Effect of Integrated Neuromuscular Inhibition Technique on Scapular Dyskinesia Type 2 (INITonSD)

November 13, 2025 updated by: Syeda Sana Waheed, Ziauddin University

Effect of Integrated Neuromuscular Inhibition Technique (INIT) Versus Conventional Exercise on Muscular Strength, Shoulder ROM and Scapular Deviation Among Young Adults With Scapular Dyskinesia II.

The goal of this clinical trial is to learn whether the Integrated Neuromuscular Inhibition Technique (INIT) can influence shoulder motion, muscle strength, and scapular positioning in young adults with Scapular Dyskinesis Type II. This study will also compare INIT with a conventional exercise program.

The main questions the study aims to answer are:

  • Does INIT affect shoulder range of motion compared with conventional exercise?
  • Does INIT affect shoulder-girdle muscle strength?
  • Does INIT influence scapular deviation as measured by a palpation meter? Participants will receive either INIT or conventional exercises three times per week for six weeks. Assessments will occur at baseline, week 4, and week 6 using a goniometer, dynamometer, and palpation meter. A physiotherapist that is the Principal Investigator and supervisor will monitor participants throughout the study.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

A total of 82 participants will be recruited using a multifaceted approach through pamphlets, emails, and WhatsApp groups. After enrollment, candidates will be screened by the principal investigator and re-evaluated by a clinical co-supervisor. Informed voluntary consent will be obtained before participation. Participants will be randomly allocated via the envelope method into:

  • Treatment group: Integrated Neuromuscular Inhibition Technique (INIT)
  • Control group: Conventional therapy Assessments will occur at baseline, week 4, and week 6 using a palpation meter (PALM), goniometer, and hand-held dynamometer. Each session will last 45 minutes and will be conducted three times per week for six weeks. The Scapular Assistance Test will be used initially to identify scapular dyskinesis, followed by PALM measurements-where positive values indicate upward and negative values indicate downward movement. The dynamometer will record peak force (Newtons) in a gravity-eliminated position. An orthopedic surgeon will monitor participant safety and manage any adverse events.

Integrated Neuromuscular Inhibition Technique (INIT):

INIT combines ischemic compression, strain-counter strain, and muscle energy technique (MET).

  • Ischemic Compression: Latent trigger points in the upper trapezius, levator scapulae, rhomboids, and serratus anterior are palpated and compressed for 90 seconds, repeated 3-5 times based on participant tolerance.
  • Strain-Counter Strain: The muscle is placed in a position of ease. For the upper trapezius and levator scapulae, the head is side-bent 10°-20° toward the affected side with the ipsilateral arm in abduction or flexion, held for 20-30 seconds.
  • Muscle Energy Technique: Using post-isometric relaxation, participants perform gentle isometric contractions of the same muscles, followed by stretching.

Conventional Therapy (Control Group):

Participants perform stretching and strengthening for the same muscles.

  • Stretching: Upper trapezius and levator scapulae-2-4 repetitions, holding 15-30 seconds each.
  • Strengthening: Rhomboids and serratus anterior-10 repetitions × 3 sets, progressing to 15 repetitions × 3 sets using a yellow TheraBand (70-80% elasticity, approximately 1.5 kg/unit).

This six-week protocol will provide a standardized framework for comparing the two interventions using planned assessments

Study Type

Interventional

Enrollment (Actual)

82

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 Locations

  • Pakistan
    • Sindh
      • Karachi, Sindh, Pakistan, 75950
        • Ziauddin University, College of Physical Therapy

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

No

Description

Inclusion Criteria:

  • ● Both male and female participants aged between 20-40 years will be diagnosed by an orthopedic consultant and screened by a physiotherapist through Scapular Assistant Test and a PALM meter.

    • Individuals presenting with scapular malposition and inferior medial border prominence, scapular dyskinesia type II with nonspecific symptoms.

Exclusion Criteria:

  • Any diagnosed neurological deficit, i.e., hemiplegic limb, winged scapula due to lesions of the long thoracic or spinal accessory nerve.

    • Diagnosed Cervical related pathologies such as stenosis, myelopathy, and prolapsed intervertebral disk.
    • Diagnosed Shoulder-related pathology such as AC joint instability, rotator cuff pathology, history of shoulder surgery, and recent upper limb fracture.
    • Individual with neurovascular deficit and rib fracture.
    • Diagnosed chest deformity and scoliosis

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: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group A
Group A receives integrated neuromuscular inhibition technique. The total time commitment encompasses these assessment points spanning six weeks with each session lasting 45 minutes occurring three consecutive days a week.
Other: Intigrated Neuromuscular Inhibition Technique

The integrated Neuromuscular Inhibition Technique (INIT) combines ischemic compression, strain-counter strain, and muscle energy techniques.

The practitioners first identified the latent trigger points to be treated using the palpation method and treated with ischemic pressure. This technique will be done for 90 seconds and repeated 3 to 5 times. After the ischemic compression therapist, the position of ease will be attained by maintaining the part of the desired muscle in the shortened position. It will be maintained for 20-30 sec. MET is a soft tissue manipulation technique in which an individual actively performs muscle contraction in a controlled manner. In this study, isometric contraction using post-isometric relaxation technique with stretching is used
Experimental: Group B
Group B receives conventional exercise. The total time commitment encompasses these assessment points spanning six weeks with each session lasting 45 minutes occurring three consecutive days a week.
Other: Conventional Exercise

Group B receives conventional exercise that includes stretches and strengthening exercises of muscles involved in SD.

For stretching: Should repeat 2-4 times increasing gradually with a 15-30 second hold.

For strengthening: Active exercise for ten reps in 3 sets gradually increases for 15 reps in 3 stages. The intensity of exercise will be determined by the RM method using a yellow Thera band with an elastic range of 70%-80% that is i.50 kilograms per unit

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Range of motion
Time Frame: Baseline
The shoulder range of motion (flexion, abduction and external and internal rotation) will be using a goniometer with a reliability ICC=0.94.
Baseline
Range of motion
Time Frame: 4 week
The shoulder range of motion (flexion, abduction and external and internal rotation) will be using a goniometer with a reliability ICC=0.94.
4 week
Range of motion
Time Frame: 6 week
Shoulder range of motion (flexion, abduction, and external and internal rotation) will be using a goniometer with a reliability ICC=0.94.
6 week
Muscular strength
Time Frame: Baseline
The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98
Baseline
Muscular strength
Time Frame: 4 week
The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98
4 week
Muscular strength
Time Frame: 6 week
The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98
6 week
Scapular deviation
Time Frame: Baseline
PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99
Baseline
Scapular deviation
Time Frame: 4 week
PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99
4 week
Scapular deviation
Time Frame: 6 week
PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99
6 week

Collaborators and Investigators

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

Sponsor

Ziauddin University

Investigators

  • Study Director: Amna Aamir Khan, PhD - PT, Ziauddin 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)

January 27, 2025

Primary Completion (Actual)

August 15, 2025

Study Completion (Actual)

August 15, 2025

Study Registration Dates

First Submitted

September 23, 2025

First Submitted That Met QC Criteria

November 13, 2025

First Posted (Actual)

November 18, 2025

Study Record Updates

Last Update Posted (Actual)

November 18, 2025

Last Update Submitted That Met QC Criteria

November 13, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 9050824SWPT (Other Identifier: Ziauddin University)

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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