Background and Aim: Myofascial pain syndrome (MPS) in the cervical region is one of the most common musculoskeletal disorders associated with myofascial trigger points that cause muscle pain, stiffness, and reduced range of motion, precipitated by forward head posture. Many non-invasive modalities, including low-level laser therapy (LLLT) and extracorporeal shockwave therapy (ESWT), have been reported to reduce symptoms. However, comparative effectiveness of these interventions remains unclear. This study aimed to compare the effectiveness of radial ESWT and LLLT in reducing pain and improving functional outcomes in patients with cervical MPS among the working-age adults. Methods: A randomized controlled study was conducted in a working-age adults with MPS. Fifty subjects, divided in two groups received either ESWT or LLLT. Numeric rating scale (NRS), cervical range of motion (ROM), and craniovertebral angle (CVA) were assessed before and throughout three weeks post intervention. Results: Both LLLT and ESWT showed significant (p \< 0.001) changes in NRS, cervical ROM, and CVA. LLLT showed a difference in pain reduction at week three (p \< 0.001) and flexion and extension ROM at week two and three (p \< 0.05). Conclusion: LLLT demonstrated superior results in pain reduction at the three-week mark and produced greater increases in cervical flexion and extension ROM during the two- and three-week periods when compared with ESWT.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
50
The first group intervened with ESWT BTL-5000 SWR radial 2000-4000 pulse per session, once a week, for a duration of 10-60 minutes, for three weeks. ESWT was applied to MTrPs bilaterally at 2.5 bar, with a frequency of up to 10 Hz and an energy flux density of 0.05-0.35 mJ/mm². Ultrasound gel was applied to the skin where ESWT probes were attached.
The second group received LLLT with BTL 4000 a total of six times, given twice a week. LLLT was applied to palpated active MTrPs at a dose of 40-50 J and an average power of 100 mW
Universitas Indonesia, Cipto Mangunkusumo General Hospital
Jakarta Pusat, DKI Jakarta, Indonesia
Pain Intensity Changes (Numeric Rating Scale)
NRS is an instrument to evaluate pain subjectively, with 11 scores of pain, ranging from 0 "no pain" to 10 "worst pain possible." Pain intensity categorized into mild (0-3), moderate (4-6), and severe (\>7). Participants must be fully conscious, mentally competent, and able to communicate verbally. MCID in the NRS score is 1.3.21
Time frame: 3 weeks
Cervical Range of Motion
Cervical ROM was used to detect movement dysfunction on patients' necks. Limitation of ROM can be caused by pain, muscle shortening, and other structural problems. ROM was measured with a goniometer.22 Patients were positioned to measure neck flexion, extension, lateral bending, and rotation. The examiner then measured the angle formed. Normal ranges are 1) flexion: 45.9-46.8°, 2) extension: 42.7-47.4°, 3) rotation to right: 63.3-67.2°, 4) rotation to left: 65.7-67.8°, 5) lateral flexion to right: 31.5-34.9°, and 6) lateral flexion to left: 31.4-36.6°.23
Time frame: 3 weeks
Craniovertebral angle
CVA is defined as the angle between a horizontal line passing through the C7 spinous process and a line connecting C7 to the tragus. A smaller CVA indicates greater anterior head displacement and increases the risk of forward head posture. The normal value is \> 50°, while forward head posture has a CVA of \< 50°. Outcome analysis was conducted based on the change from baseline values, evaluated at baseline, in Weeks 1, 2, and 3 after treatment.
Time frame: 3 weeks
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