Effect of Integrated Neuromuscular Inhibition Technique on Subjects With Neck Pain and Forward Head Posture

Study Overview
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Brief Summary
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To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles on craniovertebral angle in neck pain and forward head posture subjects. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles cervical pain intensity level in neck pain and forward head posture subjects. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles on cervical range of motion in neck pain and forward head posture subjects. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles on cervical proprioception in neck pain and forward head posture subjects. To investigate the effects of integrated neuromuscular inhibition technique for upper trapezius and suboccipital muscles cervical function in neck pain and forward head posture subjects.

Detailed Description
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Forward head posture (FHP) is one of the most common types of postural abnormality, and it is generally described as an anterior position of the head in relation to the vertical line of the body's center of gravity. Many researchers have reported that several factors, including headache, neck pain, and musculoskeletal disorders such as temporomandibular disorders or rounded shoulders, are related to FHP . It is associated with shortening of the upper trapezius, the posterior cervical extensor muscles, the sternocleidomastoid muscle and the levator scapulae muscle Forward head posture (FHP) is a forward inclination of the head with cervical spine hyperextension and is associated with shortening of the upper trapezius, the splenius and semispinalis capitis and crevice's, the cervical erector spinae and the levator scapulae musculature . A significant number of the population experiences neck related musculoskeletal problems caused by abnormal forward head posture. Forward Head Posture (FHP) is a common postural deviation reported in the literature, and has been considered as a risk factor for the development of neck pain. Around 61.3% adults with neck pain, working using computers were reported to have FHP In addition, patients with chronic neck pain demonstrated weakness in their deep neck flexors and presented with FHP when distracted. Neck pain is a common disorder characterized by pain, discomfort or soreness experienced in a region between the inferior margin of the occipital bone and T1. Prevalence of neck pain in employees is not the same all over the world. In western countries it has been reported to be between 34% and 54%.As neck pain could become a chronic and disabling symptom, discovering and controlling risk factors seems to be a reasonable prevention strategy. Improper posture could be improved by education and proper reminders to decrease the prevalence of neck pain and increase the quality of life. It is thought that adolescents or patients with neck pain (NP) have a more forward head posture, thus a smaller craniovertebral (CV) angle than age-matched pain-free participants. It was concluded that the CV angle is negatively correlated with the disability of patients with neck pain. So, patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability

Official Title
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Effect of Integrated Neuromuscular Inhibition Technique on Subjects With Neck Pain and Forward Head Posture

Conditions
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Neck Pain and Forward Head Posture

Intervention / Treatment
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* Other: Integrated Neuromuscular inhibition
* Other: traditional treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Adolescent Female physical therapy students between 18-23 years old BMI between 18.5-25 kg/m² Symptomatic forward head posture with CVA 49° or less. Latent trigger point Neck pain more than 3 months Exclusion Criteria: Cervical disc Myelopathy or cervical radiculopathy Cervical spine surgery in the past Having received physical therapy in the three months prior to the study Non- rheumatologic diseases as multiple sclerosis, thyroid dysfunction and chronic infection. Rheumatologic condition as poly-articular osteoarthritis, rheumatoid arthritis and advanced cervical spine degenerative diseases. -

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 23 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: this trial has two groups ,one experimental and one control
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Integrated Neuromuscular Inhibition<br>Integrated Neuromuscular Inhibition in addition to traditional treatment will be received three times a week for eight weeks. Integrated Neuromuscular Inhibition will be contain three combined manual treatment ( ischemic compression , strain counter strain , Muscle energy technique ) | Other: Integrated Neuromuscular inhibition<br>* Integrated Neuromuscular Inhibition in addition to traditional treatment will be received three times a week for eight weeks. Integrated Neuromuscular Inhibition will be contain three combined manual treatment ( ischemic compression , strain counter strain , Muscle energy technique ) traditional treatment will be received three times a week for eight weeks . traditional treatment in Form of stretching and strenghthening of cervical muscles and postural advices<br>* Other names: INMI;|
| Active Comparator: traditional treatment<br>traditional treatment will be received three times a week for eight weeks . traditional treatment in Form of stretching and strenghthening of cervical muscles and postural advices | Other: traditional treatment<br>* traditional treatment will be received three times a week for eight weeks . traditional treatment in Form of stretching and strenghthening of cervical muscles and postural advices<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Craniovertebral angle | Craniovertebral angle (CVA): is the angle formed between a horizontal line through the spinous process of C7 and a line from the tragus of the ear | up to eight weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck pain intensity level | Neck pain will measured by visual analogue scale ( VAS) .When responding to a VAS item, patients make marks along 100 mm line at the point they feel represents their current pain state . with 100 mm means high level of pain and 0 means no pain | up to eight weeks | 
| change in Neck Functional disability | Neck disability will measured by English neck disability index (NDI) Questionnaire is composed of a total of 10 questions.Each question has 6 answer options which pertain to a level of severity (0-5) with total score of 50 ,when NDI is high the neck function is the worst | up to eight weeks | 
| Cervical Range of motion ROM | Cervical Range of motion will measured by clinometer application | up to eight weeks | 
| Cervical proprioception | Cervical proprioception will measured by clinometer application | up to eight weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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neck pain, Forward head posture