A new method of muscle elongation in myalgia with Naqvi’s dynamic electrical therapy approach (DELTA)©: the very first case report

Trapezius myalgia (TM) characteristically means pain, stiffness and tightness of the trapezius muscle with more often involvement of the upper fibers. The current lifestyle results in chronic neck and shoulder pain that affects 10-20% of the adult population. [1]. TM marks its presence with pain, stiffness, tight bands of myofibrils, tender nodules along muscle fibers and fascia, which are also called myofascial trigger points and often result in restricted range of motion (ROM). ) [2,3].

Naqvi’s Dynamic Electrical Therapy Approach (Naqvi’s-DELTA)© is a novel approach of interfering vector current along muscle fibers in a dynamic manner. Bifurcated electrode leads are used for dynamic quadrupole application of electrical interference. Electrode selection is based on the principle that electrode size is inversely proportional to current density; as the size of the electrode decreases, the current density increases. The probes are attached diagonally and are symmetrically separated by a high dielectric constant insulator to avoid current concentration. Aquasonic gel is used to reduce the impedance of the skin, which is inversely proportional to stimulation frequency, and the probe unit is moved along the affected muscle fibers in circular, transverse or bar-shaped graphic patterns. eight. Current modulation is formulated using the interference of two medium frequency currents (1kHz-150kHz) producing a deep beat frequency in the tissues which results in the low frequency effect [4]. The four-pole vector mode is used for current administration with the triangular sweep pattern with the beat frequency for 15 minutes. The intensity of the current delivered depends on the patient’s tolerance. The therapist dynamically moves the probe unit along the muscle fibers with vector interference in the four poles of the probe unit module.

The Naqvi’s-DELTA© integrates tissue depolarization without concentrating the current at a specific point in the muscle. Being a novelty, the effectiveness of Naqvi’s-DELTA© was studied on a young adult suffering from neck and shoulder pain. The treatment protocol was synthesized based on the normal physiological tissue response to depolarization during the static electric current approach. The primary endpoints used were the visual analogue scale (VAS) for pain intensity [5]the cervical range of motion (CROM) device for restricted ROM [6]and the secondary outcome used was neck disability index (NDI) for limitation of activities of daily living (ADL) [7].

A 22-year-old man presented to the outpatient physiotherapy department (OPD) with a chief complaint of pain and stiffness in the neck and shoulder area for three years, which gradually worsened and affected his ADLs and therefore restricted its participation.

Clinical discoveries

The onset of pain was gradual, the site being the posterior face of the neck without irradiation. The character of the pain was continuous with a deep dull type of pain, and the intensity on the VAS was 5.1 at rest and 7.4 during shoulder and neck movements. Aggravating factors included any movement of the neck and relieving factors were rest and painkillers.

The patient presented with severe stiffness leading to restricted cervical range of motion. The ROMs have been evaluated (table 1) using the CROM device consecutively for seven days before and after treatment. Pain intensity and NDI score for ADL limitations were also assessed before and after treatment (Table 2).

Chronology

On July 7, 2021, the patient presented to an OPD physiotherapy service and underwent a basic assessment and diagnosis. On the same day, treatment was initiated with Naqvi’s-DELTA©. The follow-up assessment was performed and reported on July 13, 2021.

Diagnostic assessment

The patient’s condition had the differential diagnoses of cervical radiculopathy, cervical spondylosis, or neck and shoulder myalgia. The pain was not radiating in nature, excluding the possibility of cervical radiculopathy. The Spurling test was negative, which clinically excluded cervical spondylosis. The patient had pain, stiffness and tight bands along the muscle fibers pointing to myalgias in the neck and shoulder. Upon evaluation of the bands, the superior fibers of the bilateral trapezius muscle were found to be primarily involved, indicating trapezius myalgia.

Physiotherapeutic intervention

The Naqvi’s-DELTA© was used with the parameters defined for the quadrupole vector with a treatment time of 15 minutes. Channels one and two were set to deliver current according to patient tolerance in continuous mode with a beat frequency between 0 and 150 Hz with a triangular sweep pattern. The unit was moved in a dynamically overlapping circular fashion along the path of the muscle. The Naqvi’s-DELTA© covered the entire muscle’s trigger points throughout its course. The treatment protocol was continued for seven days and each day the patient’s pre-treatment and post-treatment cervical range of motion was noted.

Monitoring and results

The administration of Naqvi’s-DELTA© was undertaken for seven consecutive days, and the observed improvements were analyzed for physiological reasons. The decrease in pain intensity and increase in cervical amplitude, accompanied by ease in ADLs in the patient with TM, were noted with the outcome measures (tables 1–2). The patient was ergonomically counseled to prevent recurrence of the condition [8].

Naqvi’s-DELTA© has physiological effects involving the physical, chemical and mechanical responses of tissue to depolarization at different levels. The subsensory level activates before reaching an individual’s threshold to tolerate the intensity of the current in which leukocytes and macrophages become activated and proliferation of epithelial cells occurs, accelerating the healing process of the tissues in myalgia [9]. After reaching the current threshold, sensory level activation depolarizes the Ab nerves with a phase duration of 1-100 µsec leading to activation of the substantia gelatinosa and in turn closes the gate of pain relieving pain [10]. Motor-level stimulation depolarizes type II motor neurons with a phase duration of 200-400 µsec, developing tension and elongation in muscle fibers releasing enkephalin and endorphin, which in turn closes the door to pain [11]. Harmful level stimulation depolarizes the Ad nerves with a phase duration of 1-100 msec which stimulates the central polarization mechanism closing the pain gate and pain perception. Naqvi’s-DELTA© recruits large-diameter, fast-twitch muscle fibers, causing muscle fibers to contract and lengthen asynchronously as a function of the number of pulses per second [12]. During electrically induced muscle contraction, the Golgi tendon organ cannot undo the tension that develops in the musculotendinous unit, followed by a more rapid onset of fatigue that is alleviated in the Naqvi’s-DELTA © by moving the probe unit along the muscle fibres. [13].

Physiological effects compared to static interferential therapy suggested that the dynamic movement of the probe unit module facilitated muscle fiber contractility, improved blood supply without concentrating current at one point, and facilitated acid drainage lactic accumulated as a metabolite in the myofibrils [14]. Electrical muscle elongation using current interference has been reported as an effective treatment method for different musculoskeletal conditions [15].

The very first case report demonstrated the efficacy of Naqvi’s-DELTA© on pain, tenderness, stiffness, restricted ROM and ADL limitation for TM. The dynamic movement of the probe unit module with the vector-current applied the physiological responses of muscle fibers to depolarization. The demonstrated improvement has opened the possibility of exploring the effectiveness of different electro-medical currents using Naqvi’s-DELTA©.