Effect of INIT on Cervical Proprioception in Patients With Forward Head Posture

NCT ID: NCT06732700

Last Updated: 2024-12-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-04-18

Study Completion Date

2024-12-22

Brief Summary

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The purpose of the study is to determine the effects of Integrated Neuromuscular Inhibition Technique on Cervical Proprioception in Patients with Forward Head Posture. A randomized control trial was conducted at Riphah International University, Gulberg Green Campus, Islamabad. The sample size was 42 calculated through G-Power. The participants were divided into two interventional groups each having 21 participants. The study duration was six months. Sampling technique applied was Non-probability Purposive sampling for recruitment. Only 18 to 40 years participants with CVA angle less than 50 degree were included in the study. Tools used in this study are Inclinometer, Mobile phone, Labtop, Kinovea Software, NPRS Scale, Laser Beam. Data was collected at Baseline, after 1st session at the end of 2nd week and 4th week. Data analyzed through SPSS version 23.

Detailed Description

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Forward Head Posture is defined as ≥5 cm in horizontal distance between the tragus of the ear and the posterior angle of acromion in a standing position. The forward head position is characterized by extension of the upper cervical spine (Cl-C3), and flexion of the lower cervical spine (C4-C7), while the cervical curvature is increased. According to study conducted in 2019, Craniovertebral angle is Formed between C7 spinous process and tragus of ear. Forward head posture is present in all age groups, 22-24 years is the mean age group in males with normal CVA about 48.8 degrees, while in females the CVA angle is 47.6 and their mean age is 23-66 years. Normal craniovertebral angle is 49.9 degrees.

Joint position sense is a part of proprioception, which affects body posture and stability. It is influenced by muscle spindles, which respond to changes in muscle length and speed. Forward Head Posture (FHP) causes changes in the lengths of neck muscles, leading to poor joint position sense.

The integrated neuromuscular inhibition technique is one of the manual therapies that are directed to trigger point treatment; this technique consists of ischemic compression, Strain Counter-Strain, and Muscle Energy Technique. Intermittent ischemic pressure increases blood flow, Strain Counter-Strain decreases muscle tone, and Muscle Energy Technique encourages muscle easing, this leads to improvements in pain, function, and range of motion.

A Study in 2019 reported the shortness of Levator scapulae associated with Forward Head Posture leads.

In 2020 Khan et al. carried out research which showed tightness of Sternocleidomastoid muscle in patients with Forward Head Posture.

A study conducted in 2023 evaluated the effect of dry needling of Upper trapezius muscle in Forward Head Posture and results showed one session of dry needle therapy with stretching exercises could improve Pain and Pressure Threshold, Range of Motion, craniovertebral angle, which improved Forward Head Posture.

According to a study conducted in 2020 The craniovertebral angle had a negative correlation with position sensing and individuals with Forward Head Posture had a higher error value when observing cervical position sensing than individual with normal head posture.

According to a study of 2018, integrated neuromuscular inhibition technique is effective in improving cervical function by reducing the trigger points on upper trapezius muscle in mechanical neck pain.

Mustafa et al. in 2023 found that integrated neuromuscular inhibition technique to a multimodal treatment program (Mulligan (SNAG, NAGS) with isometric exercises) improve neck function.

Conditions

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Forward Head Posture

Keywords

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INIT, Forward Head Posture, Joint Position Error Test

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Experimental Group: Group A INIT+ Posture Corrective Exercises Control Group: Group B Posture corrective exercise
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental Group: 1

INIT+ Posture Corrective Exercises INIT consists of Ischemic Compression, Strain-Counter Strain and Muscle Energy Technique. INIT will be performed on Upper Trapezius, Levator Scapulae and Sternocleidomastoid. The patient will be lying supine; First We will identify the TrPs in the muscle. After that the patient will be placed in comfortable position, first technique applied will be Ischemic Compression. The technique will be applied for 90 secs. After this SCS will be applied, moderate digital pressure will maintained over the active TrP as the position of ease will be identified, it will be held for 20-30 s and repeated for three to five repetitions. Lastly, the subjects will receive MET directed towards the involved muscle. Each isometric contraction will be held for 7-10 sec and stretch will be held for 30 seconds and will be repeated three to five times per treatment session.

Posture corrective exercises given to control group will also be performed

Group Type EXPERIMENTAL

Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

Intervention Type OTHER

INIT will be performed for experimental group and then posture corrective exercises will be performed and for control group only posture corrective exercises will be performed

Control Group: 2

Posture corrective exercise Strengthening exercises: a) chin tuck in supine lying with the head in contact with the floor, (1 sets, 10 reps) b) Y-to-I exercise in a prone position (1 sets, 10 reps) c) Prone horizontal abduction with external rotation (1 sets, 10 reps).

Stretching Exercises:

d) one-sided unilateral self-stretch of pectoralis minor in standing position (stretch 30 sec, 5 reps) e) static sternocleidomastoid stretch (stretch 30 sec, 5 reps) f) static levator scapulae stretch (stretch 30 sec, 5 reps).

Group Type ACTIVE_COMPARATOR

Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

Intervention Type OTHER

INIT will be performed for experimental group and then posture corrective exercises will be performed and for control group only posture corrective exercises will be performed

Interventions

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Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

INIT will be performed for experimental group and then posture corrective exercises will be performed and for control group only posture corrective exercises will be performed

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Both Male and Female patients
* CVA less than 50 degree
* Age 18-40 years
* Neck pain for more than 3 months
* NPRS \> 3
* Decreased Cervical ROMs
* Active trigger points in following muscles (Upper Trapezius, Sternocleidomastoid, Levator Scapulae)

Exclusion Criteria

* History of cervical or facial trauma or surgery.
* Congenital anomalies of spine such as scoliosis.
* Systemic arthritis.
* Any disorder of Central Nervous System.
* Patients with cognitive deficit
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Riphah International University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lal Gul Khan, MScPT

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

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Riphah International University

Islamabad, Federal, Pakistan

Site Status RECRUITING

Countries

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Pakistan

Central Contacts

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Imran Amjad, PhD

Role: CONTACT

Phone: 03324390125

Email: [email protected]

Facility Contacts

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Lal Gul Khan, MScPT

Role: primary

References

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Dehqan B, Delkhoush CT, Mirmohammadkhani M, Ehsani F. Does forward head posture change subacromial space in active or passive arm elevation? J Man Manip Ther. 2021 Aug;29(4):227-234. doi: 10.1080/10669817.2020.1854010. Epub 2020 Nov 30.

Reference Type BACKGROUND
PMID: 33250012 (View on PubMed)

Gonzalez HE, Manns A. Forward head posture: its structural and functional influence on the stomatognathic system, a conceptual study. Cranio. 1996 Jan;14(1):71-80. doi: 10.1080/08869634.1996.11745952.

Reference Type BACKGROUND
PMID: 9086879 (View on PubMed)

Kim DH, Kim CJ, Son SM. Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong Public Health Res Perspect. 2018 Dec;9(6):309-313. doi: 10.24171/j.phrp.2018.9.6.04.

Reference Type BACKGROUND
PMID: 30584494 (View on PubMed)

Deshpande V, Bathia K, Kanase S, Pawar A, Jain P, Patel G. Effect of mckenzie approach and neck exercises on forward head posture in young adults. SCOPUS IJPHRD CITATION SCORE. 2019 Jul;10(7):123.

Reference Type BACKGROUND

Lee MY, Lee HY, Yong MS. Characteristics of cervical position sense in subjects with forward head posture. J Phys Ther Sci. 2014 Nov;26(11):1741-3. doi: 10.1589/jpts.26.1741. Epub 2014 Nov 13.

Reference Type BACKGROUND
PMID: 25435690 (View on PubMed)

Ali Ismail AM, Abd El-Azeim AS, El-Sayed Felaya EE. Integrated neuromuscular inhibition technique versus spray and stretch technique in neck pain patients with upper trapezius trigger points: a randomized clinical trial. J Man Manip Ther. 2024 Apr;32(2):141-149. doi: 10.1080/10669817.2023.2192899. Epub 2023 Mar 23.

Reference Type BACKGROUND
PMID: 36951194 (View on PubMed)

Khosravi F, Peolsson A, Karimi N, Rahnama L. Scapular Upward Rotator Morphologic Characteristics in Individuals With and Without Forward Head Posture: A Case-Control Study. J Ultrasound Med. 2019 Feb;38(2):337-345. doi: 10.1002/jum.14693. Epub 2018 May 15.

Reference Type BACKGROUND
PMID: 29761537 (View on PubMed)

Khan A, Khan Z, Bhati P, Hussain ME. Influence of Forward Head Posture on Cervicocephalic Kinesthesia and Electromyographic Activity of Neck Musculature in Asymptomatic Individuals. J Chiropr Med. 2020 Dec;19(4):230-240. doi: 10.1016/j.jcm.2020.07.002. Epub 2020 Nov 24.

Reference Type BACKGROUND
PMID: 33536860 (View on PubMed)

Golzareh S, Shadmehr A, Otadi K, Fereydounnia S. Dry Needling Effects of the Upper Trapezius Muscle on the Angles and Range of Motion of the Neck in Individuals with Forward Head Posture. Journal of Modern Rehabilitation. 2023.

Reference Type BACKGROUND

Ha SY, Sung YH. A temporary forward head posture decreases function of cervical proprioception. J Exerc Rehabil. 2020 Apr 28;16(2):168-174. doi: 10.12965/jer.2040106.053. eCollection 2020 Apr.

Reference Type BACKGROUND
PMID: 32509702 (View on PubMed)

Aggarwal S, Bansal G. Efficacy of integrated neuromuscular inhibition technique in improving cervical function by reducing the trigger points on upper trapezius muscle: A randomized controlled trial. Muller Journal of Medical Sciences and Research. 2018;9(1):1-6.

Reference Type BACKGROUND

Zalabia M, Abutaleb EE, Diab R, editors. Addition of integrated neuromuscular inhibition technique to amultimodal treatment program for chronic non specific neck pain. International Scientific Conference Faculty of Physical Therapy; 2018.

Reference Type BACKGROUND

Other Identifiers

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REC/01940 Iqra Rashid

Identifier Type: -

Identifier Source: org_study_id