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

Official title

UPPER CERVICAL MOBILIZATION VERSUS INTEGRATED NEUROMUSCULAR INHIBITION TECHNIQUE IN PATIENTS WITH LEVATOR SCAPULAE SYNDROME

Overview

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) .

Interventions

• Other 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
• 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
• 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 extens

Primary outcome measures

• pain pressure threshold of trigger points [Time frame: up to 4 weeks]
• Measurement of Neck Functional Disability Level using the Arabic Version of Neck Disability Index [Time frame: up to 4 weeks]

Secondary outcome measures (2)

• Measurement of cervical proprioception [Time frame: up to 4 weeks]
• Range of motion assessment of cervical spine [Time frame: up to 4 weeks]

Eligibility criteria

Inclusion criteria

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

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07208396 · P.T.REC/012/005854

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗