Effect of Integrated Neuromuscular Inhibition Technique on Subjects with Neck Pain and Forward Head Posture

1. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles on craniovertebral angle in neck pain and forward head posture subjects.
2. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles cervical pain intensity level in neck pain and forward head posture subjects.
3. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles on cervical range of motion in neck pain and forward head posture subjects.
4. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles on cervical proprioception in neck pain and forward head posture subjects.
5. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles cervical function in neck pain and forward head posture subjects.

Study Overview

• Status: Completed
• Conditions: Neck Pain and Forward Head Posture
• Intervention / Treatment: Other: Integrated Neuromuscular inhibition; Other: traditional treatment

Detailed Description

Forward head posture (FHP) is one of the most common types of postural abnormality, and it is generally described as an anterior position of the head in relation to the vertical line of the body's center of gravity. Many researchers have reported that several factors, including headache, neck pain, and musculoskeletal disorders such as temporomandibular disorders or rounded shoulders, are related to FHP . It is associated with shortening of the upper trapezius, the posterior cervical extensor muscles, the sternocleidomastoid muscle and the levator scapulae muscle Forward head posture (FHP) is a forward inclination of the head with cervical spine hyperextension and is associated with shortening of the upper trapezius, the splenius and semispinalis capitis and crevice's, the cervical erector spinae and the levator scapulae musculature . A significant number of the population experiences neck related musculoskeletal problems caused by abnormal forward head posture. Forward Head Posture (FHP) is a common postural deviation reported in the literature, and has been considered as a risk factor for the development of neck pain. Around 61.3% adults with neck pain, working using computers were reported to have FHP In addition, patients with chronic neck pain demonstrated weakness in their deep neck flexors and presented with FHP when distracted. Neck pain is a common disorder characterized by pain, discomfort or soreness experienced in a region between the inferior margin of the occipital bone and T1. Prevalence of neck pain in employees is not the same all over the world. In western countries it has been reported to be between 34% and 54%.As neck pain could become a chronic and disabling symptom, discovering and controlling risk factors seems to be a reasonable prevention strategy. Improper posture could be improved by education and proper reminders to decrease the prevalence of neck pain and increase the quality of life. It is thought that adolescents or patients with neck pain (NP) have a more forward head posture, thus a smaller craniovertebral (CV) angle than age-matched pain-free participants. It was concluded that the CV angle is negatively correlated with the disability of patients with neck pain. So, patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Faculty of Physical Therapy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 19 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. - Adolescent Female physical therapy students between 18-23 years old
2. BMI between 18.5-25 kg/m²
3. Symptomatic forward head posture with CVA 49° or less.
4. Latent trigger point
5. Neck pain more than 3 months

Exclusion Criteria:

1. Cervical disc
2. Myelopathy or cervical radiculopathy
3. Cervical spine surgery in the past
4. Having received physical therapy in the three months prior to the study
5. Non- rheumatologic diseases as multiple sclerosis, thyroid dysfunction and chronic infection.
6. Rheumatologic condition as poly-articular osteoarthritis, rheumatoid arthritis and advanced cervical spine degenerative diseases. -

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Integrated Neuromuscular Inhibition; Integrated Neuromuscular Inhibition in addition to traditional treatment will be received three times a week for eight weeks. Integrated Neuromuscular Inhibition will be contain three combined manual treatment ( ischemic compression , strain counter strain , Muscle energy technique )	Other: Integrated Neuromuscular inhibition; Integrated Neuromuscular Inhibition in addition to traditional treatment will be received three times a week for eight weeks. Integrated Neuromuscular Inhibition will be contain three combined manual treatment ( ischemic compression , strain counter strain , Muscle energy technique ) traditional treatment will be received three times a week for eight weeks . traditional treatment in Form of stretching and strenghthening of cervical muscles and postural advices; Other Names: INMI
Active Comparator: traditional treatment; traditional treatment will be received three times a week for eight weeks . traditional treatment in Form of stretching and strenghthening of cervical muscles and postural advices	Other: traditional treatment; traditional treatment will be received three times a week for eight weeks . traditional treatment in Form of stretching and strenghthening of cervical muscles and postural advices

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral angle	Craniovertebral angle (CVA): is the angle formed between a horizontal line through the spinous process of C7 and a line from the tragus of the ear	up to eight weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck pain intensity level	Neck pain will measured by visual analogue scale ( VAS) .When responding to a VAS item, patients make marks along 100 mm line at the point they feel represents their current pain state . with 100 mm means high level of pain and 0 means no pain	up to eight weeks
change in Neck Functional disability	Neck disability will measured by English neck disability index (NDI) Questionnaire is composed of a total of 10 questions.Each question has 6 answer options which pertain to a level of severity (0-5) with total score of 50 ,when NDI is high the neck function is the worst	up to eight weeks
Cervical Range of motion ROM	Cervical Range of motion will measured by clinometer application	up to eight weeks
Cervical proprioception	Cervical proprioception will measured by clinometer application	up to eight weeks

Collaborators and Investigators

• Sponsor: Cairo University

Publications and helpful links

General Publications

• 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 Oct;22(4):937-940. doi: 10.1016/j.jbmt.2018.01.002. Epub 2018 Jan 17.
• 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. Ann Rehabil Med. 2021 Aug;45(4):284-293. doi: 10.5535/arm.21018. Epub 2021 Aug 30.

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2022
• Primary Completion (Actual): December 30, 2022
• Study Completion (Actual): January 1, 2023

Study Registration Dates

• First Submitted: June 23, 2022
• First Submitted That Met QC Criteria: June 29, 2022
• First Posted (Actual): June 30, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 14, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: neck pain; Forward head posture
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Neck Pain
• Other Study ID Numbers: INMI on neck pain and FHP

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
• product manufactured in and exported from the U.S.: No