Impact of Visceral Manipulation Versus Integrated Neuromuscular Inhibition Technique in Shoulder Impingement Syndrome

This study will be conducted To evaluate the effect of Visceral Manipulation versus Integrated Neuromuscular Inhibition Technique on the upper fiber of trapezius on pain intensity, pain threshold, shoulder range of motion, and function in shoulder impingement syndrome

Study Overview

• Status: Not yet recruiting
• Conditions: Shoulder Impingement
• Intervention / Treatment: Other: visceral manipulation; Other: integrated neuromuscular inhibition

Detailed Description

HYPOTHESES

It will be hypothesized that:

1. There will be no statistically significant effect of Visceral Manipulation on the upper fiber of the trapezius on pain intensity, pain threshold, shoulder range of motion, or function in shoulder impingement syndrome
2. There will be no statistically significant effect of the Integrated Neuromuscular Inhibition Technique on the upper fiber of the trapezius on pain intensity, pain threshold, shoulder range of motion, or function in shoulder impingement syndrome.
3. There will be no statistically significant difference in the effect of visceral manipulation versus the integrated neuromuscular inhibition technique on the upper fiber of the trapezius on pain intensity, pain threshold, shoulder range of motion, and function in shoulder impingement syndrome.

This study will be conducted to answer the following questions:

Is there an effect of Visceral Manipulation versus Integrated Neuromuscular Inhibition Technique on the upper fiber of the trapezius on pain intensity, pain threshold, shoulder range of motion, and function in shoulder impingement syndrome?

• Study Type: Interventional
• Enrollment (Estimated): 75
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• -active myofascial trigger points in the upper trapezius muscle, and chronic Pain lasting more than 12 weeks
• BMI between 25 and 30 Kg/m².

Exclusion Criteria:

• a previous fracture in the cervical spine or shoulder surgery
• acute inflammatory condition.
• Malignant tumor.
• Multiple osteophytes.
• Cervical posture abnormalities.
• Osteoporosis.

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
Active Comparator: visceral manipulation; Palpation will be applied and the pressure will directly to the skin, into the direction of restriction just until resistance (tissue barrier) is felt. Once found, the collagenous barrier will be engaged for 90 to 120 seconds for each technique without sliding over the skin or forcing the tissue until the fascia complex starts to yield and a sensation of softening is achieved.	Other: visceral manipulation; visceral manipulation: A palpation technique will be applied till the barrier is felt and it will be applied until release is felt. integrated neuromuscular inhibition: ischemic compression will be applied to trigger point of upper trapezius
Active Comparator: integrated neuromuscular inhibition; The practitioner first identifies TrPs to be treated within the upper trapezius muscle. The subjects will be placed in a supine position. Their arm will be positioned in slight shoulder abduction with the elbow bent and their hand resting on their stomach. Using a pincer grasp, the practitioner will move throughout the fibers of the upper trapezius and make note of any active TrPs. Once the TrPs were identified, treatment began. The first technique applied will be ischemic compression. The therapist again utilized a pincer grasp, placing the thumb and index finger over the active TrP. Slow, increasing levels of pressure will be applied until the tissue resistance barrier is identified. The pressure will be maintained until a release of the tissue barrier is felt. At that time, pressure will again be applied until a new barrier is felt. This process will be repeated until tension or tenderness is unable to be identified or 90 seconds have elapsed.	Other: integrated neuromuscular inhibition; It involves applying direct sustained digital pressure to the TrP with sufficient force over dedicated time duration, to slow down the blood supply and relieve the tension within the involved muscle. The pressure is gradually applied, maintained and the gradually released

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
pain intensity	pain intensity will be measured by a visual analog scale, the scale is marked from 0 to 10 while 0 represents no pain and 10 represents intolerable pain	pre treatment and after 4 weeks
pain pressure threshold	pressure threshold measured by pressure algometer	pre treatment and after 4 weeks
shoulder range of motion	shoulder flexion and abduction range of motion will be measured by inclinometer	pre treatment and after 4 weeks
shoulder functional level	The functional level of the shoulder will be measured by shoulder pain and disability index. the index consists of subscales that measure how much shoulder pain interferes with the functional activity of daily living	pre treatment and after 4 weeks

Collaborators and Investigators

• Sponsor: Noha Elserty

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2024
• Primary Completion (Estimated): May 1, 2024
• Study Completion (Estimated): May 1, 2024

Study Registration Dates

• First Submitted: January 19, 2024
• First Submitted That Met QC Criteria: February 15, 2024
• First Posted (Estimated): February 22, 2024

Study Record Updates

• Last Update Posted (Estimated): February 22, 2024
• Last Update Submitted That Met QC Criteria: February 15, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Shoulder Impingement Syndrome
• Other Study ID Numbers: faculty of physical therapy (Cairo University)

Drug and device information, study documents

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