Effects of Autogenic and Reciprocal Inhibition, Muscle Energy Techniques in the Management of Mechanical Neck Pain

Neck pain is among the most common musculoskeletal disorders worldwide and is an important public health issue in terms of personal wellbeing. Prevalence of neck pain show excessive variations, with a point prevalence varying between 6% and 22%, and one year prevalence ranging between 1.5-75%. Neck pain like all other mechanical disorders leads to pain, disability and decreased range of motion (ROM). Stretching is a very common exercise performed by sportsmen, elderly, in physical therapy and rehabilitation patients, thus practiced in all sorts of fitness programs. The major types of stretching included in the literature are static, dynamic and pre-contraction stretching; of which static stretching is the conventional type of stretching. The different types of pre-contraction stretching include Proprioceptive Neuromuscular Facilitation (PNF) stretching, Post Isometric Relaxation (PIR), Post Facilitation stretch (PFS) and Active Isolated Stretch (AIS). Pre-contraction stretching is also considered a part of Muscle Energy Technique (MET). Recently MET and pre-contraction stretching have been shown to have significant superiority over conventional stretching in management of mechanical neck pain, but the evidence is currently lacking regarding which of the two pre-contraction stretching protocols, namely autogenic and reciprocal inhibition is more effective than the other. A RCT will be conducted in order to find and compare the effectiveness of conventional stretching and pre-contraction stretching (autogenic inhibition and reciprocal inhibition). One Control group (conventional group) and two Experimental groups (Experimental Group A - Autogenic Inhibition & Experimental Group B - Reciprocal Inhibition) will be formed. The participants will be recruited in the study if they meet the inclusion criteria using consecutive sampling from Fauji Foundation Hospital and randomized into the three respective groups. All the groups will receive the gold standard treatment for chronic neck pain including mobilization and modalities. In addition to the gold standard treatment the participants will receive specific stretching protocol based on their interventional group

Study Overview

• Status: Completed
• Conditions: Neck Pain
• Intervention / Treatment: Other: Group A (Control Group - Static Stretching + Standard Treatment); Other: Group B (Autogenic Inhibition - PIR + Standard treatment); Other: Group C (Reciprocal Inhibition - RI + Standard treatment)

• Study Type: Interventional
• Enrollment (Actual): 78
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Islamabad, Pakistan
    • Foundation university institute of rehabilitation sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Age 18 to 70 years;
2. Neck pain on NPRS 4 to 8 (moderate cases);
3. Subacute or chronic cases (4 to 12 weeks).
4. Decreased or painful Cervical range of motion (CROM)

Exclusion Criteria:

1. Signs of serious pathology (e.g., malignancy, inflammatory disorder, infection);
2. History of cervical spine surgery in previous 12 months;
3. History of trauma or fractures in cervical spine;
4. Signs of cervical radiculopathy or myelopathy; and
5. Vascular syndromes such as VBI

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Group A (Control Group - Static Stretching); (Control Group - Static Stretching + Standard Treatment)	Other: Group A (Control Group - Static Stretching + Standard Treatment); o Conventional Gold Standard treatment (Manual Therapy + Modalities) Conventional Static Stretching 15-30 seconds hold 3-5 repetitions (Page P, 2012) for Ant/Middle/Posterior Scaleni, Sternocleidomastoid, Levator Scapulae and Upper Trapezius Muscles.
Experimental: Group B (Autogenic Inhibition MET); (Autogenic Inhibition - PIR + Standard treatment)	Other: Group B (Autogenic Inhibition - PIR + Standard treatment); o Conventional Gold Standard treatment (Manual Therapy + Modalities) Post Isometric Relaxation MET (3-5 reps) for Ant/Middle/Posterior Scaleni, Sternocleidomastoid, Levator Scapulae and Upper Trapezius Muscles. (Chaitow L, 2006)
Experimental: Group C (Reciprocal Inhibition MET); (Reciprocal Inhibition - RI + Standard treatment)	Other: Group C (Reciprocal Inhibition - RI + Standard treatment); o Conventional Gold Standard treatment (Manual Therapy + Modalities) Reciprocal Inhibition MET (3-5 reps) for Ant/Middle/Posterior Scaleni, Sternocleidomastoid,Levator Scapulae and Upper Trapezius Muscles (Chaitow L, 2006)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain (Numeric Pain Rating Scale) - Change is being assessed	To measure the pre and post patient's perception of pain	Pre-treatment (First day before treatment), Immediate Follow Up (After 1st treatment session) & Follow Up (After 5 days of Treatment)
Cervical Range of Motion (CROM) - Change is being assessed	To measure patient's improvement in cervical range of motion	Pre-treatment (First day before treatment), Immediate Follow Up (After 1st treatment session) & Follow Up (After 5 days of Treatment)
Neck Disability Index (NDI) - Change is being assessed	to measure patient's pre and post functional disability	Pre-treatment (First day before treatment), Immediate Follow Up (After 1st treatment session) & Follow Up (After 5 days of Treatment)
Cervical Isometric Muscle Strength (Modified Sphygmomanometer dynamometry) - Change is being assessed	To measure patient's improvement in Isometric Muscle Strength	Pre-treatment (First day before treatment), Immediate Follow Up (After 1st treatment session) & Follow Up (After 5 days of Treatment)

Collaborators and Investigators

• Sponsor: Foundation University Islamabad
• Investigators: Principal Investigator: Muhammad Osama, DPT, MS-OMPT, CHPE, Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): April 11, 2017
• Primary Completion (Actual): November 30, 2017
• Study Completion (Actual): December 30, 2017

Study Registration Dates

• First Submitted: April 10, 2017
• First Submitted That Met QC Criteria: April 27, 2017
• First Posted (Actual): May 2, 2017

Study Record Updates

• Last Update Posted (Actual): February 8, 2018
• Last Update Submitted That Met QC Criteria: February 7, 2018
• Last Verified: December 1, 2017

More Information

Terms related to this study

• Keywords: VAS; Muscle Strength; Range of Motion; Neck Disability Index; Stretching; Muscle Energy Techniques; Autogenic Inhibition; Reciprocal Inhibition; NDI
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: FUI/CTR/2017/1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No