Integration of Neuromuscular Inhibition Technique On Trapezius Trigger Points.

Myofascial Trigger Point Pain Clinical Trial

Official title:

Effects Of Integrated Neuromuscular Inhibition Technique On Upper Trapezius Trigger Points In Patients With Non-Specific Neck Pain

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04993118
• Other study ID #: REC/00770 Ammara Malik
• Status: Completed
• Phase: N/A
• Start date: May 14, 2020
• Est. completion date: February 26, 2021

Study information

• Verified date: August 2021
• Source: Riphah International University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of the study is to find the effects of integrated neuromuscular inhibition technique on upper trapezius trigger points in patients with non specific neck pain. A randomized control trial was conducted at Iqbal hospital. The sample size was 24calculated through open-epitool.But 30 patients were added in the study to increase the statistical power of analysis.The participants were divided into two interventional groups each having 15 participants. The study duration was six months. Sampling technique applied was Purposive sampling for recruitment and group randomization using sealed envelope method. Only 25 to 45 years participants (both male and female) with upper trapezius trigger points and non specific neck pain of less than 3 months were included in the study. Tools that were used in this study are NDI questionnaire, NPRS and inclinometer. Data was collected at baseline , 2nd and 4th of treatment. Data was analyzed through SPSS version 20.

Description:

Neck pain is a common musculoskeletal disorder. The cause of neck pain is variable and can result from specific musculoskeletal conditions, infections, inflammatory conditions, trauma, rheumatic diseases, or congenital diseases. When neck pain is not attributed to a specific pathology, and is of a vague musculoskeletal origin which is difficult to identify, the condition is labelled non-specific. Up to 67% of world's population may present with non-specific neck pain at least once in their lives. Although the duration and course of the pain may vary, most patients experience chronic or recurrent pain. Evidence suggests that myofascial trigger points are commonly present in patients with non specific neck pain.

The myofascial trigger point ''a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Patients may have regional ,persistent pain resulting in decreased range of motion in the affected muscles. Trigger points may develop after an initial injury to muscle fibers. This injury may include a noticeable traumatic event or repetitive micro trauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. When predisposing factors combine with a triggering stress event, activation of a trigger point occurs. This theory is known as the ''injury pool theory'.

Trigger points are classified as active or latent. Active myofascial trigger point is spontaneously painful and gives rise to a number of well described symptoms: local and/or referred pain; muscle weakness and tightness. Latent myofascial trigger points on the other hand, are generally considered minor, sub-clinical neuromuscular lesions that are pain-free unless compressed though shown to be associated with increased sensitivity to muscle stretch, decreased strength. In the upper quadrant, postural muscles, in general, and the upper trapezius , in particular, are most affected by trigger points .It extends from the external protuberance of the occipital bone to the lower thoracic vertebrae and laterally to the spine of the scapula. The trapezius has upper, middle, and lower groups of fibers. Neck pain is provoked by trigger points of trapezius.Patients with trigger points of trapezius usually present with neck pain,decreased cervical range of motion,tightness of trapezius Various treatment techniques that are utilized for treating trigger points are LASER , dry needling, ultrasound, TENS, trigger point pressure release /ischemic compression, muscle energy technique , myofascial release therapy , positional release therapy i.e. strain counter strain technique and integrated neuromuscular inhibitory technique.The integrated neuromuscular inhibition technique is a manual deactivation trigger points technique and includes the application of ischemic compression, muscle energy technique and strain counter strain technique. Ischemic compression ('inhibition') is applied to an active trigger point by means of direct finger or thumb pressure until local or referred pain begins to modify. Following this, the tissues in which the trigger point lies are positioned in such a way as to modify the pain . After 90 seconds the patient is asked to introduce an isometric contraction into the tissues and to hold this for 7-10 seconds. This recruits the precise fibers which had been repositioned to obtain the positional release. These previously hypertonic or fibrotic tissues are then stretched so that the specifically targeted fibers are lengthened. A rhythmic activation of antagonist muscles in a series of 'pulsed' contractions is a useful final stage of this sequence.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: February 26, 2021
• Est. primary completion date: December 30, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 25 Years to 45 Years

Eligibility

Inclusion Criteria:

• Patients with non specific neck pain < 3 months duration

• Patients who have TrPs in upper trapezius confirmed on basis of Travel and Simons diagnostic criteria

Exclusion Criteria:

• • Patients having any trauma

• Signs of any serious pathology ( e.g malignancy, inflammatory disorder or fracture)

• Signs of spinal cord compression

• Signs of nerve root involvement

• History of neck surgery in previous 12 months

• History of cervical degenerative joint disease

• Autoimmune conditions

Related Conditions & MeSH terms

• Myofascial Pain Syndromes
• Myofascial Trigger Point Pain

Intervention

Other:
• Integrated Neuromuscular Inhibition technique
Integrated Neuromuscular inhibition technique At first ischemic compression was given using a pincer grip over the active trigger point till the tissue barrier was felt .The process was repeated till the tension reduced for 90 seconds.Ischemic compression was followed by the application of strain counterstrain. Once the position of ease was identi?ed, it was held for 90 seconds and repeated for three to ?ve repetitions. Muscle energy technique was applied as last part of integrated neuromuscular inhibition technique . Each isometric contraction was held for 7-10 seconds and was followed by further contralateral side bending, ?exion, and ipsilateral rotation to maintain the soft tissue stretch. Each stretch was held for 30 seconds and was repeated three to ?ve times per treatment session
• Ischemic Compression,Hotpack,TENS
Control group received conventional physical therapy. It included HOT Packs ( 20 minutes) , TENS (10 minutes) ,Ischemic compression .Using a pincer grasp, we identified the trigger point. Once the trigger point was identi?ed we applied ischemic compression by placing the thumb and index ?nger over the active TrP. Slow, increasing levels of pressure was applied until the tissue resistance barrier was identi?ed. Pressure was maintained until a release of the tissue barrier was felt. At that time, pressure was again applied until a new barrier was felt. This process was repeated until tension/tenderness is unable to be identi?ed

Locations

Country	Name	City	State
Pakistan	Iqbal Hospital	Attock	Punjab

Sponsors (1)

Lead Sponsor	Collaborator
Riphah International University

Country where clinical trial is conducted

Pakistan, 

References & Publications (24)

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Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of Latent Myofascial Trigger Points. Clin Biomech (Bristol, Avon). 2010 Oct;25(8):765-70. doi: 10.1016/j.clinbiomech.2010.05.006. Epub 2010 Jul 27. — View Citation

Mehdikhani R, Okhovatian F. RETRACTED: Immediate effect of muscle energy technique on latent trigger point of upper trapezius muscle. Elsevier; 2012.

Mobilization INI. Comparison of the effect of spinal accessory nerve mobilization, integrated neuromuscular inhibition technique and conventional therapy on in upper trapezius trigger point. Quadriceps Femoris Strength Training: effect of Neuromuscular Electrical Stimulation Vs Isometric Exercise in Osteoarthritis of Knee. 2015;9(3):135.

Nagrale AV, Glynn P, Joshi A, Ramteke G. The efficacy of an integrated neuromuscular inhibition technique on upper trapezius trigger points in subjects with non-specific neck pain: a randomized controlled trial. J Man Manip Ther. 2010 Mar;18(1):37-43. doi: 10.1179/106698110X12595770849605. — View Citation

NEELIMA A. TO ASSESS THE EFFECTIVENESS OF INTEGRATED NEURO MUSCULAR INHIBITORY TECHNIQUES (INIT) WITH STABILIZATION EXERCISES VERSUS ULTRASOUND WITH STABILIZATION EXERCISES ON UPPER TRAPEZIUS TRIGGERPOINTS IN MYOFASCIAL PAIN SYNDROME 2013.

Saadat Z, Hemmati L, Pirouzi S, Ataollahi M, Ali-Mohammadi F. Effects of Integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points. J Bodyw Mov Ther. 2018 Oct;22(4):937-940. doi: 10.1016/j.jbmt.2018.01.002. Epub 2018 Jan 17. — View Citation

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Sharma A, Angusamy R, Kalra S, Singh S. Efficacy of post-isometric relaxation versus integrated neuromuscular ischaemic technique in the treatment of upper trapezius trigger points. Indian Journal of Physiotherapy and Occupational Therapy. 2010;4(3):1-5.

Sibby GM, Kavitha Vishal S. Effectiveness of integrated neuromuscular inhibitory technique and LASER with stretching in the treatment of upper trapezius trigger points. Journal of exercise science and physiotherapy. 2009;5(2):115.

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* Note: There are 24 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Neck Disability Index	Neck Disability Index (NDI) questionnaire ( for measuring neck disability). Total score 50,minimum score is 0 and maximu,m score is 50 parameter minimum and max	6 months
Primary	Numeric Pain Rating Scale	NPRS, for measuring pain intensity.minimum score is o and maximum is 10	6 months
Secondary	range of motion (Cervical flexion)	inclinometer(For measuring flexion range of motion)	6 months
Secondary	range of motion (Cervical extention)	inclinometer(for measuring extension range of motion)	6 months
Secondary	range of motion (Cervical side bending,right left )	inclinometer(for measuring cervical side bending range of motion)	6 months
Secondary	range of motion (Cervical rotation right left,)	inclinometer(for measuring cervical rotation range of motion)	6 months