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

NCT ID: NCT05353075

Last Updated: 2022-06-16

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-04-25
• Study Completion Date: 2023-01-10

Brief Summary

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.

Conditions

Neck Pain Patients With Hamstring Tightness

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Sub Occipital Muscle Inhibition

Subjects in this group will receive only Sub Occipital Muscle Inhibition Technique and heating pad for 10 minutes.

Group Type: OTHER

Sub Occipital Muscle Inhibition

Intervention Type: OTHER

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.

Sub Occipital Inhibition with Hold Relax Agonist Contraction

Subjects in this group will receive Sub Occipital Inhibition and Hold Relax Agonist Contraction of hamstrings.

Group Type: EXPERIMENTAL

Sub Occipital Muscle Inhibition

Intervention Type: OTHER

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.

Sub Occipital Inhibition with Hold Relax Agonist Contraction

Intervention Type: OTHER

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.

Interventions

Sub Occipital Muscle Inhibition

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.

Intervention Type: OTHER

Sub Occipital Inhibition with Hold Relax Agonist Contraction

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.

Intervention Type: OTHER

Eligibility Criteria

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

• Minimum Eligible Age: 25 Years
• Maximum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Saima Zahid, PhD*

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Al-Mahmood Welfare Foundation

Sahiwal, Punjab Province, Pakistan

Site Status: RECRUITING

Countries

Pakistan

Central Contacts

Saima Zahid, PhD*

Role: CONTACT

Saima.zahid@riphah.edu.pk

03334349520

Facility Contacts

Saima Zahid, PhD*

Role: primary

saima.zahid@riphah.edu.pk

03334349520

References

Genebra CVDS, Maciel NM, Bento TPF, Simeao SFAP, Vitta A. Prevalence and factors associated with neck pain: a population-based study. Braz J Phys Ther. 2017 Jul-Aug;21(4):274-280. doi: 10.1016/j.bjpt.2017.05.005. Epub 2017 May 20.

Reference Type: BACKGROUND

PMID: 28602744 (View on PubMed)

Onat SS, Polat CS, Bicer S, Sahin Z, Tasoglu O. Effect of Dry Needling Injection and Kinesiotaping on Pain and Quality of Life in Patients with Mechanical Neck Pain. Pain Physician. 2019 Nov;22(6):583-589.

Reference Type: BACKGROUND

PMID: 31775405 (View on PubMed)

Kim BB, Lee JH, Jeong HJ, Cynn HS. Effects of suboccipital release with craniocervical flexion exercise on craniocervical alignment and extrinsic cervical muscle activity in subjects with forward head posture. J Electromyogr Kinesiol. 2016 Oct;30:31-7. doi: 10.1016/j.jelekin.2016.05.007. Epub 2016 May 24.

Reference Type: BACKGROUND

PMID: 27261928 (View on PubMed)

Cho SH, Kim SH, Park DJ. The comparison of the immediate effects of application of the suboccipital muscle inhibition and self-myofascial release techniques in the suboccipital region on short hamstring. J Phys Ther Sci. 2015 Jan;27(1):195-7. doi: 10.1589/jpts.27.195. Epub 2015 Jan 9.

Reference Type: BACKGROUND

PMID: 25642072 (View on PubMed)

Jeong ED, Kim CY, Kim SM, Lee SJ, Kim HD. Short-term effects of the suboccipital muscle inhibition technique and cranio-cervical flexion exercise on hamstring flexibility, cranio-vertebral angle, and range of motion of the cervical spine in subjects with neck pain: A randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(6):1025-1034. doi: 10.3233/BMR-171016.

Reference Type: BACKGROUND

PMID: 30248030 (View on PubMed)

Dhiman NR, Das B, Mohanty C, Singh OP, Gyanpuri V, Raj D. Myofascial release versus other soft tissue release techniques along superficial back line structures for improving flexibility in asymptomatic adults: A systematic review with meta-analysis. J Bodyw Mov Ther. 2021 Oct;28:450-457. doi: 10.1016/j.jbmt.2021.06.026. Epub 2021 Jun 16.

Reference Type: BACKGROUND

PMID: 34776177 (View on PubMed)

Kwon SH, Chung EJ, Lee J, Kim SW, Lee BH. The Effect of Hamstring Relaxation Program on Headache, Pressure Pain Threshold, and Range of Motion in Patients with Tension Headache: A Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Sep 27;18(19):10137. doi: 10.3390/ijerph181910137.

Reference Type: BACKGROUND

PMID: 34639438 (View on PubMed)

Jeong ED, Kim CY, Kim NH, Kim HD. Immediate effects of static and proprioceptive neuromuscular facilitation stretching of hamstring muscles on straight leg raise, craniovertebral angle, and cervical spine range of motion in neck pain patients with hamstring tightness: A prospective randomized controlled trial. J Back Musculoskelet Rehabil. 2022;35(2):429-438. doi: 10.3233/BMR-201840.

Reference Type: BACKGROUND

PMID: 34151831 (View on PubMed)

Joshi DG, Balthillaya G, Prabhu A. Effect of remote myofascial release on hamstring flexibility in asymptomatic individuals - A randomized clinical trial. J Bodyw Mov Ther. 2018 Jul;22(3):832-837. doi: 10.1016/j.jbmt.2018.01.008. Epub 2018 Feb 17.

Reference Type: BACKGROUND

PMID: 30100320 (View on PubMed)

Wilke J, Vogt L, Niederer D, Banzer W. Is remote stretching based on myofascial chains as effective as local exercise? A randomised-controlled trial. J Sports Sci. 2017 Oct;35(20):2021-2027. doi: 10.1080/02640414.2016.1251606. Epub 2016 Nov 7.

Reference Type: BACKGROUND

PMID: 27819537 (View on PubMed)

Other Identifiers

REC/Lhr/22/0133 Sumaiya

Identifier Type: -

Identifier Source: org_study_id