The Effect of Integrated Neuromuscular Inhibition Technique in Combination With Therapeutic Exercise on Patients With Chronic Mechanical Neck Pain
Condition: Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      The purpose of this study is to examine the combine effect of the integrated neuromuscular
      inhibition technique (soft tissue mobilization techniques protocol), in combination with the
      therapeutic exercise in patients with chronic mechanical neck pain in the sub-acute stage of
      symptoms, and to determine whether this combination substantially helps the faster and more
      efficient installation of adaptations of exercising.
    

Detailed description: 
      Neck pain is one of the most common and costly musculoskeletal disorders in Western
      societies, which witnesses high prevalence of repeatability and chronicity. In chronic
      mechanical neck pain, there are changes in the neck area, due to muscular imbalance between
      deep neck flexors (longus capitis and longus colli) and superficial flexors of the neck
      (sternocleidomastoid and anterior scalene). Therapeutic exercise plays a key role in the
      restoration of this muscle imbalance, comprising a combination of resistant and endurance
      training. The integrated neuromuscular inhibition technique (INIT) is a manual deactivation
      trigger points technique and includes the application of ischemic pressure and stretch, the
      muscle energy technique and the Strain-counterstrain technique.

      The aim of the research is to investigate whether the application of INIT combined with
      exercise can reduce the time required to establish the benefits of training and improve
      faster and to a greater extent the clinical figure and the quality of life of patients with
      chronic neck pain.

      Method. Single blind clinical trial lasting for 10 weeks, 40 participants (men/women) with
      chronic mechanical neck pain. Participants will be divided into two groups, following the
      same exercise program. The first group (experimental) will follow the exercise programme in
      combination with the integrated neuromuscular inhibition technique (INIT), while the second
      (active comparator) will apply the same program excluding the INIT technique. The subjective
      perception of pain by the visual analogue scale, the functionality related to neck pain with
      neck disability index, ppt of the neck muscles with pressure algometry, active range of
      motion with a bubble inclinometer, maximum isometric strength of neck muscles with a hand
      dynamometer, muscular fatigue of the flexors of the neck with special tests and the quality
      of life with the sf-36 questionnaire will be evaluated before, during and after the
      intervention, while follow-ups will take place one, three and six months later.
    

Intervention name(s): Exercise programme; Integrated Neuromuscular Inhibition Technique application.
Intervention type(s): Other; Other
Intervention description(s): Endurance and Resistant training exercise program (Duration: 45 minutes)
Muscle retraining of longus colli and endurance training of the deep cervical flexors.
Resistant exercises for the muscles involved in neck flexion, extension, side bending and rotation of the neck region. Isometric contractions exercises (20-70% of MVC) and resistant exercises (12-15RM).
Active ROM exercises for the neck muscles
Upper limbs exercises with resistant bands
Stretching exercises for the neck and upper limbs muscles; Integrated Neuromuscular Inhibition Technique application.
(Duration: 15min)
The protocol was applied to the following muscles:
Upper border of the trapezius muscle
sternocleidomastoid
levator scapulae muscle
splenius capitis muscle
Integrated Neuromuscular Inhibition Technique includes the combination of the following technique:
Ischemic compression
Muscle energy technique
Strain-counterstrain technique
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Chronic Mechanical Neck Pain; exercise; Integrated Neuromuscular Inhibition Technique