Upper Cervical Mobilization Versus Integrated Neuromuscular Inhibition Technique in Patients With Levator Scapulae Syndrome

NCT ID: NCT07208396

Last Updated: 2025-10-06

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 60 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-10-20
• Study Completion Date: 2026-06-05

Brief Summary

the study will be conducted to answer the following research question: is there a difference between the effect of upper cervical mobilization and integrated neuromuscular inhibition technique of levator scapulae muscle in patients with levator scapulae syndrome?

Detailed Description

Neck pain might be usually provoked by TrPs in the upper trapezius and levator scapulae muscles The differentiation in levator scapulae MTrPs prevalence between the right and left sides may also indicate potential asymmetries in muscle use or stress, which could be relevant for diagnosis and treatment strategies.

Integrated treatment approach (INIT) for neck pain provides greater pain relief, reduces disability, improves functional ability, and improves quality of life than other treatments Cervical Spine Mobilization (CSM) by oscillatory movements and traction to the cervical segments helps to break adhesion and stretch the hypo-mobile shortened structures.

There is a gap in the available literature about the comparative effect of upper cervical mobilization and integrated neuromuscular inhibition technique (INIT) of levator scapulae muscle on neck pain, neck disability, range of motion, and cervical proprioception in levator scapulae syndrome.

60 Participants recruited from both genders will be assigned randomly into 3 equal groups Group A : will receive upper cervical mobilization plus conventional treatment .

Group B : will receive integrated neuromuscular technique, It is a technique which combines three methods (Ischemic compression- muscle energy technique- strain counter strain) plus conventional treatment .

Group C : will receive conventional physical therapy only in the form of: (superficial heat using hot pack for 10 minutes ,Isometric Neck Exercises and Dynamic Neck) .

Conditions

Levator Scapulae Syndrome

Study Design

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

Study Groups

UPPER CERVICAL MOBILIZATION

All patients in group A will receive Grades I and II mobilizations and conventional physical therapy program in the form of :( hot pack, Dynamic and Isometric Neck Exercises) for four weeks.

Group Type: EXPERIMENTAL

Upper cervical mobilization

Intervention Type: OTHER

All patients in group A will receive Grades I and II mobilizations in the first two sessions to reduce pain. In subsequent sessions, patients will receive Grades III and IV mobilizations; typically will be utilized to stretch the joint capsule and passive tissues, which provide stability to the joint, thereby increasing ROM. Maitland usually performs treatment techniques in an oscillatory manner. These oscillations can be performed with different amplitudes in different positions in the range of movement.

The mobilizations will be delivered in the prone position. The duration of mobilization will be 30-s bouts given for three sets. The therapist places a hand dorsally at the level of the vertebral arch of C1 with the metacarpophalangeal and radial border of the index finger. The other hand will be placed posteriorly under the occiput, with the shoulder positioned anteriorly on the patient's forehead. The mobilization force will be directed dorsally from the shoulder until the therapist

Integrated neuromuscular inhibition technique

Group B will receive integrated neuromuscular inhibition Technique and conventional physical therapy program as in group A in the form of :( hot pack, Dynamic and Isometric Neck Exercises) for four weeks.

Group Type: EXPERIMENTAL

Integrated neuromuscular inhibition technique

Intervention Type: OTHER

An integrated approach to myofascial trigger point release is achieved by combining several manual therapy techniques under the name INIT (Integrated Neuromuscular Inhibition Technique). The technique combines MET and SCS with ischemic compression in one coordinated technique .

First, intermittent compression(IC) was initiated by using the thumb and index finger to apply a pincer grip to the TrP in the middle of the UT.

Second, the strain counter strain (SCS) began by applying pressure to the trigger point . The participants' heads were passively flexed laterally to the affected side. and then asked the patient about pain.

Third, the MET begins with one of the investigator's hands stabilizing the affected shoulder and the other on the head side. The participant was asked to move the stabilized shoulder and head in the direction of the other. This contraction lasted 7 seconds and had a maximum voluntary contraction of 20%. After that, the muscle was lengthened for 30 seconds

conventional treatment

Participants in group C will receive conventional physical therapy only in the form of: (superficial heat using hot pack for 10 minutes, Dynamic Neck Exercises and Isometric Neck Exercises) for four weeks

Group Type: ACTIVE_COMPARATOR

Conventional treatment

Intervention Type: OTHER

1. Hot packs Hot pack will be applied at the beginning of the treatment session for all patients participated in the study. The participants will be in prone lying position. The neck and upper thoracic region will be exposed. The hot pack then will be applied for 10 minutes on cervical and upper thoracic region.

2. Dynamic neck exercise: Dynamic neck exercises include lifting head up with the chin tucked in from supine lying for neck flexion, lifting head backwards in prone lying for neck extension lifting head sideways from pillow in side lying position for neck side flexion which will be also repeated for the other side.

3. Isometric Neck Exercises The exercises will be performed in sitting position, by holding the theraband directly forwards for neck flexion, backwards for neck extension and obliquely towards right and left and by crossing over the band for neck side flexion and rotation. All these will be done for all patients participated in the study for about 5-10 repetition

Interventions

Upper cervical mobilization

All patients in group A will receive Grades I and II mobilizations in the first two sessions to reduce pain. In subsequent sessions, patients will receive Grades III and IV mobilizations; typically will be utilized to stretch the joint capsule and passive tissues, which provide stability to the joint, thereby increasing ROM. Maitland usually performs treatment techniques in an oscillatory manner. These oscillations can be performed with different amplitudes in different positions in the range of movement.

The mobilizations will be delivered in the prone position. The duration of mobilization will be 30-s bouts given for three sets. The therapist places a hand dorsally at the level of the vertebral arch of C1 with the metacarpophalangeal and radial border of the index finger. The other hand will be placed posteriorly under the occiput, with the shoulder positioned anteriorly on the patient's forehead. The mobilization force will be directed dorsally from the shoulder until the therapist

Intervention Type: OTHER

Integrated neuromuscular inhibition technique

An integrated approach to myofascial trigger point release is achieved by combining several manual therapy techniques under the name INIT (Integrated Neuromuscular Inhibition Technique). The technique combines MET and SCS with ischemic compression in one coordinated technique .

First, intermittent compression(IC) was initiated by using the thumb and index finger to apply a pincer grip to the TrP in the middle of the UT.

Second, the strain counter strain (SCS) began by applying pressure to the trigger point . The participants' heads were passively flexed laterally to the affected side. and then asked the patient about pain.

Third, the MET begins with one of the investigator's hands stabilizing the affected shoulder and the other on the head side. The participant was asked to move the stabilized shoulder and head in the direction of the other. This contraction lasted 7 seconds and had a maximum voluntary contraction of 20%. After that, the muscle was lengthened for 30 seconds

Intervention Type: OTHER

Conventional treatment

1. Hot packs Hot pack will be applied at the beginning of the treatment session for all patients participated in the study. The participants will be in prone lying position. The neck and upper thoracic region will be exposed. The hot pack then will be applied for 10 minutes on cervical and upper thoracic region.

2. Dynamic neck exercise: Dynamic neck exercises include lifting head up with the chin tucked in from supine lying for neck flexion, lifting head backwards in prone lying for neck extension lifting head sideways from pillow in side lying position for neck side flexion which will be also repeated for the other side.

3. Isometric Neck Exercises The exercises will be performed in sitting position, by holding the theraband directly forwards for neck flexion, backwards for neck extension and obliquely towards right and left and by crossing over the band for neck side flexion and rotation. All these will be done for all patients participated in the study for about 5-10 repetition

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Patients with a primary complaint of chronic neck pain (assessed by VAS) for more than 3 months.

2. Subjects with pain provocation and reduced mobility at the upper cervical segment (assessed by passive accessory intervertebral movements (PAIVMs) and reduced mobility at cervical spine (assessed by CROM) will be included in the study.

3. Participants will be recruited from both genders with age ranged from 18 to 45 years old, and BMI from 18 to 30kg/m2

Exclusion Criteria

• 1) Previous spine surgery 2) Pregnant and breast feeding women 3) Diabetic patients 4) Hypertensive patients 5) Neck pain associated with cervical radiculopathy 6) Whiplash injuries 7) Cervical spine fracture 8) Vertebrobasilar insufficiency. 9) Red flags suggesting of cancer, infection, vascular insufficiency

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Cairo University

OTHER

Sponsor Role: lead

Responsible Party

Amira Ebrahem Sadek

principle investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Central Contacts

Amira E Sadek, master

Role: CONTACT

amerasadek21@gmail.com

01032808569

Other Identifiers

P.T.REC/012/005854

Identifier Type: -

Identifier Source: org_study_id