7. Discussion
myofascial, pain, muscle tenderness, CM, neck pain
The investigation was conducted to assess the effectiveness of combining cervical mobilization and post-isometric relaxation techniques in addressing pain intensity, pressure pain threshold, cervical side flexion range of motion, and functional limitations in individuals afflicted by mechanical neck pain linked to upper trapezius active myofascial trigger points. The outcome scores of pain intensity, muscle tenderness, cervical SF-ROM, and functional limitations were measured using VAS, PPT, cervical range of motion, and NDI, respectively. A Shapiro–Wilk test of normality revealed that the participants were normally distributed to their respective groups regarding demographic characteristics, such as age, height, weight, and BMI; and for all the study’s outcomes scores at baseline, except for the outcomes scores of VAS in Group 1 and Group 2 and PPT in Group 1 only.Thirty participants, 15 in each group were randomly distributed to their respective group to counter the invariability effect of the sample. In addition, this study utilized nonparametric tests, such as the Wilcoxon Signed-Rank and Mann–Whitney A Wilcoxon signed-rank test revealed the overall, significant differences in all variables across different time points (The findings of this study are consistent with previous research,The Mann–Whitney U test revealed the nonsignificant differences between the groups for all the outcome scores at baseline, indicating a successful randomization procedure in avoiding unmatched group comparison at starting points.Regarding post-intervention results, notable distinctions emerged between the 2 groups concerning pain intensity as evaluated by the Visual Analog Scale and quality of life as evaluated by the Neck Disability Index scores during weeks 1, 2, and 3. This suggests that the combination of cervical mobilization and post-isometric relaxation technique resulted in greater improvements in pain intensity and quality of life compared to post-isometric relaxation alone. These findings align with previous studies supporting the efficacy of combined interventions in reducing pain and improving quality of life in patients with neck pain and myofascial trigger points.Conversely, no significant variations were detected between the groups in cervical SF-ROM and PPT scores at weeks 1, 2, and 3 post-interventions, except for PPT at week 3. These results suggest that adding CM to PIR did not lead to significant variation in cervical SF-ROM and PPT scores compared to the PIR technique alone. It is worth noting that the lack of significant differences in cervical SF-ROM and most of the PPT measurements may be attributed to various factors, such as the specific characteristics of the study population, the duration and intensity of the intervention, and individual variability in response to treatment.The significant difference observed in PPT at week 3 post-intervention indicates that the combined intervention had a positive effect on the pain pressure threshold compared to PIR alone. This finding may suggest a delayed or cumulative response to the intervention, requiring further investigation to elucidate the underlying mechanisms and clinical implications.Besides the noticeable intervention effects on the study’s outcomes, this study acknowledges its certain limitations. The study’s population size and specific characteristics may limit the generalizability of the findings. Additionally, the study duration and follow-up period might not have been sufficient to capture long-term effects or potential relapses. Furthermore, the inclusion of additional outcome measures, such as functional status and patient-reported outcomes, would have provided a more comprehensive evaluation of the treatment effects.