Comparison of Integrated Neuromuscular Inhibition Technique With Myofascial Release on Rhomboids Trigger Points

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.

: 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

Eligibility Criteria:
Inclusion Criteria:

* • Shoulder or mid back pain

  * Presence of atleast one trigger points in rhomboids (diagnosed by the characteristics like hyperirritable spot in a taut band, twitch response and referral pain)
  * Presence of Jump sign

Exclusion Criteria:

* • Any history of recent shoulder or Neck surgeries

  * Fractures, Dislocations, Traumatic injuries, Adhesive capsulitis, Tendinitis, thoracic outlet syndrome, Advanced osteoporosis, Psychiatric Disorders
  * Signs of cervical spinal cord compromise (e.g. diffuse sensory abnormality, diffuse weakness, hyperreﬂexia, or the presence of clonus
  * Two or more signs of nerve root involvement (e.g. dermatomal sensation changes, myotomal weakness, or diminished/absent tendon jerk reﬂexes)
  * A history of shoulder degenerative joint disease as per radiographs, endocrine disorders, and autoimmune conditions (e.g. rheumatoid arthritis, ﬁbromyalgia etc)