Discussion
pain, chronic neck pain, neck pain, Coronavirus disease, disability
The IASTM and MFR techniques appear to have similar effects on pain and disability on college students studying using distance learning and having CMNP. The participants in group A who received IASTM, however, showed a slight clinical improvement in pain, function, and pain pressure threshold. The lack of statistical significance between the two groups may be due to the short duration time of the intervention and/or the lack of a control group. Perhaps this short time was not enough to trigger a statistical significance. It is possible that if the intervention time was more than four weeks, we could have obtained a different result.The use of valid and reliable outcome measures is always important. In this study, we used VAS, NDI, and pressure algometry to directly address the purpose of the study. It is important to note, however, that the construct of the studied outcome measures is different. In some outcome measures, the lower the scores, the better and it is the other way around in the others. For example, the lower the scores in VAS and NDI, the better the outcome, while the higher scores in the pressure algometry, the better since higher scores indicate higher tolerance for pain pressure.In this study, our sample included only college students involved in distant learning. During Coronavirus disease (COVID-19), most of the education changed to become online. The world has changed since COVID-19 started and many schools forced students to stay at home and continue their courses online. This has affected students and new complaints such as neck pain emerged due to long hours of sitting in front of computers. We were intrigued to study how interventions like ours could or could not help them. Therefore, we delimited the study participants to college students involved in distant learning.Although there are similar studies that came to similar results, [While varieties of MFR techniques exist, the type of MFR performed on the neck muscles does not seem to affect the result of pain and pain pressure threshold modulation in subjects with neck pain. In this study, we used gradual stretching for the upper trapezius and levator scapula muscles while in another study, [When compared to conventional physical therapy of therapeutic ultrasound, electrical stimulation, and regular massage, MFR was found to be superior in improving pain, increasing range of motion, and PPT in subjects with subacute and chronic neck pain [This study can be viewed within the context of several limitations. First, the sample size was small, and we had a large dropout rate, either due to COVID-19 restrictions, scheduling conflicts, and/or ineligibility criteria to participate. We could have obtained a different result if we had a larger sample size. The small sample size also limited the generalizability of the result which affects the external validity of the study. Another factor that may limit the generalizability of the results is the fact that the age range and hence the characteristics of participants are small to extrapolate the findings to the general population. Second, our intervention was for a short time. Again, we could have obtained a different result with a long time or with more visits. In addition, we did not follow up with participants beyond four weeks and we could not infer the long-term effect of our intervention.Third, we assessed trigger points found only in two muscles: the upper trapezius and levator scapulae. Different muscles have different referral patterns and could have been important to study in addition to these two muscles. Fourth, we did not have a control group to better investigate the effect of our intervention, this limits the result of this study. We recommend that future studies include more muscles in their assessment and intervention, apply the same intervention on larger sample size, increase the intervention time by more than 4 weeks, have a long-term follow-up of participants, add a control group, and study other instrument-assisted techniques on subjects with CMNP.It is important to mention that we did not conduct this study on COVID patients. It was conducted during COVID time though. Being infected with COVID was not a criterion of inclusion or exclusion, rather, it was a factor for which our participants were restricted from engagement in regular college life (probably like the rest of the world). We might though have a subject or two who was considered a “long hauler” but unfortunately, we do not have documentation of this.