International association of pain define neck pain as a pain arising from anywhere from superiorly through nuchal line to inferiorly by first thoracic vertebra and laterally up to shoulder. Its prevalence in general population is up to 50%.¹ Most patients suffer from simple or non-specific neck pain, which is mainly caused by mechanical factors such as sprain and strains. They do not only include poor posture and high physical load, but also poor psychological health, stress, low socioeconomic status, and smoking, usually mechanical pain resolves within three to six months; but 14% of the patients will suffer from recurrent or persistent pain.⁷

Myofascial pain syndrome is defined as sensory, motor, and autonomic symptoms resulting from painful spots in the fascia surrounding skeletal muscle known as myofascial trigger points (MTrPs). MTrPs are associated with palpable nodules in taut bands of muscle fibers. Compression of these points may elicit a) motor dysfunction, b) local and referred tenderness, b) pain perceived at a different spot than the site of the painful stimulus (referred pain), c) transient contraction of the muscle (local twitch response) and d) autonomic phenomena. Diagnostic findings of MTrPs include severe ROM limitation, a palpable taut band with exquisitely tender nodule and familiar to patient pain elicited from pressure on painful Spots (jump sign).⁴ There are many therapies available to treat the neck pain like Myofascial Release, Muscle Energy Technique, massage, dry needling, Cupping, Instrument Assisted Soft Tissue Mobilization (IASTM), mobilization etc.¹

IASTM techniques use special stainless-steel instruments that enable clinicians to locate efficiently and treat soft tissue dysfunctions, such as fibrosis, adhesions, chronic inflammation, or degeneration. Benefits from IASTM use include increased fibroblast proliferation, reduction in scar tissue and adhesions, increased vascular response, and remodeling of disorganized collagen fiber matrix. IASTM technique also has been found that it results in clinical benefits such as improvements in range of motion, strength and pain perception following treatment. Despite extensive use of IASTM techniques research regarding its effect on myofascial pain reduction, is limited.⁴ There is converging evidence that cupping can induce comfort and relaxation on a systemic level and the resulting increase in endogenous opioid production in the brain leads to improved pain control. Other researchers proposed that the main action of cupping therapy is to enhance the circulation of blood and to remove toxins and waste from the body.^1,3In Ayurveda also mentioned use of cupping therapy by Acharaya Sushruta named as a raktmoshana in ‘Pradhanakarma’, it implies on blood refine from blood stream. The main aim of this therapy is elimination of vitiated blood from the body. Thought of act of cupping is mainly to increase blood circulation and relive painful muscle tension.¹

From last few years there is growing evidences of dynamic cupping and IASTM in neck pain. IASTM and cupping therapy techniques are procedures rapidly growing in popularity due to their effectiveness and efficiency in treating soft tissue restrictions while remaining non-invasive.

Aim:To compare Dynamic Cupping and Instrument Assisted Soft Tissue Mobilization on myofascial trigger points in the posterior neck fascia 

OBJECTIVES:

• To check the effect of the treatment on Pressure algometer, visual analogue scale, cervical range of motion, neck disability index comparing subjects treated with dynamic cupping and IASTM.
• To check which treatment gives faster and better effects.

PROCEDURE

OUTCOME MEASURES:

GONIOMETER

PRESSURE ALGOMETER

VAS

NECK DISABILITY INDEX

For IASTM, the subject was seated in a comfortable position. The subject’s will be positioned in side lying with the posterior neck fascia exposed. A lubricant (paraffin oil) will be applied to the skin around the neck area prior to treatment and the rock blade was cleaned with an alcohol pad. First, the Rock blade was used to find the exact areas of restriction in the neck region. Then the Rock blade will be used, at an angle of 45 degree and apply slow strokes along the region, without causing any discomfort or pain (sweeping technique) for approximately 3 min.