Effect of Integrated Neuromuscular Inhibition Technique on Patients With Non-Specific Neck Pain (INIT-Neck)

Non-specific mechanical neck pain (NSNP) is a common musculoskeletal condition that causes neck pain, reduced movement, and difficulty performing daily activities. Manual therapy techniques are frequently used to manage this condition; however, evidence regarding the combined use of Integrated Neuromuscular Inhibition Technique (INIT) and cervical mobilization remains limited.

This randomized controlled trial aims to compare the effectiveness of INIT combined with cervical mobilization versus cervical mobilization with conventional physiotherapy in adults with non-specific mechanical neck pain. Forty-two participants aged 30-60 years will be allocated to one of two treatment groups. The experimental group will receive INIT, consisting of muscle energy technique, strain-counterstrain, and ischemic compression, in addition to cervical mobilization. The control group will receive cervical mobilization with conventional physiotherapy modalities. Both groups will receive five treatment sessions.

The primary outcomes are pain intensity, neck-related disability, and cervical range of motion. Outcomes will be assessed before treatment and after completion of the intervention using the Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), and cervical range of motion measurements. The findings of this study are expected to determine whether adding INIT to cervical mobilization provides greater improvements in pain, cervical mobility, and functional ability than conventional physiotherapy alone, thereby supporting evidence-based management of non-specific mechanical neck pain.

Study Overview

• Status: Completed
• Conditions: Non-specific Mechanical Neck Pain
• Intervention / Treatment: Procedure: Integrated Neuromuscular Inhibition Technique (INIT); Procedure: Cervical Mobilization; Procedure: Conventional Physiotherapy

Detailed Description

Non-specific mechanical neck pain (NSNP) is one of the most prevalent musculoskeletal disorders worldwide and is associated with pain, reduced cervical mobility, functional limitations, decreased work productivity, and impaired quality of life. The condition is commonly related to myofascial trigger points, altered neuromuscular control, muscle imbalance, postural dysfunction, and restricted cervical joint mobility. Although conventional physiotherapy, including electrotherapy and cervical mobilization, has demonstrated beneficial effects, many patients continue to experience persistent symptoms and recurrent episodes.

Integrated Neuromuscular Inhibition Technique (INIT) is a multimodal manual therapy approach that combines muscle energy technique (MET), strain-counterstrain, and ischemic compression to address both myofascial and neuromuscular dysfunction. These techniques are intended to reduce pain, deactivate myofascial trigger points, improve muscle extensibility, restore neuromuscular control, and increase cervical range of motion. Previous studies have demonstrated promising results for INIT; however, evidence regarding its effectiveness when combined with cervical mobilization remains limited.

This study is a prospective, randomized, parallel-group controlled trial conducted at the Physiotherapy Outpatient Department of Fauji Foundation Hospital, Rawalpindi, Pakistan. Forty-two participants diagnosed with non-specific mechanical neck pain will be allocated equally to either an experimental group receiving INIT combined with cervical mobilization or a control group receiving cervical mobilization with conventional physiotherapy. Each participant will complete five treatment sessions.

The primary outcome measures include pain intensity assessed using the Numeric Pain Rating Scale (NPRS), neck-related disability assessed using the Neck Disability Index (NDI), and cervical range of motion measured with a universal goniometer. Assessments will be performed at baseline and immediately after completion of the treatment protocol.

The study aims to determine whether the addition of INIT to cervical mobilization results in superior improvements in pain, cervical mobility, and functional disability compared with conventional physiotherapy. The findings are expected to provide high-quality evidence regarding the clinical effectiveness of this multimodal manual therapy approach and may contribute to improving rehabilitation strategies and clinical practice guidelines for the management of non-specific mechanical neck pain.

• Study Type: Interventional
• Enrollment (Actual): 42
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Islamabad, Pakistan, 44800
    • Physiotherapy Outpatient Department, Fauji Foundation Hospital

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Adults aged 30 to 60 years.
• Clinical diagnosis of non-specific mechanical neck pain.
• Neck pain duration of less than 6 months.
• Painful cervical extension and rotation.
• Negative Sharp-Purser test.
• Negative vertebral artery insufficiency test.
• No history of whiplash injury.
• Able and willing to provide written informed consent and comply with the study protocol

Exclusion Criteria:

• Specific causes of neck pain (e.g., fracture, infection, tumor, inflammatory disease, or cervical myelopathy).
• History of cervical spine surgery.
• Positive Sharp-Purser test or vertebral artery insufficiency test.
• History of whiplash injury.
• Neurological disorders affecting the cervical spine or upper extremities.
• Pregnancy.
• Receipt of physiotherapy or manual therapy for neck pain within the previous 4 weeks.
• Any medical condition that would prevent safe participation in the intervention or outcome assessment.

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
Experimental: Integrated Neuromuscular Inhibition Technique + Cervical Mobilization; Participants receive the Integrated Neuromuscular Inhibition Technique (muscle energy technique, strain-counterstrain, and ischemic compression) combined with cervical mobilization and conventional physiotherapy for five treatment sessions.	Procedure: Integrated Neuromuscular Inhibition Technique (INIT); Integrated Neuromuscular Inhibition Technique (INIT) is a multimodal manual therapy consisting of Muscle Energy Technique (MET), Strain-Counterstrain (SCS), and Ischemic Compression (IC). The intervention targets myofascial trigger points, muscle tightness, and neuromuscular dysfunction to reduce pain, improve cervical range of motion, and decrease functional disability. Participants received INIT in combination with cervical mobilization during five treatment sessions.; Procedure: Cervical Mobilization; Cervical mobilization was performed using Maitland mobilization techniques applied to the cervical spine (C1-C7) to improve joint mobility, reduce pain, and restore cervical range of motion. Mobilization was administered in three sets of ten repetitions during each of the five treatment sessions. This intervention was provided to participants in both study groups.
Active Comparator: Conventional Physiotherapy + Cervical Mobilization; Participants receive cervical mobilization together with conventional physiotherapy, including TENS and hot pack therapy, for five treatment sessions.	Procedure: Cervical Mobilization; Cervical mobilization was performed using Maitland mobilization techniques applied to the cervical spine (C1-C7) to improve joint mobility, reduce pain, and restore cervical range of motion. Mobilization was administered in three sets of ten repetitions during each of the five treatment sessions. This intervention was provided to participants in both study groups.; Procedure: Conventional Physiotherapy; Conventional physiotherapy consisted of transcutaneous electrical nerve stimulation (TENS) applied for 15 minutes and hot pack therapy applied to the cervical and upper back region for 10-15 minutes. These modalities were provided together with cervical mobilization during each of the five treatment sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Intensity	Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), an 11-point validated scale ranging from 0 (no pain) to 10 (worst imaginable pain). Lower scores indicate reduced pain intensity.	Baseline and immediately after completion of five treatment sessions (approximately 1 week).
Neck-Related Disability	Neck-related disability will be evaluated using the Neck Disability Index (NDI), a validated 10-item questionnaire with total scores ranging from 0 to 50. Higher scores indicate greater disability, while lower scores indicate improvement in functional status.	Baseline and immediately after completion of five treatment sessions (approximately 1 week).
Cervical Range of Motion	Active cervical extension and rotation will be measured using a universal goniometer. Changes in cervical range of motion will be compared between groups to evaluate improvements in cervical mobility following the intervention.	Baseline and immediately after completion of five treatment sessions (approximately 1 week).

Collaborators and Investigators

• Sponsor: Ibadat International University, Islamabad
• Investigators: Principal Investigator: Zahid Mehmood, DPT, MSPT, Ibadat International University

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2026
• Primary Completion (Actual): July 1, 2026
• Study Completion (Actual): July 2, 2026

Study Registration Dates

• First Submitted: July 3, 2026
• First Submitted That Met QC Criteria: July 3, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 10, 2026
• Last Update Submitted That Met QC Criteria: July 9, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Integrated Neuromuscular Inhibition Technique; Muscle Energy Technique; Ischemic Compression; Strain Counterstrain; Cervical Mobilization
• Other Study ID Numbers: Ref: USKT/RERC/ADT/2026/09/115

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because participant consent did not include permission for public data sharing, and the study institution does not have a policy supporting external sharing of de-identified participant-level data. Results will be reported in aggregate form to protect participant confidentiality.

Drug and device information, study documents

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