Sub-Occipital MIT With and Without HR Agonist Contraction of Hamstrings in Neck Pain Patients With Hamstring Tightness

Study Overview
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Brief Summary
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Hamstrings and Sub occipital muscles are part of the superficial back line of the myofascial chain which connects the neck to the lower extremity and the soft tissue in the cervical spine links the dura and sub occipital muscle fascia. Increased tension in one or other part of this myofascial chain disturbs the whole superficial back line and compromises the flexibility. The objective of this study is to determine the Effects of Sub-Occipital Muscle Inhibition technique (MIT) with and without Hold Relax (HR) Agonist Contraction of Hamstrings on Pain, Disability and Craniovertebral angle in Neck pain patients with Hamstring Tightness. This study will be a randomized controlled trial and will be conducted in Physiotherapy center of AL-Mahmood Welfare Foundation Sahiwal. This study will be completed in time duration of 10 months after the approval of synopsis and consecutive sampling technique will be used. A sample size of 34 will be randomly assigned into two groups. Group A will be given Sub Occipital Muscle Inhibition treatment while Group B will be given Sub occipital Muscle Inhibition and Hold Relax Agonist Contraction of hamstring. Each group will be given three sessions per week. Data will be collected from all participants before first session of treatment and after 6th session of treatment by using Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Cervical Range of motion (CROM), Craniovertebral Angle (CVA) and Active knee extension (AKE) test measurement.

Official Title
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Effects of Sub-Occipital Muscle Inhibition Technique With and Without Hold Relax Agonist Contraction of Hamstrings on Pain, Disability and Craniovertebral Angle in Neck Pain Patients With Hamstring Tightness

Conditions
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Neck Pain Patients With Hamstring Tightness

Intervention / Treatment
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* Other: Sub Occipital Muscle Inhibition
* Other: Sub Occipital Inhibition with Hold Relax Agonist Contraction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 25-40 years Both Genders ( Male and Female) Neck Pain on NPRS ≥5 NDI score ≥14 ( Moderate disability) Active knee extension lag ≥30 and considered as tight hamstrings Exclusion Criteria: Acute Low back or Neck pain History of lumbar and cervical herniated disc and spinal stenosis History of cervical spine surgery and Trauma History of vascular disease in head and neck Progressive neurological deficit or Inflammatory condition ( such as peripheral neuropath, rheumatoid arthritis) History of abdominal or pelvic surgery in last 6 months

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

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
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Sub Occipital Muscle Inhibition<br>Subjects in this group will receive only Sub Occipital Muscle Inhibition Technique and heating pad for 10 minutes. | Other: Sub Occipital Muscle Inhibition<br>* The therapist sits at the head end of the table, palms beneath the subject's head, pads of his fingertips on the posterior arch of the atlas, which will be palpated by the therapist between the external occipital protuberance and the spinous process of the axis vertebra. The therapist locates the gap between the occipital condyles and the spinous phase of the C2 vertebra with the middle and ring fingers of both hands the therapist then rests the base of the skull on his or her hands, with toward the therapist. The pressure will be held at the same level for four minutes until tissue relaxation will be achieved. The subject will be asked to keep his eyes closed during the SMI technique to prevent eye movements disturbing the Sub occipital muscle tone.<br>|
| Experimental: Sub Occipital Inhibition with Hold Relax Agonist Contraction<br>Subjects in this group will receive Sub Occipital Inhibition and Hold Relax Agonist Contraction of hamstrings. | Other: Sub Occipital Muscle Inhibition<br>* The therapist sits at the head end of the table, palms beneath the subject's head, pads of his fingertips on the posterior arch of the atlas, which will be palpated by the therapist between the external occipital protuberance and the spinous process of the axis vertebra. The therapist locates the gap between the occipital condyles and the spinous phase of the C2 vertebra with the middle and ring fingers of both hands the therapist then rests the base of the skull on his or her hands, with toward the therapist. The pressure will be held at the same level for four minutes until tissue relaxation will be achieved. The subject will be asked to keep his eyes closed during the SMI technique to prevent eye movements disturbing the Sub occipital muscle tone.<br>Other: Sub Occipital Inhibition with Hold Relax Agonist Contraction<br>* Therapist will passively flex the lower extremity with knee extended to the end range of Hip Flexion. Once the end range of motion will attain the patient will apply a 10second isometric force against the therapist manual resistance. After the isometric contraction of hamstring the patient will ask to perform a concentric contraction of opposing muscle (hip flexors) for 10 seconds. As the patient performs the concentric contraction the therapist takes up the slack into any ROM that was gained keeping limb into new stretch position for 10-15 seconds and then rest for 5 seconds. Three repetitions of this technique will be performed on each subject.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | The NPRS is an 11-point numerical scale used to measure average pain experience over 7 days, and ranges from 0 (no pain) to 11 (worst imaginable pain). NPRS is considered a valid and reliable scale for measures of pain intensity. | 2 weeks | 
| Bubble Inclinometer for Active Knee Extension test | For popliteal angle and cervical range of motion bubble inclinometer will be used in this study. In the Active knee extension test, the subjects knee will be extended with the subject will lying in the supine position and the hip joint flexed to 90°. This test has good validity and reliability (0.75) | 2 weeks | 
| Neck disability index | Urdu version of neck disability index will be used in this study.It consists of ten items related to pain intensity, headache, concentration and different physical activities (lifting, personal care, recreation, work, driving, reading and sleeping) with six possible responses per item. The score of each item ranges from 0 to 5. The highest total possible score is 50, and this score is converted to a percentage. Higher scores represent higher levels of disability. The NDI has been shown to be a valid and reliable questionnaire for patients with neck pain. | 2 weeks | 
| Image J software for Craniovertebral Angle | Craniovertebral angle will be measured by using a camera and Image J analysis software. For this purpose, patient will sit on a stool or chair in comfortable position, hands should be relaxed on thighs and feet on floor. A camera will set at I meter distance from patient and perpendicular to the height of patient's shoulder. The measuring evaluator attached two body markers, one on the tragus of ear and the other on the seventh spinous process. Patients will be asked to fix their gaze on a mark on the wall directly in front of them. Once the photograph was obtained, the CVA was used to measure the angle between a line extending from the tragus of the ear to C7 and the horizontal line passing through the C7 spinous process. | 2 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PNF Stretching, Range of Motion, Hamstring Muscles, Neck Pain, Muscle Tightness