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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 51  |  Issue : 4  |  Page : 145-150

Comparison between myofascial release and myofascial taping as an adjunct to conventional occupational therapy in the management of dequervain's tenosynovitis: A randomized controlled trial


1 Occupational Therapist, M.O.Th. (Musculoskeletal Sciences), B.O.Th., Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India
2 OT School and Centre, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India

Date of Submission25-Sep-2019
Date of Acceptance13-Dec-2019
Date of Web Publication3-Jan-2020

Correspondence Address:
Dr. Taslina Abdulkader
48, Malik Dinar Manzil, Kambekar Street, Byculla, Mumbai - 400 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoth.ijoth_26_19

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  Abstract 


Background: De Quervain's tenosynovitis, the most common overuse injury involving the wrist. There is no consensus in the treatment of De Quervain's tenosynovitis; both surgical and conservative medical management have adverse effects. Myofascial release (MFR) and myofascial taping (MFT) are newer techniques which have been proven effective for other inflammatory and noninflammatory musculoskeletal conditions. Hence, the study was planned to determine and compare the effectiveness of the both the above-mentioned adjunct method along with conventional occupational therapy in the treatment of De Quervain's tenosynovitis. Objective: The objective of this study is to compare and study the effectiveness of MFT and MFR as an adjunct to conventional occupational therapy treatment in patients with De Quervain's tenosynovitis. Study Design: A prospective, comparative randomized controlled trial was conducted for 18 months. Methods: A total of 31 patients (both males and females aged 20-40 years) diagnosed with De Quervain's tenosynovitis, referred to outpatient department were randomized into two groups after screening by simple random allocation using computerized generated table, patients in MFT group (n = 16, 11 females and 5 males) received MFT along with conventional treatment and patients in MFR group (n = 15, 9 females and 6 males) received MFR along with conventional treatment. They followed up for treatment for 5 weeks, two times a week with each session lasting for 30-40 min. Pain level and functional improvement were evaluated using Visual Analog Scale (VAS) score and Patient-Specific Functional Scale (PSFS) score, respectively, before therapy and at the end of the 3rd and 5th week of the 5-week therapy program. Results: Both the groups showed significant improvement in pain scores on VAS at the 3rd and 5th weeks (P < 0.05). There was no significant difference in the values between the two groups at 3rd week, but at the end of 5th week, MFT Group showed significant improvement in pain than MFR Group. Both the groups showed significant improvement in functional scores on PSFS at the 3rd and 5th weeks at value ofP < 0.05 with 95% confidence interval. Conclusion: Although both MFT and MFR showed improvement in function and decrease in pain, when compared we could conclude that MFT along with conventional occupational therapy yield significantly better outcome measures in terms of decreasing pain and improving function.

Keywords: Myofascial Pain, Myofascial Release, Occupational Therapy, Pain Relief, Tenosynovitis, Therapeutic Taping


How to cite this article:
Abdulkader T, Nadkarni K. Comparison between myofascial release and myofascial taping as an adjunct to conventional occupational therapy in the management of dequervain's tenosynovitis: A randomized controlled trial. Indian J Occup Ther 2019;51:145-50

How to cite this URL:
Abdulkader T, Nadkarni K. Comparison between myofascial release and myofascial taping as an adjunct to conventional occupational therapy in the management of dequervain's tenosynovitis: A randomized controlled trial. Indian J Occup Ther [serial online] 2019 [cited 2020 Sep 22];51:145-50. Available from: http://www.ijotonweb.org/text.asp?2019/51/4/145/274807




  Introduction Top


De Quervain's tenosynovitis is the most common overuse injury involving the wrist and often occurs in individuals who regularly use a forceful grasp coupled with ulnar deviation of the wrist. It is a thickening of the sheath encompassing the tendons of the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons which provides motion at the first metacarpophalangeal and first carpometacarpal joint, respectively. Stenosis of the synovial sheath encompassing these tendons, resulting resisted gliding of the APL and EPB, leads to pain with movement of the thumb, especially with repetitive extension and abduction. However, there is no consensus in the treatment of this.[1],[2] Both the operative and nonoperative management of this disease have complications.[3],[4],[5],[6],[7],[8],[9] Myofascial release (MFR) and myofascial taping (MFT) are newer techniques which have been proven effective for other inflammatory and noninflammatory musculoskeletal conditions.[10],[11],[12] Hence, the study was planned to determine the effectiveness of MFT and MFR as an adjunct to conventional occupational therapy treatment on patients with De Quervain's tenosynovitis.


  Methods Top


Research design was a prospective, interventional, comparative, randomized controlled study. The study was initiated after receiving an approval from the Institute Ethics Committee and the Maharashtra University of Health Sciences Review Board. The sample size calculated for the study was a total of 50 patients including the dropouts, 25 patients in each group. A total of 36 patients both males and females, who attended occupational therapy outpatient department, aged between 20 and 40 years, diagnosed with De Quervain's tenosynovitis, meeting the inclusion and exclusion criteria were included in the study. Written informed consent was obtained from all patients who participated in the research study. Patients were allocated into two groups by simple random allocation using the computerized generated table. MFT Group included a total of 19 patients (11 females and 8 males) and MFR Group included a total of 17 patients (10 females and 7 males). There were five dropouts from the study, three from MFT group (3 males), and two from MFR group (1 male and 1 female) Hence, the study was completed by 31 patients with 16 in MFT group (11 females and 5 males) and 15 in MFR group (6 males and 9 females). Case record forms were filled which included demographic data, diagnosis, medical history dominance, and occupation of the individual. Baseline evaluations included assessing pain level on Visual Analog Scale (VAS) and functional activity limitations on Patient-Specific Functional Scale (PSFS) provided in Hindi, Marathi, or English) and were assessed on the 1st day before the initiation of therapy, end of 3rd week, and end of 5th week after the therapy. Patients in MFT Group received MFT along with conventional treatment and patients in MFR Group received MFR along with conventional treatment. They followed up for treatment for 5 weeks, two times a week with each session lasting for 30-40 min. A home program was also given for the other days of the week.

Outcome Measures

Visual Analog Scale

VAS[13] is a unidimensional subjective measure of pain intensity. The patients were asked to mark on the line, marked with numbers ranging from 0 to 10; at the point that they feel represents their perception of their current state.

Patient-Specific Functional Scale

PSFS, a subjective scale, was developed by Stratford, Gill C, Westaway M, and Binkley J (1995).[14] This is a questionnaire used to quantify activity limitation and measure functional outcome for patients with any orthopedic conditions, where the examiner will ask the patients to identify up to five activities that the patient is unable to do or having difficulty with the result of their condition. It provides scoring scheme ranging from 0 to 10 points where the patient points to one number between 0 and 10 for each activity, 0 indicates unable to perform activity, and 10 indicates able to perform activity at the same level as before injury or problem.

Protocol

Myofascial Taping Group: Myofascial Taping along with Conventional Treatment

Patients in this group received following treatment. MFT of the thumb along the radial side of the wrist after the acute stage of tenosynovitis and conventional occupational therapy treatment according to the stage of tenosynovitis. The type of the tape used was elastic, self-adhesive, air permeable FLEXOTAPE with an elasticity of approximately 130% of its original length which ensures full range of motion and simultaneously enhances muscle function. The material consists of cotton with polyurethane threads with a hypoallergic 100% acrylic adhesive. Altogether it is water resistant, air and liquid permeable, providing proper ventilation. The tape was worn by the patient for 3-4 days depending how long it stays on patient's hand. Taping was started in the subacute phase of the conventional treatment method as soon as the symptoms start to subside. Two strips of the tape were used and all the borders were cut curved to prevent early separation. Position Wrist in radial deviation and slight extension, thumb and first metacarpal extension and abduction. Split one end of the first strip down up to the middle leaving approximately “1” as full width. Commence on the distal phalanx of the thumb to maximize the lever arm. Maintain the thumb and wrist position and apply the first strip along the APL and EPB tendons. Direct the remaining half of the tape along the extensor pollicis longus tendon. The elastic energy in the tape will create a longitudinal gathering of soft tissue. Second strip will be a transverse strip and pinch offload can be applied to increase the soft tissue offload. The transverse strip is also applied with the thumb and wrist in same position. This method assists eccentric control of thumb flexion and assists extension and abduction. The split “V” formation creates an effective lift, enhanced by the transverse strip, to provide a soft tissue offload through the anatomical snuff box. Reduce loading of APL, EPB and EPL, decreases pain, enhance tendon gliding, and improved function. It also provides approximation force to enhance proprioception and joint stability.

Myofascial Release Group: Myofascial Release along with Conventional Treatment

Patients were given MFR using the direct release method for 15 min. MFR was started in the subacute phase of conventional treatment method as soon as the symptoms started subside. The direct release method was used. It is a method which works directly on the restricted fascia. Restricted fascia was located by palpation. Once in contact with the restricted fascia tension or stretch is applied along the line of tension. Move or drag the fascia across the surface while staying in touch with the underlying layer and exit. Repeat until the trigger point or the restricted fascia is palpably relaxed and also, conventional occupational therapy treatment according to the stage of tenosynovitis.

Conventional Treatment for Myofascial Taping and Myofascial Release Group

Progressive program which was individualized according to the patient's tolerance for activity and his or her stage of tenosynovitis.

Acute stage: In this stage, there is increased fluid in the sheath mainly serous exudate, and hence, conventional treatment aimed to protect injury from further damage and included symptom control measures.

  1. Hand splint for thumb and wrist for at least 2 weeks to settle the pain before starting to move the thumb or wrist[15],[16]
  2. Help identify risk factors/aggravating activities. Patients were advised to avoid motions that evoke pain, such as those involving twisting of the wrist and pinching with the thumb (activity modification)
  3. Task modifications and ergonomic recommendations. Workspaces and hobbies can be evaluated and modified ergonomically to accommodate neutral alignment of the wrists and hands with activities such as typing. This helps to decrease chronic overuse of the APL and EPB tendons
  4. Icing to reduce inflammation and edema twice a day for 5 min
  5. Therapeutic ultrasound.[17]


Patients were advised to take splint off for light activities of daily living activities and gentle range of motion exercises such as wrist flexion/extension/deviation exercises and finger range of motion exercises and stretching of the muscles like opposition stretch was started within patient's pain tolerance.

Subacute/chronic stage: Progressive strengthening program was started as soon as the symptom begin to subside in terms of

  1. Increasing repetitions and adding small weights
  2. Isometric grip and pinch exercises 3-5 repetitions at first, increases should be made only if the symptoms do not increase
  3. Wrist flexion/extension/deviation exercises contractions were initially sub maximal. Conditioning was started after symptoms completely subsided
  4. Increase in the intensity and duration of exercises with added resistance
  5. Wrist flexion extension strengthening, radial deviation strengthening with weights, palm down curls, finger spring, and rubber band exercises
  6. Ergonomic workstation assessment if needed
  7. Educating patient to either avoid or decrease repetitive hand motions such as pinching, wringing, turning, twisting, or grasping.


Data Analysis

Composite total score of VAS scale and PSFS scale at day 1, 3rd week, and 5th week were analyzed statistically using the IBM® SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp.). The Wilcoxon signed-rank test is to assess the statistical significance between two successive assessments over two related samples for components and total score of each outcome measure, i.e., VAS and PSFS. The Mann-Whitney U-test is to assess the statistical significance between the two Independent samples at baseline, 3rd, and 5th weeks for components and total score of each outcome measure VAS and PSFS. The level of statistical significance was set as P ≤ 0.05 and 95% confidence interval values were also computed.


  Results Top


Both the groups showed significant improvement in pain scores on VAS at the 3rd and 5th weeks [Table 1] and [Table 2]. Both the group also showed significant improvement in functional performance on PSFS at 3rd and 5th weeks [Table 3] and [Table 4], However, as the intervention progressed MFT Group showed significant improvement in pain, compared to MFR group at the end of 5th week [Table 5] and significant improvement in PSFS score over MFR group at the end of 3rd week and 5th week [Table 6].
Table 1: Visual Analog Scale Scores at Day 1, 3rd Week, and 5th Week of Myofascial Taping Group

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Table 2: Visual Analog Scale Scores at day 1, 3rd Week, and 5th Week of Myofascial Release Group

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Table 3: Patient-Specific Functional Scale Scores at Day 1, 3rd Week, and 5th Week of Myofascial Taping Group

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Table 4: Patient?Specific Functional Scale Scores at day 1, 3rd Week, and 5th Week of Myofascial Release Group

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Table 5: Comparison of Visual Analog Scale Scores at day 1, 3rd Week, and 5th Week of Myofascial Taping Group and Myofascial Release Group

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Table 6: Comparison of Patient-Specific Functional Scale Scores at Baseline, 3rd Week, and 5th Week of Myofascial Taping Group and Myofascial Release Group

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  Discussion Top


In this study, our primary outcome measures were pain and function during 5-week rehabilitation program. Both the groups showed significant improvement in pain scores on VAS at 3rd and 5th week. This shows that both MFT and MFR are effective in reducing pain, which is in conjunction with similar studies done, showing that taping method was effective for pain relief and increasing range of motion of the knee joint in the elderly patients, in patients with OA knee, and in stroke patients.[18],[19],[20] Similarly, MFR was effective for pain relief in Whiplash syndrome patients, neck pain patients, chronic low back pain patients, patients with fibromyalgia and for occupational mechanical neck pain[21],[22],[23],[24],[25] When compared, there was no significant difference in the values between the two groups A and B at 3rd week. This could be explained by the fact that the aim in both the groups was to immobilize and reduce pain for the first 2 weeks. However, as the intervention progressed Group A showed significant improvement in pain, compared to Group B at the end of 5th week. This could be because the tape after applied stays for around 2-3 days and the most important advantages are that the effects are maintained during any movement 24/7 in that time span, thereby maintaining the enhanced microcirculation of the blood and lymph and helps in accelerating tissue repair and thereby sustained reduction of pain, which might not have happened in MFR.[10] Both the groups also showed significant improvement in functional performance on PSFS at the 3rd and 5th weeks. This shows that both MFT and MFR are effective in improving functional outcome which have been shown in similar studies done, showing that taping improves functional activities with both, upper and lower limbs, and improves functional independence in individuals with patellofemoral pain syndrome, and functional outcome in children with motor impairments.[26],[27] Similarly, MFR has shown to decrease functional disability in lateral epicondylitis in computer professionals, in patients with plantar heel pain and in fibromyalgia.[25],[28],[29],[30] When compared Group A showed significant improvement in PSFS score over Group B at the end of 3rd week and 5th weeks which may be because the tape after applied stays for around 2-3 days and regulates myofascial tension and supports and unloads injured soft tissues. It also gives a constant proprioceptive feedback and help facilitate muscle activity to increase the effectiveness of therapeutic exercises.[10]


  Conclusion Top


Although the results showed statistically significant improvement in visual analog score and patients-specific functional score indicating both methods as effective adjuncts to conventional occupational therapy management of Dequervain's Tenosynovitis, when compared, MFT showed significant improvement in the scores over MFR and with comparison to the existing literature we could conclude that MFT along with conventional occupational therapy management yields better outcome in decreasing pain and improving functions.

Acknowledgment

The author would like to thank the Dean of our institution and Dr. Jayashree Kale, Professor and Head of Department of O.T. Training School and Centre, Seth G.S. Medical College and K.E.M Hospital for kind permission to conduct the study.

Dr. Karuna Nadkarni for continuous guidance and support. Our patients and caregivers for their consent to participate in the study.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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