The subject entered the treatment room and filled out the pain scale. If the pain level was at least 30 mm, the examiner then took the other baseline measurements. The TrP located in the area of TrP1 or TrP2, on the same side as the neck pain, was marked with a cross using a skin-pencil. If both trigger points were involved, the most tender TrP was used. If the subject had bilateral neck pain, the upper trapezius with the most tender TrP was used.
To determine cervical lateral flexion, the CROM device was attached to the subject’s head with straps and the subject was asked to sit up straight and first laterally flex the head to the right (degrees of lateral flexion was recorded) and then laterally flex the head to the left (degrees of lateral flexion was recorded). For entry into the study, the subject had to have decreased lateral flexion to the side opposite the active upper trapezius TrP. It was this measurement that was used in the statistical analysis.
To measure PPT, the rubber tip of the PA was placed over the cross signifying the TrP location and the patient was instructed to indicate when the sensation changed from pressure to pain. The pres- sure was steadily increased at a rate of 1 kg/cm2/s.
The examiner then left the room and the treat- ing clinician entered. The clinician opened the next consecutively numbered envelope and deliv- ered the assigned treatment. To mask the exam- iner to treatment assignment, the clinician set the timer on the ultrasound machine for each subject, placed ultrasound lotion over the trigger point and then wiped it off for each subject, and kept each subject in the treatment room for 3min. The clinician advised each subject not to discuss any- thing about the treatment with the examiner. The clinician then left the room and the examiner entered and conducted the post-tests within 5 min of treatment.