.69 3.769 12.14 34 .000 months in 11 of 20 patients, and four were still pain-free.
POST VAS This technique has been recommended for physical ther-
STRETCH
apy for treatment of pain in tender points of musculature,
PRE NDI Dardzinski J A (2000) [15].
STRETCH
- POST 12.200 7.654 1.294 9.57 14.83 9.43 34 .000 This study has reported that there is an improvement in
NDI
STRETCH neck function, reduction of pain and tenderness over up-
per trapezius after the intervention with stretching and
Table 3: Paired t test within the Group B strain counter strain.
Paired Samples Test The outcome measure was analyzed between the group and
95% Confidence found strain counter strain has more effect over stretching
Sig.
Group B
Mean
Std.
Devia-
Std.
Error
Interval of the t df
(2- treatment technique.
Difference
tailed)
tion Mean
Lower Upper
Ethical Clearance of the Study: This study has got ethical
clearance from the research and development committee
PRE VAS
SCS- of KPJ Healthcare University College, Nilai, Malaysia.
3.829 1.361 .230 3.36 4.296 16.64 34 .000
POST
VAS SCS
Conflict of interest: No conflict of interest on the outcome
PRE
of this study.
NDI SCS
22.686 6.825 1.154 20.34 25.03 19.67 34 .000 CONCLUSION
-POST
NDI SCS This study concluded that both stretching and strain count-
Table 2 and 3 show the outcome of stretching and strain er strain technique could reduce pain in the upper trape-
counter strain technique on neck pain and function in zius of the neck and improve neck function. The neck is
Group A and Group B respectively. stretching, and strain counter strain technique can induce
DISCUSSION relaxation of upper neck muscles thereby increased neck
muscle flexibility and function among the patients.
Total seventy (70), patients of both genders with nonspe-
cific neck pain participated in the study. Fifty-three (53) Acknowledgment: The investigators would like to express
patients were female and seventeen (17) males with age their gratitude to the management and research and devel-
group of eighteen (18) to forty-three (43). opment of KPJ Healthcare University College for their sup-
port and motivation to conduct this study. The researchers
Paired t-test (Dependent) on the visual analogue scale are thankful to all the participants to conduct this study
(VAS) and Neck Disability Index (NDI) among stretching successfully.
group found significant (P< .0001) improvement in the
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Citation
Paul, J., & Balakrishnan, P. (2018). EFFECT OF STRAIN COUNTER STRAIN TECHNIQUE AND STRETCHING IN
TREATMENT OF PATIENTS WITH UPPER TRAPEZIUS TENDERNESS IN NECK PAIN. International Journal of
Physiotherapy, 5(4), 141-144.

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