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If the stuff were thicker, people would be bulletproof. This directly contradicts a major popular rationale for fascial manipulation. This paper is only clinically relevant to fascial therapy insofar as it presents evidence that discourages and undermines existing common practices and beliefs. Therefore, perhaps it was a poor choice to cite it in this context.

For instance, Dr. He dismisses the traditional explanations of thixotropy and peizoelectric-effect-mediated adaptation, and thoroughly describes fascial toughness. It does not refer to any known, specific state of soft tissue. Most therapists say — not all of them, importantly, but most — that they can feel tissue changing texture as they work, but that could easily be misinterpreted muscle behaviour and palpatory pareidolia. But we have almost no idea what any of these sensations imply about tissue state, if anything. People also have profound shifts in sensation from a good back scratch, fervent prayer, and eating cheesecake!

No doubt the first thing — a quick change in texture — happens in the course of manual therapy. It is not safe to assume the rest, though. In my many years working as a massage therapist, I felt various and sundry ripplings, twitchings, and shifts under the skin. Sometimes they did, but often they did not. So I always thought they were really quite random, occurring with great variety pretty much no matter what I did, or what patients reported.

Or, if they are more meaningful, they are nearly impossible to interpret. But we round it up to something more specific and definite and meaningful, an oversimplification that is more poetic than biologic. A thick stew of good intentions, ego, and the human habit of selective perception and imposing simplistic explanations on chaotic systems.

But the connection to fascia here is weak. Volume 17, Number 1, 83—8. Jan For context, visceral massage is often perceived as being about fascial manipulation, without much justification, or perhaps any at all. The point of this was to see if the massage would prevent a common post-surgical complication: postoperative ileus, AKA impaired bowel motility, AKA constipation.

The poop chute gets balky. This is a real thing that happens to both rats and humans after abdominal surgery, usually temporary, but occasionally more serious and long-lasting. The authors speculate that reducing inflammation may be the mechanism. Chapelle and Bove were so confident in their conclusion that they baked the good news right into the title. Since then, fascia enthusiasts have often used this study as a basis for speculation that massage can have a measurable effect on connective tissue, and as justification for visceral manipulation especially.

But those are a big leaps with many problems. But the bigger leap is from the results to their meaning. Even if we do accept the results at face value, would it matter? The alleged importance of the study is that it demonstrates a meaningful biological effect on fascial tissue. And there might be other effects with more practical clinical implications than trying to reduce post-surgical adhesions. This is mildly interesting massage science, not fascia science. It definitely does not constitute evidence of an effect of manipulation on connective tissue at all, let alone one that is robust and relevant to common aches and pains and the day-to-day work of most manual therapists.

Perhaps … but the clinical relevance of this data is tenuous at best — so low that I would never normally be interested in this paper. I spent some time on it only as an gesture of good faith to a critic, who supplied the paper as an example of basic fascia science that matters. It was probably not a good choice for that purpose. Volume 14, Number 2, — Apr Even if true and reproducible, this data would mainly support the rationale for MFR specifically for post-exercise soreness — something of a dead end for clinical relevance, because exercise-induced soreness has little to do with the main claims of fascial release therapy, which primarily concerns correcting postural asymmetries, eliminating alleged restrictions, and treating chronic pain.

My point is that there are so many problems that its relevance is watered down to quite a thin sauce — way too thin. I do concede that the paper shows some evidence that fibroblasts have interesting and perhaps positive responses to mechanical forces. The next example of fascia science was suggested to me by Gil Hedley. Since he clearly believed me to be ignorant of fascia science and in dire need of educating, I asked him to recommend some reading to me — a favourite paper showing something interesting and clinically relevant about fascia.

Much more interesting stuff than the previous two examples. I will get into much more detail about this paper than the first two. Proceedings of the 5th World Congress of Biomechanics, Munich. Volume , Number , 51— Schleip and colleagues convincingly showed that fascia contains muscle cells — sort of 48 — and that they can contract, slowly and weakly. That is undeniably interesting biology! But the point of this analysis is to ask: Does it even matter whether its right or wrong?

Is it clinically relevant? Does it improve how we do therapy? Can we use the knowledge to affect the body with hands? That is the question. It is also a question that Dr. Schleip and his colleagues have addressed themelves on their website, FasciaResearch. What follows is my own analysis, which is generally consistent with theirs. Important update: Dr. Schleip has read this article and corresponded with me about it amiably, and expressed clear agreement with my main point.

Although he also had some thoughtful criticisms, we agree on what matters, and he shares my frustration with clinical overconfidence in fascia. I invited him to make a statement for my readers about this: look for it at the end of this part of the discussion. Slow, weak contractions. But they contracted. By any measure, fascial contractions are dramatically less powerful than muscular contractions. Some important context that fascia fans will appreciate: for a long time, fascia was and often still is incorrectly thought of as a fairly lifeless, inert substance, the Saran Wrap of biology.

I still hear various educated people referring to it in this way. However, massage therapists and chiropractors in particular are prone to swinging to the opposite extreme and talking about fascia as though it is more interesting than a lifetime subscription to National Geographic.

The truth is somewhere in the middle. Fascia is not inert. But neither is it all that lively — at least not in terms of contractility. We are not talking about a lot of muscle cells here. Nor are we talking about particularly strong contractions.

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The maximum force generated by a small bundle of contractile rat fascia was around 35mN. I have a weird job. Schleip et al. But for the property they described to matter to therapists who are choosing to focus their therapeutic attention on fascia — for any biological property to be clinically relevant — it must be significant enough to have an effect on health. I deliberately made it sound trivial, within the bounds of their numbers. Even if you exaggerate their numbers, they would still only account for a small fraction of the postural muscle power involved in dynamic spinal stabilization, never mind the generally astounding structural toughness and resilience of the human spine.

The idea that low back stability could be affected in any way by such a small, slow-motion force is a bit much for me to swallow. In most places in the body, fascia is much less substantial — tough for its weight , but mostly quite thin and wispy, and a lot of it even microscopic. The validity of such a concern depends on just how sensitive you think human biomechanics are to forces so subtle that no one really had any idea that fascia contraction was even happening before this study. The wording of the conclusions of Schleip et al.

Weak, slow fascial contractions strike me as being scientifically valid and interesting, but clinically minor. Once again, far from making me interested in fascia as a target for therapy, fascia science is convincing me of just the opposite. Other evidence might even reveal something important — although that would surprise me.

In a follow-up paper for Medical Hypotheses , 59 he and several colleagues generally suggest that fascial contractility is a factor in muscle stiffness.

1st Edition

The high water mark for potential clinical relevance is spelled out in this passage:. This offers the possibility of a new understanding for many pathologies that involve a chronically increased myofascial tonus. Examples include conditions such as torticollis, low back pain associated with paraspinal compartment syndrome, tension headaches, and others.

Similarly a decreased fascial tone could be a contributing factor in conditions that are often associated with decreased myofascial tension, such as in back pain due to segmental spinal instability, peripartum pelvic pain, or fibromyalgia. While usually other factors play a major role as well in these pathologies, it is possible that their progress could be influenced additionally by the regulation of fascial tissue tone ….

Some of the items listed are particularly implausible to me. Another peculiar item here is fibromyalgia, a fascinating condition that might conceivably be affected in some small way by fascial contraction, but which is overwhelmingly a nasty disease of the nervous system. Suggesting it as a main example 60 of how fascial contraction might matter makes about as much sense to me as saying that people with cancer might have some contracted fascia — would it matter if they did?

If fascia were to start squeezing a compartment for some reason, it might be a problem. That is clinical relevance. And yet there is still a clear problem with the scale of the forces here. Compartment syndrome is by definition only a problem when the pressure is significant, probably dramatically exceeding the maximum force with which fascia could squeeze the compartment. The pressure inside is immense, and it would make no practical difference if the hot water heater itself was a little larger or smaller. Again, fascial contraction is probably not nearly strong enough to matter.

To prevent chronic exertional compartment syndrome, it is necessary to address aspects other than the muscle fascia. So you see how this goes: for one candidate example after another, the clinical relevance of fascial contraction is dubious or minor. Of course. Similarly, the presence of muscle cells in fascia is no shocker. I never believed fascia was entirely inert any more than I believed in the junkiness of any DNA. If you spend much time studying biology, it quickly becomes apparent that there are no sharp lines or divisions, and that we consist of an incomprehensibly diverse and interconnected community of cells.


That connective tissue hosts a small population of muscle cells strikes me as blindingly un surprising. Fascia surrounds and fractally wraps every muscle inside and out, for crying out loud — how could it not have a few muscle cells and overlapping properties? I suspect that the slightly contractile properties of fascia are simply at one end of a continuum of motor function. Our muscular system is overwhelmingly our primary means of reacting to stimuli — the major output of our nervous systems — and in general terms the slight contractility of fascia is probably just the fringes of that functionality, a little bit more of the same.

There are probably some subtle differences, but they are subtle and arcane and ultimately just a slight variation on the biological theme of muscularity. And, in terms of clinical relevance, the muscular system itself is in turn overshadowed by neurology. Recently Dr. He is not thrilled with the way his research is being used to justify premature overconfidence in fascial therapy.

He also offered some thoughtful criticism on some specific points and I made some changes, and will probably make more. Most of the people who criticize you have not done a portion of your reading work and could certainly learn a lot from the debate you started. I invited him to make a statement for my readers about this. Here is it in full, with some emphasized highlights:. I share your emotional frustration with the current trend among bodyworkers of attributing anything wonderful or astonishing to the properties of fascia.

In fact, our Fascia Research Group at Ulm University has been receiving an almost exponentially increasing number of inquiries from enthusiastic healers and martial art teachers worldwide who wish that we would sanctify their claims that fascial contraction provides the explanation for their observed miracle powers. While I do tend to believe that the fascial net plays much larger roles in human functioning than previously assumed in orthopedic medicine, I am afraid that such over-zealous claims and projections are undermining the seriousness of the investigation and academic rigor that characterizes the work of the current leaders in fascia research, such as P.

Huijing, H.

Effect of Direct Myofascial Release and Kinesio Tape on Axillary Web Syndrome

Langevin, T. Findley, P. Standley and A. This of course applies as much to fascia-oriented therapists as it does to those who base their work on supposed neuromuscular or other physiological effects, most of which are still unproven. While scientists can learn a whole lot from the intuitive and experiential wisdom of complementary therapists, particularly about the non-fragmented and connecting properties of the fascial net, we bodyworkers can learn at least as much from the careful, questioning approach of good scientists, who are willing to doubt their own assumptions and to refrain from premature confidence and over interpretation of their findings.

It is this mutual learning and interdisciplinary enrichment which in my opinion characterizes the best qualities of the current fascia research field, as expressed in the international Fascia Congress series and associated activities. Again, Dr. Schleip and I do not agree about everything — but that is unimportant compared to our shared values and commitment to cautiously reserving judgement. We have each placed our bets on this topic, but not closed our minds. I fully support and endorse his enthusiasm to explore the biology … and he supports and endorses the value of my critical analysis.

Over the last couple years, by far the most common answer to my fascia science challenge has been: Langevin, Langevin, Langevin. Specifically Langevin et al. Chronic back pain is a notoriously inexplicable and invisible condition. Things that turn up on MRI that seem like they might explain the pain are often irrelevant.

A clear, consistent, measurable biological sign of chronic low back pain like thickened fascia would be inherently interesting — downright cool, even!

But that thickened, stiffened fascia is probably not the cause of back pain. But no one knows. The purpose of this article is to challenge hype about fascia. Langevin et al. Does knowing that the thoracolumbar fascia is thicker and stiffer inform diagnosis? Not really. Does knowing it inform treatment? And bear in mind that stretching did not help the poor pigs.

If the findings can reproduced. If they can be explained. If the explanation does in fact turn out to be clinically relevant. Frozen shoulder is one of the few common, familiar musculoskeletal problems that definitely can be blamed on misbehaving fascia. Could something like it happen to the back too? This is just a thought experiment! That joint capsule is exceedingly tough. Frozen shoulder defies manual therapists all the time, despite cocky claims to the contrary.

Both shoulder capsules and the thoracolumbar fascia are super tough human gristle, and are unlikely to change much or for long — if at all — in response to any non-traumatic external stimulus. And the thoracolumbar fascia is not only much tougher — the biggest and thickest sheet of fascia in the body — but it is much harder to apply force to than the shoulder joint which has a giant lever.

And so Langevin et al. Nerves can get a little tangled up in connective tissue and cause peripheral neuropathy. And yet I came across it myself. No one defending fascial therapy hype has ever brought this idea to my attention — I am including it on my own intiative, not as a response to a claim made by fascial therapists. To the extent that this causes peripheral neuropathy, it is obviously clinically relevant. The cluneal nerves pass from the low back and sacrum into the buttocks, just under the skin, and they can get snared in connective tissue on their way.

Cluneal nerve entrapment is a good example because it may be a common undiagnosed cause of back pain that is not obviously neuropathic in character. It took a second attempt to find the main problem, a surgery I would definitely have been reluctant to try myself. They found a tiny spot where the nerve passed through a ligament, cut it free, and that was the ticket: she was decisively cured.

Which is pretty cool. On its face, this seems like an open-and-shut case of a nasty pain problem caused by connective tissue in an abnormal state, and therefore a good example of how fascia can actually matter. Which no fascial therapist has ever actually mentioned to me as a reason why they are doing fascial therapy. The physical predicament of the nerve may have been like kindling for a fire — a fire that was then lit by something else and then burned for years. Admittedly, even if that was the case — and it would certainly be fascinating — diagnosing the vulnerability and solving it might be next to impossible.

It might be much more pragmatic to just free the poor nerve, rather than trying to fiddle with the biological dials so that the nerve stops being bothered. No kindling, no fire. Or it could be as simple as getting off a certain medication, or taking some vitamin D. Who knows. There are many unanswered questions here. Was there any abnormal tissue there, or was the passageway through the ligament just too narrow?

Had it always been narrow, and only eventually became a problem for some other reason? Or had it become a problem? Did the pathway get narrower, or stickier? But clearly it was not necessarily so. Imagine a hair stuck to a hardwood floor by some spilled honey, and covered with a Persian rug. Good luck with that. This patient probably actually needed surgery. There is more fascia science, and I will extend this article with more analysis in the future.

I honestly hope that there is clinically relevant fascia science — that would be terrific. So far, however, I see no good reason for therapists to be fascinated by fascia and to make it a target tissue. Other alleged fascial properties and clinical relevance issues I intend to address eventually definitely not a complete list :. This is one of the most striking stories of incompetent and harmful manual therapy that I have ever received from a reader.

And I get a lot. It is notable not only for the seriousness of the outcome, but also for the glaring excess of the treatment: so unnecessary! What happened to this patient needs to be discussed openly. Funny drawing for a most unfunny story. I have re-written the story a little to anonymize and condense it, but it is otherwise presented as it was received:. Claiming that tight calf muscles and hamstrings were causing my heel to lift too far thus placing pressure on the balls of my feet , she proceeded with a half hour fascial release therapy on my calves, using her full weight and her elbows.

It was extremely painful, but I gritted my teeth, thinking it necessary "to break up the knotty muscles. A week later I had another such treatment, and she also also persuaded me to buy a rubber roll so that I could do the "therapy" at home. She told me I should try to reproduce the same pain level, on calves and hamstrings. I did this every day for one hour for five days. I did the same with a wooden roller under my feet, using my own weight. During that time, I started getting stabbing and burning pains in my feet, the backs of my legs, and then later my hands and armpits.

The burning was either tingly or felt like bad sunburn. I had trouble sleeping, because I could not have heavy bedclothes on my feet, and nor could I put one leg on top of the other , without pain. I returned to my GP, had blood tests, x-rays, a CT scan. Because my symptoms seemed neuropathic in nature, I was referred to a neurologist. After eliminating a number of other diagnoses, the neurologist thinks the problem is biomechanical or related to muscles, and that the MFR may have caused an oversensitivity to pain.

I then searched the Internet for information about myofascial release being damaging or making pain worse. It was very difficult to find, because of all the "positive" hype around MFR. Fortunately, I found your website …. What happened here? Having also personally experienced that intense style of fascial release many times, I knew all too well what these patients were talking about.

Almost none had found the courage to discuss their concerns with the confident overbearing? Almost all had even earnestly tried to like it, at first. Sometimes, rather sadly, they were even still trying to rationalize it as positive, i. Most of those therapists have many devoted patients who, for various reasons biological and psychological, are more willing and able to tolerate extreme therapy. However, they are also leaving behind them a trail of angry, injured patients … patients who never raised a word of objection.

There are bound to be therapists reading this who have actually done this to patients, who do it every day. Many will react defensively. Many will delude themselves into believing that they are the more judicious exception to the rule. But some, perhaps a few who are already questioning their own methods, will probably be moved further in that direction.

I hope. Fascia sells. Its prevalence in the marketplace has much more to do with marketing than sound clinical reasoning. But this is still progress! Why should yoga help digestive problems, or some of my bodywork clients report increased regularity of their periods? This points the way. Such a mechanism more or less had to be there. Connecting that to yoga and manual therapy is an odd but inevitable spin. The other hand was over the upper thoracic spine.

Gross stretch was performed by stretching upward at the base of the occiput and downward at the upper thoracic spine. Stretch was hold for 90 s until release and was stretched again by increasing traction. With each release, capital extension should increase. This release sequence was repeated until an end feel was reached. The arm pull is a straight plan stretch parallel to the floor. Arm was in a neutral position as the initial stretch was applied. Stretch was hold until the fibers were released, and then, stretch was given again by increasing traction.

This sequence was repeated until an end feel was reached. Traction was maintained and forearm was rotated into supination until restriction was felt. Traction was maintained and stretched again by increasing supination. This position was held, released, and stretched again. One session per day for 6 days for both the groups was delivered by an experienced physiotherapy practitioner.

During the therapy, the subject was instructed to lie in the supine position stay relaxed not sleep during procedure. The subjects were also instructed to report the therapist if any discomfort or pain was felt during the procedure. The data of the study were statistically analyzed using SPSS software version Statistical analysis was performed using independent t -test and dependent t -test.

All parameters for day 1 and day 6 scores followed a normal distribution. Therefore, the parametric tests were applied. The pre- and post-comparison within the group was done using dependent t -test and between the groups was done by independent t -test. A total of 40 patients were participated in this study. Table 1 summarizes their general characteristics.

The present randomized controlled trial was done to study the effect of MFR of the upper limb and neck in subjects with mechanical NP with referred pain to unilateral upper limb. The results from the statistical analysis of the present study support the alternate hypothesis that gross MFR of neck and quarter arm pull technique was more beneficial in experimental group, although both the treatment groups proved to be effective in treating mechanical NP referred to unilateral upper limb except that the control group did not show any significant improvement in CFE.

In the present study, the age of patient ranged from 20 to 50 years with mean age of Age group between 20 and 50 years was taken as an inclusion criteria as several prevalence studies have shown an increase in the occurrence of mechanical NP in the above-mentioned working age group. According to BMI, the subjects in the present study fall in the category of borderline overweight for India, Asia population. The occurrence of pain referral more on the dominant side was probably related to their difficult work positions, repetitive precision-demanding handgrips, and overuse of dominant side.

Mechanical NP leads to upper limb involvement due to a reduction in the use of upper limb and referred pain. The initial treatment in the conventional therapy included modalities to relieve pain and spasm. Hence, the improvement in pain, ROM, and function was achieved prior than the improvement in the endurance scores.

The possible reasoning of failure to show improvement can be that the 6-day intervention period might not have been sufficient to show the changes in the endurance after treating with the conservative treatment. The stretching strengthening protocol given was as a home program and hence was not supervised. This might have led to the failure. This is in contrary with the previous research studies which have proved that strengthening exercise, with or without combination with other techniques, appears to be more beneficial to patients with chronic NP.

In agreement with Chiu et al. The experimental group proved to be more beneficial in all terms in treating mechanical NP referred to upper limb. This can be attributed first because MFR is an approach that focuses on freeing restrictions of movement that originates in the soft tissues of the body.

Second, by applying pressure and administering fascial release to areas of the body, this therapy aims to improve the health of fascia tissue. Fascia is a connective tissue along with tendons, ligaments, bone, and muscle. As this technique produces heat and increases blood flow which releases tension from fibrous band of connective tissue, it thus results in softening, elongating, and realigning the fascia and removing restrictions or blockages in the fascia. Gross MFR of the neck with arm pull technique is a form of indirect technique which is suggested for acute cases.

A non-randomized clinical trial with no control group determined the effect of Gross MFR on upper limb and neck in subjects with mechanical NP to reduce pain and improve functional abilities. The present study has both objective and subjective outcome measures and found results similar to the above study with statistical significance in all domains.

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Another randomized controlled trial study found out the effect of MFR technique on chronic non-specific NP on 30 subjects. It concluded that MFR is one of the effective manual therapy techniques in reducing pain and disability and improving the isometric extension strength of neck in patients with non-specific chronic NP. Furthermore, the present study included larger number of subjects as compared to the above study. Yet another study evaluated the effect of MFR with arm pull technique in decreasing neck disability NDI in patients with cervical radiculopathy and found that MFR with arm pull reduces the neck disability and hence helps the patients to return to their previous normal life and might be used as an effective treatment technique for the patients with cervical radiculopathy.

However, the population was cervical radiculopathy and the outcome measures used were subjective in comparison to the present study. In the present study, experimental group which was treated with gross MFR of posterior cervical musculature and upper quarter arm pull technique showed more improvement in reducing pain, improving neck flexor endurance, range of motion, and functional abilities in subjects with mechanical NP referred to unilateral upper limb with gross MFR when compared to control group.

This was a single-centric study and carry over or long-term follow-up effect was not monitored. Furthermore, the effect of only six sessions was assessed. If more number of sessions were included, the patients would get completely recovered. Acute and chronic cases based on the duration of symptoms were not separately categorized. Trigger point assessment and ultrasound screening can be assessed. Long-term outcomes can be investigated.

Effect of gross MFR in acute and chronic cases can be studied separately. Number of sessions can be increased to 10—12 sessions. The study concluded that the interventions given to each of the groups showed an improvement in terms of pain intensity, CFE, range of motion, and functional levels in the neck, except for CFE in control group which did not show significance. Gross MFR of upper limb and neck showed significantly more improvement in terms of all outcome measures such as pain intensity, CFE, cervical range of motion, and functional outcomes. Gross MFR of upper limb and neck showed improvement with early and lesser treatment sessions, i.

Thus, the study suggests that gross MFR of upper limb can be implemented into rehabilitation protocols for the treatment of mechanical NP with referred pain to upper limb and should not be only seen as an adjunct or complementary therapy. We express our sincere gratitude to all the patients who participated in this study. We are grateful to the management and staff of KLE University for Institute of Physiotherapy for supporting this study. National Center for Biotechnology Information , U. Int J Health Sci Qassim.

Sweta V.

New Release: Myofascial Release Therapy - North Atlantic Books

Gauns and Peeyoosha V. Peeyoosha V. Author information Copyright and License information Disclaimer. Address for Correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

Abstract Objective: Mechanical neck pain NP with referred pain to upper limb is a common problem and often leads to functional impairment of common activities of daily living. Methods: Design: This was a experimental study; a total of 40 subjects clinically diagnosed with mechanical NP along with referred pain between the age group of 20 and 50 years.

Conclusion: Gross MFR of upper limb and neck is an effective technique for subjects with mechanical NP and has a faster rate of improvement. Keywords: Cervical flexor endurance, gross myofascial release technique, mechanical neck pain, myofascial release, referred pain.

Marina Snyder

Introduction Neck pain NP is considered to occur insidiously[ 1 ] and is multifactorial in origin. Methods The study design was a double-blinded randomized controlled trial, where the assessor and the therapist were blinded to the groups. Inclusion criteria The following criteria were included in the study: Subjects clinically diagnosed with mechanical NP along with referred pain to unilateral upper limb between the age group of 20 and 50 years of both genders.

Willingness to participate in the study. Exclusion criteria The following criteria were excluded from the study: Specific causes of NP conditions with neurological involvement such as myelopathy with weakness, numbness and sensory loss, cervical disc prolapse, and cervical spinal stenosis Previous neck and upper limb surgery.

History of cervical trauma whiplash disorder , fractures, dislocations. History of congenital torticollis. Frequent migraine. Group A: Experimental group. Group B: Control group. Procedure Step 1: A brief demographic data were noted from the subjects.

Direct Release Myofascial Technique

Open in a separate window. Figure 1. Figure 2. Figure 3. Active ROM exercises Subjects in sitting position actively performed neck rotations and side bending on both sides, forward bending, neck extension, and shoulder rolls. Neck isometrics In sitting position, subject performed an isometric push against the hand to strengthen the neck.

Neck retraction exercise While lying faceup or sitting, bring the head straight back, without bending the neck. Neck stretches Subject in sitting position is told to reach the right arm over the head so that palm is on top of the skull with fingers resting just above the left ear. Experimental group Subjects in the experimental group were given HMP on the neck region for 15 min after which they underwent a manual intervention of gross MFR technique for posterior cervical musculature[ 26 ] and gross stretch of upper quarter: Arm pull[ 26 ] for the duration of 10—15 min.

Gross stretch of posterior cervical musculature [ Figure 4 ]. Figure 4. Gross stretch of the upper quarter: Arm pull [ Figure 5 ]. Figure 5. Gross stretch of posterior cervical musculature [ Figure 4 ] is prepended before gross stretch of upper quarter: Arm Pull [ Figure 5 ] Dosage One session per day for 6 days for both the groups was delivered by an experienced physiotherapy practitioner. Consort Chart. Results A total of 40 patients were participated in this study. Table 1 Demographic distribution of parameters in two study groups.

Table 2 Pre—post comparison for experimental group. Table 3 Pre—post comparison for control group. Table 4 Between-group comparison of experimental and control groups. Discussion The present randomized controlled trial was done to study the effect of MFR of the upper limb and neck in subjects with mechanical NP with referred pain to unilateral upper limb. Limitations This was a single-centric study and carry over or long-term follow-up effect was not monitored. Scope of the study Trigger point assessment and ultrasound screening can be assessed.

Conclusion The study concluded that the interventions given to each of the groups showed an improvement in terms of pain intensity, CFE, range of motion, and functional levels in the neck, except for CFE in control group which did not show significance. Acknowledgment We express our sincere gratitude to all the patients who participated in this study. References 1. Neck pain in the general population. Spine Phila Pa ; 19 —9. The prevalence of neck pain in the world population:A systematic critical review of the literature. Eur Spine J. Sharan d. A Prevalence study of neck disorders in Bangalore.