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EFFECTS OF THE WINBACK THERAPY ON PAIN AND PHYSIOLOGICAL CHARACTERISTICS OF THE TRAPEZIUS IN PATIENTS WITH WORK-RELATED MUSCULOSKELETAL DISORDERS

SAMWON YOON

Department of Physical Therapy, Catholic University of Pusan, Pusan 46252, Republic of Korea

E-mail Address: idmap33@naver.com

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CHANHEE PARK

Department of Physical Therapy, Yonsei University Wonju 26493, Republic of Korea

E-mail Address: chaneesm@gmail.com

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ILBONG PARK

Department of Sports Rehabilitation, Busan University of Foreign Studies, Busan 46234, Republic of Korea

E-mail Address: Fnjboss@naver.com

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CHAEKWAN LEE

Department of Sports Rehabilitation, Busan University of Foreign Studies, Busan 46234, Republic of Korea

E-mail Address: cklegend@naver.com

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, and

YOUNGJOO CHA

Department of Physical Therapy, Cheju Halla University, Jeju 63092, Republic of Korea

E-mail Address: daylight0z@naver.com

Corresponding author.

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https://doi.org/10.1142/S0219519422400449Cited by:0 (Source: Crossref)

This article is part of the issue:

A Special Selection on Emerging Techniques for Biomechanics — Part III
Guest Editors: E. P. Pitarch and E. Y. K. Ng

Abstract

The purpose of this study is to investigate how the pain and physiological characteristics of the trapezius change when the Winback therapy is applied to the trapezius in patients with work-related musculoskeletal disorders (WMSDs). This study was conducted on 30 healthy adults living in Jeju Island. After applying the Winback 3SE high-frequency equipment developed in France, the muscle tone, muscle stiffness, pressure pain threshold, and visual analog scale (VAS) of the trapezius were measured. After the intervention, muscle tone decreased from 16.15 ± 2.02 to 14.22 ± 1.83, muscle stiffness decreased from 285.81 ± 58.26 to 245.83 ± 51.62, pressure pain threshold increased from 62.58 ± 23.28 to 79.38 ± 28.27, and VAS decreased from 3.73 ± 0.73 to 1.01 ± 0.02. These improvements were statistically significant (p < 0.05), and the muscle tone, muscle stiffness, pressure pain threshold improved in the experimental group compared to the control group. The Winback therapy was effective in reducing muscle tone, muscle stiffness, and pain of trapezius in WMSDs.

Keywords:

1. Introduction

Work-related musculoskeletal disorders (WMSDs) are accompanied by pain in muscles, tendons, and nerves when repeatedly performing long-term tasks in an unnatural manner, and the incidence rate has been increasing significantly. WMSDs are not limited to industrial work but include administrative work on computers for a long time. WMSDs have also been increasing even in people who use smartphones for long periods of time in an incorrect manner.¹ The most common sites for WMSDs are the shoulder, elbow, and hand/wrist regions.² The lower extremities may be at risk for WMSDs due to work in a long-standing position.³ Recently, many problems due to pain around the neck and shoulder have occurred because of increased computer work or smartphone use. Pressure pain over the upper trapezius may gradually worsen, leading to tension-type neck syndrome.⁴ Posture improvement is the priority to prevent WMSDs of the upper trapezius, and appropriate treatment includes steroid injection therapy, local anesthesia, exercise therapy, and physical therapy. Typical physical therapies for WMSDs in the upper trapezius include mechanical stimulation, such as therapeutic massage, Graston therapy, and electrical therapy.⁵ Mechanical stimulation includes massage, stretching, and Graston therapy.⁵ Mechanical stimulation is visible for extracellular structural changes and is effective in fibroblast and muscle regeneration and pain reduction.⁶ Graston therapy has been reported to be effective in reducing pain by the inactivation of trigger points, taking advantage of these mechanical stimulations. The most common electrotherapy in WMSDs therapy is transcutaneous electrical nerve stimulation (TENS) that uses low frequency and interferential current therapy (ICT) that uses medium frequency, which have been reported by many clinical studies. Gemmell and Hilland reported that TENS causes pain reduction by changing the trapezius pressure pain threshold by currenting at a low frequency. ICT is an electrical treatment that uses new interference currents due to interference phenomena by cross-currenting medium-frequency alternating current at the same point in the human body.⁷ Suh and Lee reported that ICT, unlike TENS, has low skin resistance and subcutaneous tissue resistance; therefore, it is effective in pain and inflammation release and reduces discomfort and burn risk during electrotherapy.⁸ Although not as much as TENS and ICT, which use low and medium frequencies, high-frequency therapy is also being applied. High-frequency therapy is an electrical therapy that applies heat to deep tissues by applying an alternating current of ≥ 100,000Hz as thermal energy.⁹ Unlike TENS and ICT, it generates thermal energy and releases the muscles, tendons, and ligaments, and activates the autonomic nervous system, thereby reducing the fatigue. With the recent development of science and technology, a new method of high-frequency treatment has been widely used in clinical practice. Winback is a high-frequency therapy device developed in France that can effectively treat not only deep muscles and joints, but also the epidermis by currenting the body with a high frequency of 0.4–1.0MHz. The Winback therapy is also called transfer energy capacitive and resistive (TECAR) therapy because it generates TECAR energy, which is a high-frequency energy source. TECAR energy can further promote the physiological metabolism of tissues by passing deep heat to the cell membrane. The WINBACK therapy involves the direct movement of the conductor by the therapist’s hand, so a resistive current with a deep penetration depth and a capacitive current with a low penetration depth can be selectively applied to the area desired by the therapist.¹⁰ However, only a few studies have investigated the effect of the Winback therapy on the trapezius in WMSDs. Therefore, the purpose of this study was to determine how the pain and physiological characteristics of the trapezius change when the Winback therapy is applied to the trapezius in WMSDs. We tested the hypothesis that Winback therapy would improve physiological characteristics and pain of the trapzius, compared to Graston therapy.

2. Materials and Methods

2.1. Subjects

This study recruited patients from Jeju Island who voluntarily agreed to participate in the experiment after knowing the purpose and method of the study. The patients included in this study complained of pain in the upper trapezius fibers when raising the arm, had muscle pain that lasted for more than a month, and had not received physical therapy within the last month. If cervical and thoracic spine problems were the cause of pain, people with neurological symptoms and other musculoskeletal disorders were excluded. The experimental and control groups comprised 15 randomly assigned patients each (Table 1).

**Table 1. General characteristics of the patients.**
	EG	CG
	(n = 15)	(n = 15)	P-value
Gender (male/female)	9/6	10/5
Age (years)	23.53 ± 2.92	23.20 ± 2.81	0.264
Heigh (cm)	167.86 ± 8.72	167.67 ± 7.41	0.812
Weigh (kg)	68.89 ± 13.37	68.24 ± 15.66	0.503

Notes: EG: Experimental group, CG: Control group, and *Mean ± standard deviation.

2.2. Measurements

Both groups underwent trapezius muscle tone, stiffness, pressure pain threshold, and VAS tests before and after the intervention.

2.3. Physiological characteristics of trapezius

The physiological characteristics of the trapezius were measured using MyotonPRO (myoton Ltd., London and myotonas, Estonia) equipment. The MyotonPRO is a device that can quickly and accurately measure the characteristics of a muscle function by measuring the muscle tone and muscle stiffness. The measurement site was used in the same manner as the site where the pressure pain threshold test was performed. For accurate measurement, we attempted to increase the reliability by measuring the same point by marking the muscle belly with a surgical marker pen.¹¹ In one evaluation, the average value was recorded through five percussions, and MyotonPRO was applied vertically to the marker point for evaluation. Muscle tone is denoted as F (frequency, Hz) and is a measure of muscle vibration caused by passive percussion in the stable state of the trapezius.

Muscle stiffness is denoted as S (Stiffness) and refers to the physiological characteristics of a muscle that maintain its shape without changing the original shape during passive percussion of the muscle.¹² This study has reported a high level of reliability.¹¹

2.4. Pressure pain threshold

Algometer pressure (FDX 25 Force Gage, Wagner instruments, USA) was used to measure the pressure pain threshold of trapezius. These tests were consistently implemented by the same investigator (SY) in pre-test and post-test. Subjects who suggest that their physical condition has improved, and subjectively delay the time to say “ouch” or frown after receiving treatment.

At that time, the value of the instrument was extracted from the data. After obtaining three measurements, the average value was recorded as data.¹³

2.5. Visual analog scale

The visual analog scale (VAS) was used to measure trapezius pain. The VAS is scored on a scale of 0–10, where 0 indicates no pain and 10 indicates severe pain. Patients were asked to indicate the level of pain they felt under usual conditions on a chart, and they were measured before and after the intervention.¹⁴

2.6. Intervention

The Winback therapy was applied only to the experimental group using the Winback 3SE high-frequency equipment for 15min. In the first 0–7min, the capacity electric transfer (CET) mode was applied to relax the tense superficial muscles through heat transfer. In the remaining 8–15min, the resistive electric transfer (RET) mode was applied to transfer heat to the deep tissues. The intensity of therapy was maintained in the state just before the patient felt a strong amount of heat. The CET was applied with a fixed electrode attached to the body and coated electrodes in contact with the body. RET was applied using a bracelet-shaped RET conductor fixed on both wrists of the operator.¹⁵

Instrument-assisted soft tissue mobilization (IASTM) was applied only to the control group. IASTM was performed by a physiotherapist. Massage cream was applied to the trapezius muscle of the patients who were sitting correctly, and SWEEP was performed using a Dr. YOUSTM device (Dr. YOUSTM, SEED Technology, Seoul, Republic of Korea). The SWEEP was continuously applied with the skin pressed at a strength of 1kgf for 10min.¹⁶

2.7. Statistical analysis

The data obtained from the study was analyzed using SPSS 22.0 for Windows. All data are presented as mean and standard deviation. Homogeneity verification of the ‘patients’ characteristics was performed using the independent $t$ -test. Normality tests were performed using the Shapiro–Wilk test, and all items were found to be normally distributed. A paired $t$ -test was used to compare the differences in the dependent variables before and after the intervention in each group. An independent $t$ -test was used to determine group differences in each variable for the measured test. Statistical significance (a) was set at 0.05.

3. Results

3.1. Participants’ characteristics

3.2. Muscle tone

There was a statistically significant difference between the two groups after the intervention. After intervention, the experimental group. The changes in the muscle tone after the intervention in the experimental and control groups were 14.22±1.83 (P < 0.001) and 15.03 ± 2.28 (P < 0.012), respectively (Table 2).

**Table 2. The changes in the muscle tone after intervention.**
	Pre	Post	t	P
EG	16.15 ± 2.02	14.22 ± 1.83	7.57	< 0.001*
CG	15.87 ± 2.09	15.03 ± 2.28	2.88	< 0.012*

Notes: EG: Experimental group, CG: Control group, and *Mean ± standard deviation.

3.3. Muscle stiffness

There was a statistically significant difference between the two groups after the intervention. The changes in the muscle stiffness after the intervention in the experimental and control groups were 245.83 ± 51.62 (P < 0.001) and 261.93 ± 52.05 (P < 0.023), respectively (Table 3).

**Table 3. Changes in the muscle stiffness after the intervention.**
	Pre	Post	t	P
EG	285.81 ± 58.26	245.83 ± 51.62	8.21	< 0.001*
CG	273.61 ± 57.64	261.93 ± 52.05	2.55	< 0.023*

Notes: EG: Experimental group, CG: Control group, and *Mean ± standard deviation.

3.4. Pain threshold

There was a statistically significant difference between the two groups after the intervention. The changes in the pain threshold after the intervention in the experimental and control groups were 79.38 ± 28.27 (P < 0.001) and 70.21 ± 26.12 (P < 0.002), respectively (Table 4).

**Table 4. Changes in the pain threshold after the intervention.**
	Pre	Post	t	P
EG	62.58 ± 23.28	79.38 ± 28.27	−6.92	< 0.001*
CG	67.61 ± 25.92	70.21 ± 26.12	−3.89	< 0.002*

Notes: EG: Experimental group, CG: Control group, and *Mean ± standard deviation.

3.5. Visual analog scale

There was a statistically significant difference between the two groups after the intervention. The changes in VAS after the intervention in the experimental and control groups were 1.01 ± 0.02 (P < 0.001) and 1.26 ± 0.45 (P < 0.001), respectively (Table 5).

**Table 5. Changes in VAS after the intervention.**
	Pre	Post	t	P
EG	3.73 ± 0.79	1.01 ± 0.02	13.25	< 0.001*
CG	3.81 ± 0.77	1.26 ± 0.45	11.76	< 0.001*

Notes: EG; Experimental group, CG; Control group, and *Mean ± standard deviation.

3.6. Comparison between groups

There were statistically significant differences in the muscle tone between the groups (P < 0.001). After the intervention, the experimental group changed by 1.92 ± 0.98, whereas the control group changed by 0.57 ± 0.54. There were statistically significant differences in pain threshold between the groups (P < 0.001). After the intervention, the experimental group changed by 16.81 ± 9.39, whereas the control group changed by 2.59 ± 2.57. There were statistically significant differences in the muscle stiffness between the groups (P < 0.001). After the intervention, the experimental group changed by 40.01 ± 18.87, whereas the control group changed by 11.66 ± 17.67. There were no significant differences in VAS scores between the groups (P = 0.508). After the intervention, the experimental group changed by 2.73 ± 0.79, whereas the control group changed by 2.53 ± 0.83 (Table 6).

**Table 6. Comparison of all variables between groups.**
	EG	CG	t	P
MT	1.92 ± 0.98	0.57 ± 0.54	4.64	< 0.001*
MS	40.01 ± 18.87	11.66 ± 17.67	4.24	< 0.001*
PT	16.81 ± 9.39	2.59 ± 2.57	5.65	< 0.001*
VAS	2.73 ± 0.79	2.53 ± 0.83	0.67	0.508

Notes: EG; Experimental group, CG; Control group, MT; Muscle tone, MS; Muscle stiffness, PT; Pain threshold, VAS; Visual analog scale, and *Mean ± standard deviation.

4. Discussion

This study was conducted on patients with WMSDs. We applied the Winback therapy to the trapezius and measured the physiological characteristics, pressure pain threshold, and VAS of the trapezius to examine the effect of the intervention. The physiological characteristics of the trapezius were measured based on the muscle tone and stiffness. Both the experimental and control groups showed a statistically significant decrease in muscle tone after the intervention, with no significant difference between the groups. Similarly, there was a statistically significant decrease in muscle stiffness after the intervention but there was no significant difference between the groups. Kim et al. also reported that muscle tone and stiffness of the gastrocnemius improved when the Winback therapy was used.¹⁷ Ganzit et al. reported that the Winback therapy has a positive effect on the locomotor system by improving muscle tone and muscle stiffness.¹⁰ Based on Kim et al. which claims that the Winback therapy can improve muscle tone and muscle stiffness by providing heat to deep tissue, and the results of this study, Winback therapy can be seen to be effective for muscle tone and muscle stiffness of the trapezius in WMSDs.¹⁷ The pressure pain threshold and VAS score were used to determine the patient’s pain level. The pressure pain threshold indicates the minimum pressure that causes pain and is used as a pain assessment tool. When the pressure pain threshold is lowered, it indicates higher sensitivity to pain. Both the experimental and control groups showed a statistically significant increase in the pressure pain threshold after the intervention, and there was no significant difference between the groups. This result suggests that the Winback therapy had a positive effect on the pressure pain threshold of the trapezius, similar to the IASTM technique. Both the experimental and control groups showed a statistically significant decrease in VAS after the intervention, and there was no significant difference between the groups. This result seems to indicate that the Winback therapy had a positive effect on the resting pain of the trapezius, similar to the Graston technique. Park et al. applied the Winback therapy to the trapezius and reported a significant increase in the pressure pain threshold of the trapezius after the intervention.¹⁸ High-frequency diathermy in the Winback therapy can increase the pain thresholds because it locally raises the tissue temperature by 40°–45°.¹⁵ Bretelle et al. and Ha and Lee reported that the Winback therapy was effective in reducing the VAS scores.^19,20 Based on the results of previous studies and this study, the Winback therapy is considered to be effective in reducing the pain of the trapezius muscles. The high-frequency current provided by the Winback therapy is converted into thermal energy in the body, leading to an increase in the temperature of the deep tissues and vasodilation, microcirculation, and activation of the autonomic nerve. Therefore, it is thought to be effective in reducing muscle tone, stiffness, and pain, as in this study.^10,21 However, this study had some limitations. Because the standard deviation of the measured values was large, statistical interpretation was difficult. It is difficult to generalize the results of this study because there were not enough patients, and only short-term effects were studied. Therefore, it will be necessary to recruit more patients in the future and determine the long-term effects of the Winback therapy.

5. Conclusions

This study aimed to investigate the effect of the Winback therapy on muscle tone, muscle stiffness, pressure pain threshold, and pain in the trapezius in WMSDs. The Winback therapy decreased muscle tone and muscle stiffness, increased pressure pain threshold, and reduced pain, similar to the IASTM technique. The results of this study showed that the Winback therapy is effective for the physiological characteristics and pain reduction of the trapezius in WMSDs. In the future, we propose a study to investigate the long-term effects of the Winback therapy for the trapezius in WMSDs by securing more patients and a longer study period.

Acknowledgment

This work was supported by a research grant from the Busan University of Foreign Studies in 2022.

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Vol. 22, No. 09

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History

Received 12 January 2022

Accepted 8 June 2022

Published: 4 November 2022

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This is an Open Access article published by World Scientific Publishing Company. It is distributed under the terms of the Creative Commons Attribution 4.0 (CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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