Effects of Post Isometric Relaxation as Compared to Post Isometric Stretching Muscle Energy Technique in the Management of Neck Pain: a Randomized Controlled Trial

Effects of Post Isometric Relaxation as Compared to Post Isometric Stretching Muscle Energy Technique in the Management of Neck Pain

This study aims to compare the effects of post-isometric relaxation (PIR) and post isometric stretching (PIS) techniques on reducing neck pain, improving range of motion, and decreasing neck disability in individuals with neck pain. A randomized controlled trial will be conducted with 50 participants, who will be randomly assigned to one of two groups: one receiving PIR and the other receiving PIS. A single-blind method will be used, meaning the participants will not know which group they belong to. Participants will be selected based on specific criteria related to neck pain and will then be randomly allocated to the PIR or PIS group. Initially, all participants will receive two standard treatments: Transcutaneous Electrical Nerve Stimulation (TENS) and hot pack application. After these treatments, one group will undergo post-isometric relaxation (PIR), which involves 3-5 repetitions of muscle contraction and relaxation, conducted over five consecutive sessions. The other group will receive post-isometric stretching (PIS), which involves stretching after muscle contraction and relaxation, also administered over five consecutive sessions. At the end of the intervention, pain, range of motion, and neck disability will be measured. Pain will be assessed using a standardised pain scale, range of motion will be measured with a goniometer or other appropriate tools, and neck disability will be evaluated using the Neck Disability Index (NDI). Statistical analysis will be performed to compare the effectiveness of PIR and PIS in terms of pain reduction, range of motion improvement, and decreased neck disability.

Study Overview

• Status: Recruiting
• Conditions: Chronic Neck Pain
• Intervention / Treatment: Procedure: Post Isometric Relaxation; Procedure: Post Isometric Stretching

Detailed Description

Neck pain is one of the most prevalent musculoskeletal complaints among young adults, with studies reporting a prevalence of up to 75.7%, making it the fourth leading cause of disability worldwide. Research suggests that weak cervical musculature, reduced muscle-to-bodyweight ratios, and imbalances in muscle strength are key contributors to neck pain and associated disability. Muscle Energy Techniques (METs), particularly Post-Isometric Relaxation (PIR) and Post-Isometric Stretching (PIS), have been widely used to address these issues. PIR involves gentle isometric contractions followed by muscle relaxation and is effective for managing active muscle tone, making it suitable for acute conditions. However, it lacks a stretching component to target passive tone. PIS adds a post-contraction stretch, potentially addressing both active and passive tone, but may cause discomfort in sensitive individuals. While both techniques have shown positive outcomes in reducing pain and improving function, limited research directly compares their effectiveness. Therefore, this study aims to compare PIR and PIS in terms of pain relief, cervical range of motion, and functional improvement in individuals with mechanical neck pain.

According to M.Osama et al in 2020 a study was conducted to compared autogenic inhibition (AI) and reciprocal inhibition (RI) muscle energy techniques (MET) to static stretching (SS) for managing mechanical neck pain. Both AI-MET and RI-MET outperformed SS in enhancing isometric strength, with no adverse effects observed. The findings highlight AI-MET's superiority and support its use in neck pain rehabilitation.

Another study was conducted by Osama M 2024, 78 participants a randomized trial concluded that Muscle and Movement specific PIR is effective in improving neck pain, disability and ROM. Dudonienė V et al preformed a study in 2024 that aimed to investigate the 3 effectiveness of post-isometric relaxation (PIR) compared to self-stretching (SS) in working-age individuals with chronic non-specific neck pain. Result showed PIR group achieved lower pain intensity, greater neck extension ROM and lower neck disability index compared to the SS group.

A study conducted in 2022 investigates the effects of post-isometric relaxation (PIR) versus myofascial release therapy on non-specific neck pain management. Results showed that the PIR group had significant improvements in pain (measured by VAS), disability (NDI), cervical extension, and social QoL compared to the MFR group.

Another study investigated the effectiveness of post isometric relaxation (PIR) combined with traditional physical therapy for treating chronic mechanical neck pain compared to traditional therapy alone. Results showed significant reductions in pain and increases in cervical range of motion (ROM) for group adding PIR to conventional therapy.

The study compares the effectiveness of post-isometric relaxation (PIR) and passive neck retraction mobilization (PNRM) in treating nonspecific neck pain. This study suggests that PIR to be a more effective treatment option for nonspecific neck discomfort.

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

Contacts and Locations

• Study Contact: Name: Muhammad Furqan Hassan, MS-OMPT; Phone Number: +923334056768; Email: furqan.hassan@fui.edu.pk
• Study Contact Backup: Name: Areeka Riasat, DPT; Phone Number: 03219390688; Email: arikariasat4830@gmail.com

Study Locations

• Pakistan
  • Punjab Province
    • Islamabad, Punjab Province, Pakistan, 46000
      • Recruiting
      • Foundation University College of Physical Therapy
      • Contact: Areeka Riasat, DPT; Phone Number: 03219390688; Email: arikariasat4830@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria: • Age ranging from 19-44 years old

• Both gender
• With sub-acute or chronic neck pain for at least 4 to 12 weeks
• Pain intensity on NPRS ranging 4-8
• Limitation on neck movement

Exclusion Criteria:

• • Positive history of fracture

  • Surgery in the cervical region
  • Any sort of physical trauma in the cervical region in the last 12 months
  • Thoracic Outlet syndrome
  • Cervical radiculopathy
  • Cervical myelopathy
  • Cervical spondylosis
  • Cervical syringomyelia
  • Any systemic disorder including malignancy or inflammatory and rheumatic disorders
  • Infection
  • Vascular syndromes such as vertebrobasilar insufficiency (VBI).

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Post Isometric Relaxation; Post-Isometric Relaxation (PIR) is used for treating muscle tightness or spasms. It involves a sequence of steps that aim to improve flexibility and reduce muscle tension.	Procedure: Post Isometric Relaxation; All patients were given Trans-Cutaneous Electrical Nerve Stimulation (TENS) in combination with superficial heat for 10 minutes. with a session of 5 days/ week. Group A (PIR) : In this group, participants performed 3-5 rounds of post-isometric relaxation (PIR). Each round involved contracting the target muscle at 30-50% strength for 7-10 seconds, resting for 5 seconds .
Experimental: Post Isometric Stretching; Post-Isometric Stretching (PIS) is a technique used improve flexibility while working on passive tone of the muscle	Procedure: Post Isometric Relaxation; All patients were given Trans-Cutaneous Electrical Nerve Stimulation (TENS) in combination with superficial heat for 10 minutes. with a session of 5 days/ week. Group A (PIR) : In this group, participants performed 3-5 rounds of post-isometric relaxation (PIR). Each round involved contracting the target muscle at 30-50% strength for 7-10 seconds, resting for 5 seconds .; Procedure: Post Isometric Stretching; All patients were given Trans-Cutaneous Electrical Nerve Stimulation (TENS) in combination with superficial heat for 10 minutes. with a session of 5 days/ week.Group B (PIS) : In this group participants performed 3-5 rounds of post-isometric relaxation (PIR), which is then followed by a stretch of the same muscle to its new range of motion. Followed by rest of 5 seconds, and then stretching the muscle and holding the stretch for 10-60 seconds

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	The Visual Analog Scale (VAS) will be used to measure the intensity of neck pain before and after the intervention. Participants will mark their level of pain on a 100 mm horizontal line, where: 0 mm indicates "no pain", and 100 mm indicates "the worst imaginable pain".	1 week
Cervical range of motion	A universal goniometer will be used to assess cervical spine mobility in the following directions: Flexion Extension Lateral Flexion (Right and Left) Rotation (Right and Left) ROM will be recorded in degrees.	1 week
Functional Disability	The Neck Disability Index (NDI) will be used to assess functional impairment related to neck pain. It is a self-administered questionnaire consisting of 10 sections, including pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each section is scored from 0 to 5, with higher total scores indicating greater disability. The NDI is a validated, open-access tool commonly used in research to measure changes in disability levels pre- and post-intervention.	1 week

Collaborators and Investigators

• Sponsor: Foundation University Islamabad
• Investigators: Principal Investigator: FUI, Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): January 15, 2025
• Primary Completion (Estimated): December 30, 2025
• Study Completion (Estimated): December 15, 2026

Study Registration Dates

• First Submitted: December 26, 2025
• First Submitted That Met QC Criteria: December 26, 2025
• First Posted (Actual): January 9, 2026

Study Record Updates

• Last Update Posted (Actual): January 9, 2026
• Last Update Submitted That Met QC Criteria: December 26, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: Chronic Neck Pain; Muscle Relaxation; Pain Management; Neck Muscles; Isometric Contraction; Subacute neck pain
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neurobehavioral Manifestations; Perceptual Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Agnosia
• Other Study ID Numbers: FUI/CTR/2025/08

Drug and device information, study documents

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