Data for admission;
Demographics details (age (25-50), weight, height), VAS> 30mm with activity at baseline, Patients diagnosed with chronic nonspecific neck pain following palpable trigger points for more than 3 months, Presenting unilateral (or bilateral) trapezius myofascial trigger points (3 to 6) for more than 3 months with an intensity disturbing normal daily activity.
Sampling
The sample size was measured using the “G-power” 3.1.9.4 version available software by taking into consideration the mean and standard deviation of previous published data. Then, 15 participants were specified as the sample of each group.
Myofascial trigger point will be confirmed by the following diagnostic criteria:
Primary criteria (all 5 are needed):
1. Regional pain complaint.
2. Pain complaint or altered sensation in the expected distribution of referred pain from a trigger point.
3. Taut band palpable in an accessible muscle
4. Exquisite spot tenderness at 1 point along the length of the taut band.
5. Some degree (20 to 60 degrees) of restricted range of motion.
Secondary criteria (1 of 3 is needed):
1. Reproduction of clinical pain complaint, or altered sensation, by pressure on the tender spot.
2. Local twitch response elicited by snapping palpation at the tender spot or by needle insertion into the tender spot.
3. Pain alleviated by elongating (stretching) the muscle or by injecting the tender spot.
Method of assignment to study groups
The simple random sampling technique will be used to distribute 45 participants into groups of intervention; each participant has the opportunity to choose the intervention group randomly by pick up a small paper on which the name of the intervention will be written.
Procedure of Intervention:
The participants will be randomly allocated into three groups:
1) Group A: High power static ultrasound + dry cupping + standard medical care
2) Group B: Dry cupping + standard medical care
3) Group C: standard medical care
Each protocol of intervention consists of 8 sessions over 4 weeks (2 sessions per week). All participants will receive standard medical care including 7 minutes of superficial heat (hot pack) at a temperature of 65.5 °C, 20 minutes of pulsed mode TENS with a duration of 100–110 μs, and a frequency of 70–80 Hz, symmetrical with 4 electrodes and Upper trapezius stretching exercises.
Additionally, the High power static ultrasound technique will be applied according to the following settings: 1 MHz frequency, 1.5 W/cm2 intensity, for 2 minutes on each point (Less than 10 points). And Dry cupping, plastic cups with medium power of suction will be applied on injured area by 4-10 glasses with sizes of cup 25 to 50 mm, 10 to 15 min on the trigger points for each cup. It’s worth mention that the participants were asked not to take analgesics or non- steroid anti-inflammatory drugs (NSAIDs) to avoid the analgesic effects of these drugs throughout the study period.
Data Analysis
The SPSS version 26 will be used. The normality of the data will be assessed using the Kolmogorov-Smirnov test, then it would be confirmed by using the one-way ANOVA test at baseline to check any significant difference between participants before the intervention. After that, if the data was normally distributed, the repeated measures ANOVA will be used to compare between groups and the paired sample t-test will be used to assess the significance of the improvement after the intervention. If the data was not normally distributed, the Wilcoxon test and the Mann-Whitney U test will be used. It’s worth noting that the level of significance will be considered at p<0.05 with an interval of confidence of 95%. Moreover, the descriptive analysis will be based on mean and standard deviations of the demographic variables of the participants.