Document Type : Original Articles
Authors
1 Department of Physiotherapy, Guru Jambheshwar University of Science & Technology, Hisar, Haryana, India
2 Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
3 College of Physiotherapy, Pt. BD Sharma University of Health Sciences, PGIMS, Rohtak, Haryana, India
Abstract
Background: This study aimed to compare the effectiveness of the Integrated Neuromuscular Inhibition Technique (INIT)—a manual therapy approach combining Muscle Energy Techniques (MET), Ischemic Compression (IC), and Strain-Counterstrain (SCS)—with posture correction using a postural belt in individuals with mechanical neck pain.
Methods: In this single-blinded randomized clinical trial, 40 participants with mechanical neck pain (mean age: 34.32 ± 7.90 years) were randomly assigned to two groups. Group A received INIT, while Group B received posture correction through a postural belt. Interventions were administered three times per week over three weeks. Pain intensity, craniovertebral angle (CVA), and neck disability were assessed at baseline and after the third week of intervention.
Results: Both groups showed statistically significant improvements in pain, CVA, and neck disability scores after the intervention (p < 0.05). However, the INIT group demonstrated superior outcomes across all measured variables compared to the posture correction group.
Conclusion: INIT proved more effective than posture correction in reducing pain and disability and improving craniovertebral angle in individuals with mechanical neck pain. Nonetheless, posture correction using a belt may still serve as a viable secondary treatment option due to its simplicity, ease of use, and demonstrated benefits in pain relief and functional improvement.
Keywords
- Bier JD, Scholten PWG, Staal JB, Pool J, Van TMW, Beekman E et al. Clinical practice guideline for physical therapy assessment and treatment in patients with nonspecific neck pain. Physical therapy, 2018;98(3):162-171. DOI: 10.1093/ptj/pzy078.
- Stieven FF, Ferreira GE, Wiebusch M, De Araujo FX, da Rosa LHT, Silva MF. No added benefit of combining dry needling with guideline-based physical therapy when managing chronic neck pain: a randomized controlled trial. The Journal of Orthopaedic & Sports Physical Therapy, 2020;50:1-21. DOI: 10.2519/jospt.2020.9389
- Sultan N, Khushnood K, Altaf S, Awan MMA, Qureshi S, Mehmood R. Muscle Energy Technique Augmented with Sustained Natural Apophyseal Glides; An Effective Way to Improve Mechanical Neck Pain and Range of Motion: A Randomized Control Trial. Journal of Islamic International Medical College, 2021;16(2):96-100.
- Al-Najjar HMM, Mohammed AH, Mosaad DM. Effect of ice massage with integrated neuromuscular inhibition technique on pain and function in subjects with mechanical neck pain: randomized controlled trial. Bulletin of Faculty of Physical Therapy, 2020;25(1):7. doi: 10.1186/s43161-020-00011-x
- Mehraban Jahromi M, Abolahrari-Shirazi S, Safari S, & Moslemi Haghighi F. Prevalence of musculoskeletal disorders risk factors and ergonomic assessment of posture among senior students of Rehabilitation School of Shiraz University: a cross-sectional study. Journal of Rehabilitation Sciences & Research, 2022;9(4),180-184. doi: 10.30476/jrsr.2022.93682.1243.
- Abdelaziz YM, Abulkasem ST, Yamny AA. Dry needling versus integrated neuromuscular inhibition technique on upper trapezius myofascial trigger points. Egyptian Journal of Applied Science, 2020;35(7):45-56. doi:10.21608/ejas.2020.120567.
- Lytras DE, Sykaras EI, Christoulas KI, MyrogiannisIS, Kellis E. Effects of exercise and an integrated neuromuscular inhibition technique program in the management of chronic mechanical neck pain: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics, 2020;43(2):100-113. doi: 10.1016/j.jmpt.2019.03.011
- Azhdari N, Kamali F, Vosooghi O, Petramfar P, Rahimijaberi A. The effect of manual therapies on tension-type headache in patients who do not respond to drug therapy: a randomized clinical trial. J Man Manip Ther. 2023;31(4):246-252. doi: 10.1080/10669817.2022.2107446.
- Rojhani-Shirazi Z, Barzegar A, Nouraddini E, Azhdari N, & Mohamadi M. Can muscle relaxation affect balance in patients with tension-type headache? A pre-post study. Journal of Rehabilitation Sciences & Research, 2017;4(3),84-87. doi: 10.30476/jrsr.2017.41124
- Kim D, Cho M, Park Y, Yang Y. Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 2015;27(6):1791-4. doi: 10.1589/jpts.27.1791
- Lee KS. Effect of a five-week scapular correction exercise in patients with chronic mechanical neck pain. The Journal of Korean Physical Therapy, 2020;32(2):126-31. doi:10.18857/jkpt.2020.32.2.126
- Azhdari N, Ghanbari A, Mohamadi M. Are Tension-type Headaches Associated with Flexible Flat Feet? A Cross-sectional Study. JRSR. 2023;10(1):55-60. https://doi.org/10.30476/jrsr.2022.90422.1146
- Chaurasia P, Mhase S, Panda M, Khan S, Bedre V, Nagrale W. Impact of Scapular Repositioning Using a Scapular Belt for Axioscapular Muscle Imbalance in Patients with a Non-specific Neck Pain: A Case Report. Cureus, 2022;14(8):e28126. doi: 10.7759/cureus.28126
- Celenay ST, AkbayrakT, Kaya DO. A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients with Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial. The Journal of orthopaedic and sports physical therapy, 2016;46(2):44–55. DOI: 10.2519/jospt.2016.5979
- Akodu A, Akinbo S, and Young Q. Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates, Journal of Taibah University Medical Sciences, 2018;13(6):528-534. doi: 10.1016/j.jtumed.2018.09.001.
- Kaka B, Ogwumike OO, Ogunlade S, Adeniyi FA. Effects of neck stabilization and dynamic exercises on pain, disability and fear avoidance beliefs in patients with non-specific neck pain; a randomized clinical trial. Archives of Physiotherapy and Global Researches, 2015;19(3):17-29. doi: 10.15442/apgr.19.2.14.
- Hoy D, March L, Woolf A, Blyth F, Brooks P, Smith E, et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Annals of the rheumatic diseases, 2014;73(7):1309–1315. doi:10.1136/annrheumdis-2013-204431
- Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, et al. Global, regional, and national burden of neck pain in the general population, 1990- 2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ, 2020;368:m791. doi: 10.1136/bmj.m791.
- Verhagen AP. Physiotherapy management of neck pain. Journal of physiotherapy, 2021;67(1):5–11. doi: 10.1016/j.jphys.2020.12.005
- Dhami H, Kaur J, Kaur M. Comparison of Integrated Neuromuscular Inhibition Technique versus Myofascial Release of Upper Trapezius on Neck Range of Motion and Dysfunction in Individuals with Nonspecific Neck Pain. Indian Journal of Physiotherapy & Occupational Therapy, 2022;16(4):30–35. DOI: 10.37506/ijpot.v16i4.18701
- Thakur R, Mande P, Lokwani M. Effectiveness of Integrated Neuromuscular Inhibition Technique and Instrument Assisted Soft Tissue Mobilisation in the Management of Upper Trapezius Myofascial Trigger Points. Indian Journal of Physiotherapy & Occupational Therapy, 2022;16(4):94–100. doi:10.37506/ijpot.v16i4.18713
- Mohamed DA, Kamal RM, Gaber MM, Aneis YM. Combined Effects of Extracorporeal Shockwave Therapy and Integrated Neuromuscular Inhibition on Myofascial Trigger Points of Upper Trapezius: A Randomized Controlled Trial. Annals of rehabilitation medicine, 2021;45(4):284–293. doi: 10.5535/arm.21018
- Metgud CS, Monteiro SS, Heggannavar A, D'Silva PV. Effect of integrated neuromuscular inhibition technique on trigger points in patients with nonspecific low back pain: Randomized controlled trial. Indian Journal of Physical Therapy and Research, 2020;2(2):99. doi: 10.4103/ijptr.ijptr_49_19.
- Nagrale AV, Glynn P, Joshi A, Ramteke G. The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial. J Man Manip Ther. 2010;18(1):37-43. doi: 10.1179/106698110X12595770849605.
- Saadat Z, Hemmati L, Pirouzi S, Ataollahi M, Ali-mohammadi F. Effects of integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points, J Bodyw Mov Ther. 2018;22(4):937-940. doi:10.1016/j.jbmt.2018.01.002
- Danazumi MS, Yakasai AM, Ibrahim AA, Shehu UT, Ibrahim SU. Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome. Journal of osteopathic medicine, 2021;121(8):693–703. doi:10.1515/jom-2020-0327
- Chavan SE, Shinde DS. Effect of Integrated Neuromuscular Inhibition Technique on Iliotibial Band Tightness in Osteoarthritis of Knee. International Journal of Health Sciences & Research,2019;9(6):123-129. Corpus ID:234789299
- Lee KS. Effect of a five-week scapular correction exercise in patients with chronic mechanical neck pain. The Journal of Korean Physical Therapy, 2020;32(2):126-31. doi:10.18857/jkpt.2020.32.2.126
- Kim, Eun K. Comparison of Vital Capacity and Balance between Elderly Women and Young Women with Forward Head Postures According to the Use of Figure-8 brace. The Journal of Korean Physical Therapy,2019;31(4):248-253. doi:10.18857/jkpt.2019.31.4.248.
- Barbari V, Storari L, Maselli F, Testa M: Applicability of pain neuroscience education: where are we now? Journal of Back and Musculoskeletal Rehabilitation, 2021:34(4);511-20. doi:10.3233/BMR-200091
- Noordin NB, Chyi LK, Ting A,Wah YC. Innovation of Forward Head Posture Orthosis with Kyphosis Brace. Journal of Positive School Psychology, 2022;6(4):3517-3524.
- Mulcahy MJ, Dower A, and Tait M. Orthosis versus no orthosis for the treatment of thoracolumbar burst fractures: A systematic review. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia, 2021;85:49–56. doi:10.1016/j.jocn.2020.11.044
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