Comparison of Integrated Neuromuscular Inhibition Technique With Myofascial Release on Rhomboids Trigger Points
Condition: Trigger Point Pain, Myofascial
MeSH terms: Myofascial Pain Syndromes
Study type: Interventional

Summary: 
      The aim of this research is to compare the effect of integrated neuromuscular inhibition
      technique and myofascial release on pain, pain pressure threshold and shoulder disability in
      patients with rhomboid muscle. Randomized controlled trials will be done at Benazir Bhutto
      Hospital. The sample size is 32. The subjects will be divided in two groups, 16 subjects in
      integrated neuromuscular inhibition technique group and 16 in myofascial release group. Study
      duration will be of 6 months. Sampling technique applied will be non-probability purposive
      sampling technique. Only 25-45 years patients with shoulder/mid back pain and the presence of
      atleast one trigger point in rhomboid muscles will be included. Tools used in the study are
      algometer, shoulder pain and disability index (SPADI) and Numeric pain rating scale (NPRS).
      Data will be analyzed through SPSS 21.
    

Detailed description: 
      : Trigger points (TrPs) are focal, discrete, and hyperirritable spots located in a taut band
      within a skeletal muscle. These are painful on compression and can produce referred pain,
      tenderness, autonomic nervous system symptoms, restricted range of motion and motor
      dysfunction. These trigger points are developed as a result of trauma, overuse, joint
      dysfunction, mechanical pressure overload, psychological distress, repetitive overhead
      activities, and postural stress. Shoulder imbalances can cause tightness of the Rhomboid
      muscles. The pathogenesis results from the overloading and injury of muscle tissue, leading
      to involuntary shortening of localized fibers.

      However, there is dearth of literature showing the effects of INIT or MFR on trigger points
      of muscles like Trapezius, IT band, gluteus medius and piriformis etc. Rhomboids trigger
      points treatment has quiet limited evidence. The available studies focus on these trigger
      point release by electrotherapy or by muscle energy techniques.

      Soft tissue manual mobilization like INIT can provide an effective mean to treat these
      trigger points as they have beneficial effects in other areas. This study focused on use of
      both manual techniques to find out their effects on pain, pain pressure threshold and
      shoulder disability of Rhomboid trigger points. Both manual techniques are easy to administer
      and require no equipment. INIT is proven to have beneficial effects on multiple muscles of
      body but its efficacy has not been tested on rhomboid so this study will also add to that and
      specifically in Pakistan there is no single study has been conducted to compare the effects
      of INIT and MFR in patients with Rhomboid Trigger Points. The results of this study therefore
      had therapeutic significance for determining whether the two approaches yield comparable
      results or whether one is more effective than the other. This would assist in laying the
      groundwork for more research and developing treatment regimens for the aforementioned
      population
    

Intervention name(s): Integrated neuromuscular inhibition technique; Myofascial Release
Intervention type(s): Other; Other
Intervention description(s): Ischemic compression will be applied for 90 seconds followed by the SCS technique with a reduction in pain of at least 70%. it will be held for 20-30 sec followed by the Muscle energy technique in which the isometric contraction will be held for 7-10 sec and then the stretch will be held for 30 sec. This will be repeated 5 times per session with a 30-second rest interval in between each repetition Session will be held 3 times per week for 2 consecutive weeks; Deep sustained pressure on the trigger points will be applied with thumb in 5-7/10 pain tolerance and maintained for 60 seconds and then will be released in a vertical direction followed by stretch of the rhomboid muscle held for 30 sec. This Sustained manual pressure will be applied for 3 times each followed by a stretch per session with a 30 sec rest interval in between .Session will be held 3 times per week for 2 consecutive weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: pain pressure threshold; algometer; SPADI