Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014

23







TO ANALYSE THE SHORT TERM EFFECT OF UPPER TRAPEZIUS
INHIBITION TAPING IN PATIENTS WITH MECHANICAL NECK PAIN

Meenakshi Verma*, Nidhi Gautam**, Deepak Raghav***, Tanvi Aggarwal****


ABSTRACT
Background and Purpose: Improving pain & functional performance in patients with mechanical
neck pain is the priority. The purpose of the study was to visualize the effect of upper trapezius
Inhibition taping on pain score and functional outcome in mechanical neck pain. Method: Thirty
patients who were assessed and diagnosed by mechanical neck Pain were selected. Patients were
given hot pack, stretching strengthening exercises of neck and taping assessed of VAS & NDI score
on 0 sitting,5
th
sitting & 10
th
sitting during intervention . Results : The outcome measures (NDI and
VAS) over the periods were compared by one factor repeated measures analysis of variance (ANOVA)
using general linear models (GLM) and significance between groups (periods) was done by Turkey
HSD (honestly significance difference) post hoc test after ascertaining the normality by Shapiro-Wilk
test and the homogeneity of variance by Levenes test. Conclusion: the result of the study suggests that
upper trapezius inhibition taping shows significant improvement in visual analogue scale and neck
disability index in patients with mechanical neck pain in 2 weeks.

Keywords. Mechanical neck pain,upper trapezius inhibition taping,neck disability index,Visual
Analogue Scale Upper trapezius stretching, scalene(anterior) stretching,sternocleidomastoid
stretching,neck isometrics.
24
INTRODUCTION
Mechanical neck pain defines cervical spine
pain as pain perceived anywhere in the
posterior region of the cervical spine, from the
superior nuchal line to the first thoracic spinous
process
1
Mechanical neck pain commonly
arises insidiously and is generally multifactorial
in origin, including one or more of the
following: poor posture, anxiety, depression,
neck strain, and sporting or occupational
activities.
2,3

Neck pain affects 3050% of the general
population annually 15% of the general
population will experience mechanical neck
pain (>3 months) at some point in their
lives.1114% of the working population will
annually experience activity limitations due to
neck pain. Prevalence peaks at middle age, and
women are more often affected than men. Risk
factors include repetitive work, prolonged
periods of the cervical spine in flexion, high
psychological job strain, smoking, and previous
neck/shoulder injury.
4
Despite the prevalence,
less-than optimal prognosis, associated risk of
disability, and economic consequences of
individuals suffering from mechanical neck
pain, there remains a significant gap in the
literature, which fails to provide sufficient,
high-quality evidence to effectively guide the
conservative treatment of this patient
population
5

A biomechanical mechanism that may explain
this association involves impairment in
alignment of cervical spine and scapula are
commonly cited as possible source of pain and
dysfunction
6
and Range of motion
limitations
7
.The scapula and cervical spine are
anatomically linked through the upper trapezius
muscle,changes of the alignment of either the
scapula or cervical spine can potentially
influence the biomechanics of the other by
altering the tension at the upper trapezius
muscle
8
it has been suggested that an ideal
vertical scapular alignment is when the scapula
is located between the spinous process of
second and seventh thoracic vertebrae
9
.It has
been proposed that the depressed scapular
alignment affect neck function potentially
through increasing compressive loading in the
neck region . Mechanical pain occurs due to
changes in muscle length when assuming a
poor posture for a prolonged period and
performing repetitive movements
10
. Faulty
cervical spinal alignment, such as Forward
Head Posture(FHP), is usually associated with
shortening of the neck extensor muscles i.e.
trapezius, levator scapulae, serratus
anterior,rhomboids etc, and lengthning and
weakness of the anterior neck muscles i.e.
scalene,sternocleidomastoid,longus capitis
longus colli and , as well as the shoulder
muscles, affecting scapular position and
kinematics
11
.Weakness of anterior cervical
muscles is postulated to contribute to persistent
neck pain in patients with mechanical neck
pain, quantitation of weakness has never been
reported
12
. The trapezius muscle is divided into
3 areas upper fibers,middle fibers & lower
fibers. The significance of this division lies in
the variety of functions performed by this
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
25
muscle. The trapezius muscle has several
functions to move the shoulder blade in toward
the spine, to rotate the shoulder blade so that
the topmost part of the upper arm faces up,to
move the shoulder blade up and down,to bring
the head and neck in a backward direction, to
rotate and side bend the neck,to assist in
breathing etc. The trapezius muscle works to
move the neck in several directions, its degree
of tightness or looseness affects neck
flexibility. For people who work at desks and
computers, or who spend many hours driving,
the upper trapezius is the muscle on top of your
shoulder that becomes very sore and
painful
36,37,38

Postural deviations observed in FHP involve a
downwardly rotated, anteriorly tilted, and
protracted scapula leading to imbalanced
movement of neck.
13
Physiotherapists often
give advice about changing lifestyles with an
emphasis on posture, in addition to teaching
specific exercises. Exercises and certain
electrotherapeutic modalities are commonly
used to improve pain & neck muscle function
& thereby decrease pain or other symptoms.
Massage, manual therapy, neck strengthening
& stretching exercises have also improved pain
& neck functions
14
Elastic therapeutic taping
offers a unique combination of flexibility and
support, providing practitioners with a tool to
address a variety of conditions. Since 1973,
when Kenzo Kase, DC, began developing the
concepts in his practice, and then introduced its
use in the 1980s, the range of applications has
expanded tremendously
15
.
To the extent there is no evidence shows the
study about analysis of short term effect of
upper trapezius inhibition taping technique in
patients with mechanical neck pain.

METHODOLOGY
Subjects: 30 patients were taken in the study
with mechanical neck pain with duration of
symptoms for 2 week. The exclusion criteria
included that patient Cervical pathologies
Cervical spine Fracture, Migraine,
Cervicogenic Headache, Trigger points in neck
or scapular muscles, allergy to taping product.
Subjects were selected and received
conventional treatment of neck with upper
trapezius inhibition taping. Protocol : All
patients underwent a descriptive orthopaedic
assessment. A baseline measurement of all the
variables visual analogue scale , neck disability
index was taken.

Visual analogue scale
The VAS is presented as a 10 cm horizontal
line, anchored by verbal descriptors labeled
with no pain at point zero (0 cm) and worst
imaginable pain at point ten (10 cm). The
patient marks the line at the point
corresponding to the intensity of the pain
currently experienced. Using a 1 cm-per-point
scale to measure the patients score, the VAS
provides ten levels of pain intensity. The visual
analog scale (VAS) is a valid and reliable
measure of chronic pain Intensity.
19


Neck Disability Index
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26
The NDI is the most widely used, translated
and oldest questionnaire for neck pain. It has
been shown to have high test-retest
reliability. It consists of 10 questions.
Questions include activities of daily living,
such as: personal care, lifting, reading, work,
driving, sleeping, recreational activities, pain
intensity, concentration and headache. Each
item scored from 0-5 and total score is
expressed as a percentage with high scores
corresponding to greater disabilities.
20,28,29


Upper trapezius Inhibition Taping
Elastic therapeutic taping offers a unique
combination of flexibility and support,
providing practitioners with a tool to address a
variety of conditions. Since 1973, when Kenzo
Kase, DC, began developing the concepts in his
practice, and then introduced its use in the
1980s, the range of applications has expanded
tremendously.

DATA ANALYSIS
The data were summarized as Mean SD. The
outcome measures (NDI and VAS) over the
periods (sitting 0, sitting 5th and 10th ) were
compared by one factor repeated measures
analysis of variance (ANOVA) using general
linear models (GLM) and significance between
groups (periods) was done by Tukey HSD
(honestly significance difference) post hoc test
after ascertaining the normality by Shapiro-
Wilk test and the homogeneity of variance by
Levenes test. All analyses were performed on
STATISTICA (window version 6.0).

RESULTS
Table shows the mean age and standard
deviation of patients.
Characteristics Statistics
Age (yrs) 25.30 2.84

Comparisons NDI
0 sitting vs. 5
th
sitting P<0.001
0 sitting vs. 10
th
sitting P<0.001
5
th
sitting vs. 10
th
0.149

Comparisons VAS
0 sitting vs. 5
th
sitting P<0.001
0 sitting vs. 10
th

sitting
P<0.001
5
th
sitting vs. 10
th

sitting
0.149

NDI (score)
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
day 1 day 5 day 10
Treatment periods
M
e
a
n

S
D


Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
27
VAS (score)
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
day 1 day 5 day 10
Treatment periods
M
e
a
n

S
D


DISCUSSION
The aim of the study was to analyze the short
term effects of upper trapezius inhibition taping
in patients with mechanical neck pain. The
results of the study suggest significant
differences in NDI & VAS score favouring the
upper trapezius inhibition taping. Upper
trapezius inhibition taping may be a viable
option for treating mechanical neck pain.
It has been observed and described how Pain
in the neck region may occur because of a
downward pull on the cervical vertebrae or
facets by the upper trapezius muscle as well as
by the weight of the upper extremity along with
mal-alignment or movement of scapula has the
potential to alter the biomechanics of the
cervical spine and produce neck pain..
Increased upper trapezius stiffness may
contribute increased compressive load and
shear force on the cervical spine during active
neck movement. Repetitive and excessive stress
on the upper trapezius muscle has the potential
to cause cumulative micro trauma in the
cervical region, neck pain, and limited neck
rotation range of motion. Upper trapezius
inhibition taping technique significantly
increased the maximum active neck rotation
range of motion ,neck pain and daily functions.
Taping the skin overlying the trapezius muscle,
as performed in this study, traction on the skin
Or the pressure of the tape provides cutaneous
sensory cues, thus providing additional
proprioceptive input to the central nervous
system. inhibits its reflexes therefore results in
reduction of swelling, Accelerate blood flow
,Contribute to optimizing movement patterns
34
,
therefore reduce mechanical stress on the
cervical spine, and does Promotion of optimal
inter joint coordination, modification of
scapular alignment is currently performed in
the clinical field and in studies. Effect of
Taping on posture is Inhibition of overactive
movement synergists and antagonists;
Facilitation of underactive movement
synergists; Direct optimization of joint
alignment during static postures or movement;
Offloading irritable neural tissue; Direct or
indirect reduction of pain associated with
movement.
31,40,17
. These findings are supported
by study done by Host HH et al a case reports
scapular taping can be used as an adjunctive
therapy to attempt to attain a more favorable
scapular alignment and alleviate pain
31
The
tape should never restrict a patients ROM
,Additionally it should allow the patient to
perform motions that would have been painful
without the tape in place thus providing an
immediate assessment of the tapes
effectiveness. upper trapezius inhibition taping
should be used in conjunction with other
intervention especially selected exercise and
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28
patient education about modification of
performing neck movements. Taping along the
length of a muscle inhibits that muscles reflex
excitability
41
.
It is also supported by the study done by peter
miller et al they suggested there may be a
potential role for taping as an adjunct to usual
physiotherapy treatment in management of
people with mechanical neck pain.
35


CONCLUSION
The present study evaluates the short term
effect of upper trapezius inhibition taping and
hypothesized that it may be effective in
treatment of mechanical pain, was found to be
true. The neck related disability (NDI) and pain
(VAS) improved significantly by 85.4% and
74.5%, respectively in patients of mechanical
neck pain. The present study thus concluded
that there is a short term effect of upper
trapezius inhibition taping in mechanical neck
pain. The study states that null hypothesis is
rejected.

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CORRESPONDING AUTHOR:
*Assistant Professor, Santosh College of Physiotherapy, Ghaziabad
**Student MPT Musculoskeletal, Santosh College of Physiotherapy, Ghaziabad
***Principal, Associate Professor, Santosh College of Physiotherapy, Ghaziabad
****Assistant Professor, Santosh College of Physiotherapy, Ghaziabad