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

Riphah International University

Status: Enrolling

Conditions: Forward Head Posture

Treatments: Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

Study type: Interventional

Funder types: Other

Identifiers

NCT06732700

REC/01940 Iqra Rashid

Details and patient eligibility

About

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.

Full 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.

Enrollment: 42 estimated patients

Sex: All

Ages: 18 to 40 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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42 participants in 2 patient groups

Experimental Group: 1

Experimental group

Description:

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

Treatment:

Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

Control Group: 2

Active Comparator group

Description:

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).

Treatment:

Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.