Integrated Neuromuscular Inhibition, Muscle Energy and Strain Counter Strain Techniques in Neck Pain

Study Overview
=================
Brief Summary
-----------------
To determine effects of Neuromuscular Inhibition, Muscle energy and strain counter strain techniques on Pain, disability, pain pressure threshold, range of motion, and health-related quality of life in mechanical neck pain. To compare the effects of Integrated Neuromuscular inhibition, Muscle energy and strain counter strain techniques in the Management of mechanical neck pain.

Official Title
-----------------
Effect of Integrated Neuromuscular Inhibition, Muscle Energy and Strain Counter Strain Techniques in the Management of Mechanical Neck Pain.

Conditions
-----------------
Neck Pain

Intervention / Treatment
-----------------
* Other: Strain Counter Strain Technique
* Other: Muscle Energy Technique,
* Other: Integrated Neuromuscular Inhibition Technique


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Participants falling in this category would be recruited into the study. Patients with chronic mechanical neck pain (symptoms for more than 3 months). Age group between 30 - 60 years. Patients willing to participate and take treatment. Patients must have at least 1 active trigger point at upper trapezius, levator scapulae, SCM. Gender (Both) VAS >3 Exclusion Criteria: • Patients having severe neck pain. Patients having any systemic joint pathology, inflammatory joint disease (e.g rheumatoid arthritis, gouty arthritis, psoriatic arthritis). Patients who had any neurological deficit, myelopathy any mental illness. Patients on medication like antidepressants, corticosteroid, anti-inflammatory medications.

Ages Eligible for Study
-----------------
Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Strain Counter Strain Technique<br>When general or local pain began to diminish, upper trapezius , levator scapulae and SCM was placed in a position of ease and was held for approximately 20 to 30 seconds. Moderate digital pressure was applied to the identified MTrP as participants rated their level of pain on a scale ranging from 1 to 10.3. Ease was defined as the point at which a reduction in pain of at least 70% was achieved.Once the position of ease was identified, it was held for 20 to 30 seconds. | Other: Strain Counter Strain Technique<br>* When general or local pain began to diminish, upper trapezius , levator scapulae and SCM was placed in a position of ease and was held for approximately 20 to 30 seconds. 2. Moderate digital pressure was applied to the identified MTrP as participants rated their level of pain on a scale ranging from 1 to 10. 3. Ease was defined as the point at which a reduction in pain of at least 70% was achieved. 4. Once the position of ease was identified, it was held for 20 to 30 seconds.<br>|
| Experimental: Muscle Energy Technique,<br>After the ease position was maintained for 20 to 30sec an isometric contraction focused on the muscle fibers around the MTrP was performed. Each isometric contraction was held for 7 to 10 sec and was followed by a soft-tissue stretch for 15 seconds and then relax for 30 seconds. Each stretch was held for 30 seconds, and it was repeated 3 times during the treatment session. 3. Treatment was performed on the 3 most painful areas between the upper border of the upper trapezius muscle, the SCM, the levator scapulae, and the SC muscle. | Other: Muscle Energy Technique,<br>* After the ease position was maintained for 20 to 30sec an isometric contraction focused on the muscle fibers around the MTrP was performed. 2. Each isometric contraction was held for 7 to 10 sec and was followed by a soft-tissue stretch for 15 seconds and then relax for 30 seconds. Each stretch was held for 30 seconds, and it was repeated 3 times during the treatment session. 3. Treatment was performed on the 3 most painful areas between the upper border of the upper trapezius muscle, the SCM, the levator scapulae, and the SC muscle.<br>|
| Experimental: Integrated Neuromuscular Inhibition Technique<br>1. Group c will receive Combination of exercise (strain counter strain , muscle energy & ischemic compression. In ischemic compression patient will receive compression,2. After MTrPs identification, 3. Ischemic compression was applied in an intermittent manner for up to 2 minutes for each MTrP. 4. The pincer grasp (for the trapezius muscle and SCM) or direct digital pressure (for the levator scapulae and SC muscle) was used with the patients in either the supine position or sitting upright. | Other: Integrated Neuromuscular Inhibition Technique<br>* Group c will receive Combination of exercise (strain counter strain , muscle energy & ischemic compression. In ischemic compression patient will receive compression, After MTrPs identification, Ischemic compression was applied in an intermittent manner for up to 2 minutes for each MTrP. The pincer grasp (for the trapezius muscle and SCM) or direct digital pressure (for the levator scapulae and SC muscle) was used with the patients in either the supine position or sitting upright<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| • Visual analog scale. | Pain was assessed by the VAS, which is a card with an uncalibrated scale ranging from 0 to 10. 0 represent no pain and 10 represent the highest level of pain. A vertical line on the scale drawn by the patient marked their subjective pain estimation ranging from 0 to 10. Subsequently, a single ruler was used to record the exact pain level. The reliability of the scale is quite satisfactory, especially in people with moderate and high educational levels (r = .94, P = .001) (6). reference for tools should be added | 4 weeks | 
| • Neck disability index. | Disability was evaluated using the NDI questionnaire. It is a self-reported 10-item scale. Each item assesses different neck pain complaints. Most of the items are related to restrictions in activities of daily life, and each item is expressed by 6 different assertions in the range 0 to 5, with 0 indicating no disability and 5 indicating the highest disability. The total score ranges from 0 to 50. Its credibility in people with neck pain is moderate to high and has been considered a valid tool in patients with neck problems. NDI has high reliability i.e. ICC 0.97 and good internal validity i.e. Cronbach's alpha = 0.86.(6) | 4 Weeks | 
| • 36-Item Short Form Health Survey score | SF-36 consists of 36 questions, selected from the Medical Outcomes Study. These questions are related to 8 different parameters of mental and physical health.SF-36 has satisfactory support in the literature.51 Total Physical and Mental Health, and the subcategory of Bodily Pain, were evaluated in this study. SF-36 shows a high rate of validity and reliability in patients with neck pain. In all 8 categories, both the ICC and the Cronbach's alpha index are high 0.75-0.94 and 0.69-0.88, correspondingly | 4 Week | 
| • Goniometer | Goniometer measures the available range of motion of cervical flexion, extension, rotation and side bending. To see the restriction in cervical moments we compare the available ROM's to the normal ROM's. | 4 Week | 
| algometer | Pressure pain threshold is measured by Pressure algometry was conducted using a Wagner digital algometer (Wagner FPX 25 Digital Algometer; Wagner Instruments, Greenwich, CT). PPT was assessed bilaterally over the upper border of the trapezius muscle, halfway between the midline and the lateral border of the acromion, the levator scapulae muscle 2 cm above the lower insertion and located in the upper medial border of the scapulae, the SCM upper insertion, and the SC 2 cm lateral to the spinous processes of the axis. The metal rod of the algometer was placed vertically on the site, and the examiner applied gradually increasing pressure at a rate of 1 kg/s. The examinees indicated when they began to feel pain or discomfort. Then, the examiner ceased the pressure and noted the value. Pressure algometry showed from satisfactory to fairly high reliability by various researchers both in repeated measurements of the same examiner and between measurements of different examiners.(14) | 4th Week | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Mechanical Neck Pain, Chronic Neck Pain, Muscle Energy Technique, Strain counter Strain, INIT