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Integrated Neuromuscular Inhibition, Muscle Energy and Strain Counter Strain Techniques in Neck Pain

Primary Purpose

Neck Pain

Status

Completed

Phase

Not Applicable

Locations

Pakistan

Study Type

Interventional

Intervention

Strain Counter Strain Technique

Muscle Energy Technique,

Integrated Neuromuscular Inhibition Technique

About this trial

This is an interventional treatment trial for Neck Pain focused on measuring Mechanical Neck Pain, Chronic Neck Pain, Muscle Energy Technique, Strain counter Strain, INIT

Eligibility Criteria

30 Years - 60 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Participants falling in this category would be recruited into the study.
- Patients with chronic mechanical neck pain (symptoms for more than 3 months).
- Age group between 30 - 60 years.
- Patients willing to participate and take treatment.
- Patients must have at least 1 active trigger point at upper trapezius, levator scapulae, SCM.
- Gender (Both)
- VAS >3

Exclusion Criteria:

• Patients having severe neck pain.
- Patients having any systemic joint pathology, inflammatory joint disease (e.g rheumatoid arthritis, gouty arthritis, psoriatic arthritis).
- Patients who had any neurological deficit, myelopathy any mental illness.
- Patients on medication like antidepressants, corticosteroid, anti-inflammatory medications.

Sites / Locations

Atta Memorial Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Arm Label

Strain Counter Strain Technique

Muscle Energy Technique,

Integrated Neuromuscular Inhibition Technique

Arm Description

When general or local pain began to diminish, upper trapezius , levator scapulae and SCM was placed in a position of ease and was held for approximately 20 to 30 seconds. Moderate digital pressure was applied to the identified MTrP as participants rated their level of pain on a scale ranging from 1 to 10.3. Ease was defined as the point at which a reduction in pain of at least 70% was achieved.Once the position of ease was identified, it was held for 20 to 30 seconds.

After the ease position was maintained for 20 to 30sec an isometric contraction focused on the muscle fibers around the MTrP was performed. Each isometric contraction was held for 7 to 10 sec and was followed by a soft-tissue stretch for 15 seconds and then relax for 30 seconds. Each stretch was held for 30 seconds, and it was repeated 3 times during the treatment session. 3. Treatment was performed on the 3 most painful areas between the upper border of the upper trapezius muscle, the SCM, the levator scapulae, and the SC muscle.

1. Group c will receive Combination of exercise (strain counter strain , muscle energy & ischemic compression. In ischemic compression patient will receive compression,2. After MTrPs identification, 3. Ischemic compression was applied in an intermittent manner for up to 2 minutes for each MTrP. 4. The pincer grasp (for the trapezius muscle and SCM) or direct digital pressure (for the levator scapulae and SC muscle) was used with the patients in either the supine position or sitting upright.

Outcomes

Primary Outcome Measures

• Visual analog scale.

Pain was assessed by the VAS, which is a card with an uncalibrated scale ranging from 0 to 10. 0 represent no pain and 10 represent the highest level of pain. A vertical line on the scale drawn by the patient marked their subjective pain estimation ranging from 0 to 10. Subsequently, a single ruler was used to record the exact pain level. The reliability of the scale is quite satisfactory, especially in people with moderate and high educational levels (r = .94, P = .001) (6). reference for tools should be added

• Neck disability index.

Disability was evaluated using the NDI questionnaire. It is a self-reported 10-item scale. Each item assesses different neck pain complaints. Most of the items are related to restrictions in activities of daily life, and each item is expressed by 6 different assertions in the range 0 to 5, with 0 indicating no disability and 5 indicating the highest disability. The total score ranges from 0 to 50. Its credibility in people with neck pain is moderate to high and has been considered a valid tool in patients with neck problems. NDI has high reliability i.e. ICC 0.97 and good internal validity i.e. Cronbach's alpha = 0.86.(6)

• 36-Item Short Form Health Survey score

SF-36 consists of 36 questions, selected from the Medical Outcomes Study. These questions are related to 8 different parameters of mental and physical health.SF-36 has satisfactory support in the literature.51 Total Physical and Mental Health, and the subcategory of Bodily Pain, were evaluated in this study. SF-36 shows a high rate of validity and reliability in patients with neck pain. In all 8 categories, both the ICC and the Cronbach's alpha index are high 0.75-0.94 and 0.69-0.88, correspondingly

• Goniometer

Goniometer measures the available range of motion of cervical flexion, extension, rotation and side bending. To see the restriction in cervical moments we compare the available ROM's to the normal ROM's.

algometer

Pressure pain threshold is measured by Pressure algometry was conducted using a Wagner digital algometer (Wagner FPX 25 Digital Algometer; Wagner Instruments, Greenwich, CT). PPT was assessed bilaterally over the upper border of the trapezius muscle, halfway between the midline and the lateral border of the acromion, the levator scapulae muscle 2 cm above the lower insertion and located in the upper medial border of the scapulae, the SCM upper insertion, and the SC 2 cm lateral to the spinous processes of the axis. The metal rod of the algometer was placed vertically on the site, and the examiner applied gradually increasing pressure at a rate of 1 kg/s. The examinees indicated when they began to feel pain or discomfort. Then, the examiner ceased the pressure and noted the value. Pressure algometry showed from satisfactory to fairly high reliability by various researchers both in repeated measurements of the same examiner and between measurements of different examiners.(14)

Secondary Outcome Measures

Full Information

NCT ID

NCT05262062

First Posted

February 20, 2022

Last Updated

July 7, 2023

Sponsor

Riphah International University

1. Study Identification

Unique Protocol Identification Number

NCT05262062

Brief Title

Integrated Neuromuscular Inhibition, Muscle Energy and Strain Counter Strain Techniques in Neck Pain

Official Title

Effect of Integrated Neuromuscular Inhibition, Muscle Energy and Strain Counter Strain Techniques in the Management of Mechanical Neck Pain.

Study Type

Interventional

2. Study Status

Record Verification Date

July 2023

Overall Recruitment Status

Completed

Study Start Date

October 25, 2021 (Actual)

Primary Completion Date

March 24, 2022 (Actual)

Study Completion Date

March 28, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

Riphah International University

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

To determine effects of Neuromuscular Inhibition, Muscle energy and strain counter strain techniques on Pain, disability, pain pressure threshold, range of motion, and health-related quality of life in mechanical neck pain. To compare the effects of Integrated Neuromuscular inhibition, Muscle energy and strain counter strain techniques in the Management of mechanical neck pain.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Neck Pain

Keywords

Mechanical Neck Pain, Chronic Neck Pain, Muscle Energy Technique, Strain counter Strain, INIT

7. Study Design

Primary Purpose

Treatment

Study Phase

Not Applicable

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

51 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Strain Counter Strain Technique

Arm Type

Experimental

Arm Description

Arm Title

Muscle Energy Technique,

Arm Type

Experimental

Arm Description

Arm Title

Integrated Neuromuscular Inhibition Technique

Arm Type

Experimental

Arm Description

Intervention Type

Other

Intervention Name(s)

Strain Counter Strain Technique

Intervention Description

When general or local pain began to diminish, upper trapezius , levator scapulae and SCM was placed in a position of ease and was held for approximately 20 to 30 seconds. 2. Moderate digital pressure was applied to the identified MTrP as participants rated their level of pain on a scale ranging from 1 to 10. 3. Ease was defined as the point at which a reduction in pain of at least 70% was achieved. 4. Once the position of ease was identified, it was held for 20 to 30 seconds.

Intervention Type

Other

Intervention Name(s)

Muscle Energy Technique,

Intervention Description

After the ease position was maintained for 20 to 30sec an isometric contraction focused on the muscle fibers around the MTrP was performed. 2. Each isometric contraction was held for 7 to 10 sec and was followed by a soft-tissue stretch for 15 seconds and then relax for 30 seconds. Each stretch was held for 30 seconds, and it was repeated 3 times during the treatment session. 3. Treatment was performed on the 3 most painful areas between the upper border of the upper trapezius muscle, the SCM, the levator scapulae, and the SC muscle.

Intervention Type

Other

Intervention Name(s)

Integrated Neuromuscular Inhibition Technique

Intervention Description

Group c will receive Combination of exercise (strain counter strain , muscle energy & ischemic compression. In ischemic compression patient will receive compression, After MTrPs identification, Ischemic compression was applied in an intermittent manner for up to 2 minutes for each MTrP. The pincer grasp (for the trapezius muscle and SCM) or direct digital pressure (for the levator scapulae and SC muscle) was used with the patients in either the supine position or sitting upright

Primary Outcome Measure Information:

Title

• Visual analog scale.

Description

Time Frame

4 weeks

Title

• Neck disability index.

Description

Time Frame

4 Weeks

Title

• 36-Item Short Form Health Survey score

Description

Time Frame

4 Week

Title

• Goniometer

Description

Time Frame

4 Week

Title

algometer

Description

Time Frame

4th Week

10. Eligibility

Sex

All

Minimum Age & Unit of Time

30 Years

Maximum Age & Unit of Time

60 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Participants falling in this category would be recruited into the study. Patients with chronic mechanical neck pain (symptoms for more than 3 months). Age group between 30 - 60 years. Patients willing to participate and take treatment. Patients must have at least 1 active trigger point at upper trapezius, levator scapulae, SCM. Gender (Both) VAS >3 Exclusion Criteria: • Patients having severe neck pain. Patients having any systemic joint pathology, inflammatory joint disease (e.g rheumatoid arthritis, gouty arthritis, psoriatic arthritis). Patients who had any neurological deficit, myelopathy any mental illness. Patients on medication like antidepressants, corticosteroid, anti-inflammatory medications.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Lal Gul Khan, MSPT

Organizational Affiliation

Riphah International University Islamabad

Official's Role

Principal Investigator

Facility Information:

Facility Name

Atta Memorial Hospital

City

Rawalpindi

State/Province

Punjab

ZIP/Postal Code

46222

Country

Pakistan

12. IPD Sharing Statement

Plan to Share IPD

Citations:

PubMed Identifier

32517732

Citation

Jahre H, Grotle M, Smedbraten K, Dunn KM, Oiestad BE. Risk factors for non-specific neck pain in young adults. A systematic review. BMC Musculoskelet Disord. 2020 Jun 9;21(1):366. doi: 10.1186/s12891-020-03379-y.

Results Reference

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Citation

2. Lin CC, Hua SH, Lin CL, Cheng CH, Liao JC, Lin CF. Impact of prolonged tablet computer usage with head forward and neck flexion posture on pain intensity, cervical joint position sense and balance control in mechanical neck pain subjects. Journal of Medical and Biological Engineering. 2020 Jun;40(3):372-82

Results Reference

background

PubMed Identifier

8942688

Citation

Aker PD, Gross AR, Goldsmith CH, Peloso P. Conservative management of mechanical neck pain: systematic overview and meta-analysis. BMJ. 1996 Nov 23;313(7068):1291-6.

Results Reference

background

PubMed Identifier

33679948

Citation

Ashfaq R, Riaz H. Effect of Pressure biofeedback training on deep cervical flexors endurance in patients with mechanical neck pain: A randomized controlled trial. Pak J Med Sci. 2021 Mar-Apr;37(2):550-555. doi: 10.12669/pjms.37.2.2343.

Results Reference

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PubMed Identifier

32217608

Citation

Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D, Ashrafi-Asgarabad A, Almasi-Hashiani A, Smith E, Sepidarkish M, Cross M, Qorbani M, Moradi-Lakeh M, Woolf AD, March L, Collins G, Ferreira ML. 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 Mar 26;368:m791. doi: 10.1136/bmj.m791.

Results Reference

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Citation

6. Fryer G. Muscle energy technique: An evidence-informed approach. International Journal of Osteopathic Medicine. 2011 Mar 1;14(1):3-9.

Results Reference

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Citation

7. Paul J, Balakrishnan P. Effect of strain counter strain technique and stretching in treatment of patients with upper trapezius tenderness in neck pain. INTERNATIONAL JOURNAL OF PHYSIOTHERAPY. 2018 Aug 1;5(4):141-4.

Results Reference

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Citation

8. Ganjave P, Shikrapurkar S. Prevalence of Neck Pain among Clinical Laboratory Technicians in Mumbai

Results Reference

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PubMed Identifier

32482433

Citation

Lytras DE, Sykaras EI, Christoulas KI, Myrogiannis IS, Kellis E. Effects of Exercise and an Integrated Neuromuscular Inhibition Technique Program in the Management of Chronic Mechanical Neck Pain: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2020 Feb;43(2):100-113. doi: 10.1016/j.jmpt.2019.03.011. Epub 2020 May 30.

Results Reference

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Citation

10. Nugraha MH, Antari NK, Saraswati NL. The Efficacy Of Muscle Energy Technique In Individuals With Mechanical Neck Pain: A Systematic Review. Sport and Fitness Journal. 2020;8(2):91-8

Results Reference

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Citation

11. Gohil D, Vaishy S, Baxi G, Samson A, Palekar T. Effectiveness of strain-counterstrain technique versus digital ischemic compression on myofascial trigger points. Archives of Medicine and Health Sciences. 2020 Jul 1;8(2):191.

Results Reference

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Citation

12. Kumar GY, Sneha P, Sivajyothi N. Effectiveness of Muscle energy technique, Ischaemic compression and Strain counterstrain on Upper Trapezius Trigger Points: A comparative study. International journal of physical education, sports and Health. 2015;1(3):22-6.

Results Reference

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PubMed Identifier

33831805

Citation

Toprak Celenay S, Mete O, Sari A, Ozer Kaya D. A comparison of kinesio taping and classical massage in addition to cervical stabilization exercise in patients with chronic neck pain. Complement Ther Clin Pract. 2021 May;43:101381. doi: 10.1016/j.ctcp.2021.101381. Epub 2021 Apr 2.

Results Reference

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PubMed Identifier

33829681

Citation

Nunes AMP, Moita JPAM, Espanha MMMR, Petersen KK, Arendt-Nielsen L. Pressure pain thresholds in office workers with chronic neck pain: A systematic review and meta-analysis. Pain Pract. 2021 Sep;21(7):799-814. doi: 10.1111/papr.13014. Epub 2021 May 6.

Results Reference

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Integrated Neuromuscular Inhibition, Muscle Energy and Strain Counter Strain Techniques in Neck Pain

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