Effect of INIT on Cervical Proprioception in Patients With Forward Head Posture

December 12, 2024 updated by: Riphah International University

The Effect of Integrated Neuromuscular Inhibition Technique on Cervical Proprioception in Patients With Forward Head Posture

The purpose of the study is to determine the effects of Integrated Neuromuscular Inhibition Technique on Cervical Proprioception in Patients with Forward Head Posture. A randomized control trial was conducted at Riphah International University, Gulberg Green Campus, Islamabad. The sample size was 42 calculated through G-Power. The participants were divided into two interventional groups each having 21 participants. The study duration was six months. Sampling technique applied was Non-probability Purposive sampling for recruitment. Only 18 to 40 years participants with CVA angle less than 50 degree were included in the study. Tools used in this study are Inclinometer, Mobile phone, Labtop, Kinovea Software, NPRS Scale, Laser Beam. Data was collected at Baseline, after 1st session at the end of 2nd week and 4th week. Data analyzed through SPSS version 23.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Forward Head Posture is defined as ≥5 cm in horizontal distance between the tragus of the ear and the posterior angle of acromion in a standing position. The forward head position is characterized by extension of the upper cervical spine (Cl-C3), and flexion of the lower cervical spine (C4-C7), while the cervical curvature is increased. According to study conducted in 2019, Craniovertebral angle is Formed between C7 spinous process and tragus of ear. Forward head posture is present in all age groups, 22-24 years is the mean age group in males with normal CVA about 48.8 degrees, while in females the CVA angle is 47.6 and their mean age is 23-66 years. Normal craniovertebral angle is 49.9 degrees.

Joint position sense is a part of proprioception, which affects body posture and stability. It is influenced by muscle spindles, which respond to changes in muscle length and speed. Forward Head Posture (FHP) causes changes in the lengths of neck muscles, leading to poor joint position sense.

The integrated neuromuscular inhibition technique is one of the manual therapies that are directed to trigger point treatment; this technique consists of ischemic compression, Strain Counter-Strain, and Muscle Energy Technique. Intermittent ischemic pressure increases blood flow, Strain Counter-Strain decreases muscle tone, and Muscle Energy Technique encourages muscle easing, this leads to improvements in pain, function, and range of motion.

A Study in 2019 reported the shortness of Levator scapulae associated with Forward Head Posture leads.

In 2020 Khan et al. carried out research which showed tightness of Sternocleidomastoid muscle in patients with Forward Head Posture.

A study conducted in 2023 evaluated the effect of dry needling of Upper trapezius muscle in Forward Head Posture and results showed one session of dry needle therapy with stretching exercises could improve Pain and Pressure Threshold, Range of Motion, craniovertebral angle, which improved Forward Head Posture.

According to a study conducted in 2020 The craniovertebral angle had a negative correlation with position sensing and individuals with Forward Head Posture had a higher error value when observing cervical position sensing than individual with normal head posture.

According to a study of 2018, integrated neuromuscular inhibition technique is effective in improving cervical function by reducing the trigger points on upper trapezius muscle in mechanical neck pain.

Mustafa et al. in 2023 found that integrated neuromuscular inhibition technique to a multimodal treatment program (Mulligan (SNAG, NAGS) with isometric exercises) improve neck function.

Study Type

Interventional

Enrollment (Estimated)

42

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Pakistan
    • Federal
      • Islamabad, Federal, Pakistan, 44000
        • Recruiting
        • Riphah International University
        • Contact:
        • Principal Investigator:
          • Iqra Rashid, MSPT(OMPT)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Both Male and Female patients
  • CVA less than 50 degree
  • Age 18-40 years
  • Neck pain for more than 3 months
  • NPRS > 3
  • Decreased Cervical ROMs
  • Active trigger points in following muscles (Upper Trapezius, Sternocleidomastoid, Levator Scapulae)

Exclusion Criteria:

  • History of cervical or facial trauma or surgery.
  • Congenital anomalies of spine such as scoliosis.
  • Systemic arthritis.
  • Any disorder of Central Nervous System.
  • Patients with cognitive deficit

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental Group: 1

INIT+ Posture Corrective Exercises INIT consists of Ischemic Compression, Strain-Counter Strain and Muscle Energy Technique. INIT will be performed on Upper Trapezius, Levator Scapulae and Sternocleidomastoid. The patient will be lying supine; First We will identify the TrPs in the muscle. After that the patient will be placed in comfortable position, first technique applied will be Ischemic Compression. The technique will be applied for 90 secs. After this SCS will be applied, moderate digital pressure will maintained over the active TrP as the position of ease will be identified, it will be held for 20-30 s and repeated for three to five repetitions. Lastly, the subjects will receive MET directed towards the involved muscle. Each isometric contraction will be held for 7-10 sec and stretch will be held for 30 seconds and will be repeated three to five times per treatment session.

Posture corrective exercises given to control group will also be performed
Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.
INIT will be performed for experimental group and then posture corrective exercises will be performed and for control group only posture corrective exercises will be performed
Active Comparator: Control Group: 2

Posture corrective exercise Strengthening exercises: a) chin tuck in supine lying with the head in contact with the floor, (1 sets, 10 reps) b) Y-to-I exercise in a prone position (1 sets, 10 reps) c) Prone horizontal abduction with external rotation (1 sets, 10 reps).

Stretching Exercises:

d) one-sided unilateral self-stretch of pectoralis minor in standing position (stretch 30 sec, 5 reps) e) static sternocleidomastoid stretch (stretch 30 sec, 5 reps) f) static levator scapulae stretch (stretch 30 sec, 5 reps).
Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.
INIT will be performed for experimental group and then posture corrective exercises will be performed and for control group only posture corrective exercises will be performed

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Numeric Pain Rating Scale
Time Frame: 40 minutes session, thrice a week for 4 weeks.
The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. Where 0 means no pain and 10 means worst imaginable pain. NPRS was measured at Baseline, 1st Session, 2nd Week and 4th Week
40 minutes session, thrice a week for 4 weeks.
Cranio-vertebral Angle
Time Frame: 40 minutes session, thrice a week for 4 weeks.
For measuring the angle, the reflective markers will be placed on the tragus of the ear and spinous process of the C7. The camera will be positioned on a tripod 50 cm away from the participant. The axis of the lens of the camera was placed at the level of the shoulder. The photos will be taken and the CVA angle will be calculated by Software Kinovea. CVA was measured at Baseline, 1st Session, 2nd Week and 4th Week
40 minutes session, thrice a week for 4 weeks.
Cervical Joint Position Error Test
Time Frame: 40 minutes session, thrice a week for 4 weeks.
For measurement of proprioception, Joint Position Error Test is used. The distance/deviation will represent the proprioception deficit (JPE) of each participant. Angle is then calculated by taking arc tan of error distance divided by 90. A meaningful distance of 7.1cm or angle greater than 4.5 degree represents proprioception deficit. JPE Test was measured at Baseline, 1st Session, 2nd Week and 4th Week
40 minutes session, thrice a week for 4 weeks.
Cervical Range of Motion
Time Frame: 40 minutes session, thrice a week for 4 weeks.
Cervical ROM will be measured by using an inclinometer for Flexion, Extension, Lateral Flexion and Rotation. The normal Range for Flexion is usually approximately 80º. Normal cervical extension is usually 50°, Value for Lateral Flexion is 45° and for rotation its approximately 80°. Cervical ROM were measured at Baseline, 1st Session, 2nd Week and 4th Week
40 minutes session, thrice a week for 4 weeks.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Lal Gul Khan, MScPT, Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 18, 2024

Primary Completion (Estimated)

December 22, 2024

Study Completion (Estimated)

December 22, 2024

Study Registration Dates

First Submitted

October 28, 2024

First Submitted That Met QC Criteria

December 12, 2024

First Posted (Estimated)

December 13, 2024

Study Record Updates

Last Update Posted (Estimated)

December 13, 2024

Last Update Submitted That Met QC Criteria

December 12, 2024

Last Verified

December 1, 2024

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • REC/01940 Iqra Rashid

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

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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