Comparison of Integrated Neuromuscular Inhibition Technique (INIT) and Active Release Technique (ART) in Patients With Upper Trapezius Trigger Points

Official title

COMPARATIVE EFFECT OF INTEGRATED NEUROMUSCULAR INHIBITION TECHNIQUE AND ACTIVE RELEASE TECHNIQUE ON PAIN, RANGE OF MOTION AND FUNCTIONAL DISABILITY IN PATIENTS WITH UPPER TRAPEZIUS TRIGGER POINTS

Overview

The goal of this clinical trial is to determine whether two manual therapy techniques-Integrated Neuromuscular Inhibition Technique (INIT) and Active Release Technique (ART)-can reduce pain, improve neck range of motion, and decrease functional disability in adults with upper trapezius myofascial trigger points. The main questions it aims to answer are: Does INIT reduce pain, improve ROM, and reduce functional disability more effectively than ART? Does ART provide similar or different treatment benefits compared to INIT? Researchers will compare INIT with ART to see which technique produces greater improvements in pain, ROM, and functional disability. Participants will: Receive treatment sessions of either INIT or ART. Undergo assessment of pain, cervical range of motion, and functional disability before and after the intervention.

Detailed description

Myofascial trigger points in the upper trapezius are a common cause of neck pain, restricted cervical mobility, and functional limitations. Manual therapy techniques are frequently used to deactivate trigger points and improve muscle function, but evidence comparing specific techniques remains limited.

This study investigates two commonly used interventions: the Integrated Neuromuscular Inhibition Technique (INIT), which combines sustained pressure, muscle energy technique, and stretching; and the Active Release Technique (ART), which involves movement-based soft tissue release. Both techniques target trigger point sensitivity and muscle tightness but use different mechanisms.

Participants with diagnosed upper trapezius trigger points will be randomly assigned to receive either INIT or ART. Each group will follow a structured treatment protocol over a defined period. Pain intensity, cervical range of motion, and functional disability will be measured at baseline and after the intervention using validated outcome tools.

The study aims to provide comparative evidence on which technique offers greater clinical effectiveness for reducing pain, improving cervical mobility, and enhancing function in individuals with upper trapezius trigger points. Results may assist clinicians in selecting more effective manual therapy strategies for managing myofascial pain.

Interventions

• Other Group A
  Participants will receive treatment three times per week for 6 weeks. Each session will begin with a moist hot pack for 10 minutes followed by TENS for 15 minutes to relax the muscles and reduce pain. After this preparation, participants will receive 15 minutes of Integrated Neuromuscular Inhibition Technique, including ischemic compression, strain-counterstrain, and muscle energy technique, applied to the identified myofascial trigger points.
• Other Group B
  Participants will receive treatment three times per week for 6 weeks. Each session will begin with a moist hot pack for 10 minutes and TENS for 15 minutes to prepare the tissues. This will be followed by 15 minutes of Active Release Technique, including repeated active passes, targeted fiber release, and mild stretching, applied to the upper trapezius myofascial trigger points.

Primary outcome measures

• Goniometer (Range of Motion) [Time frame: Assessment at baseline, after 3rd and 6th weeks.]
• Numeric Pain Rating Scale (NPRS) [Time frame: Assessment at baseline, after 3rd and 6th weeks.]
• Neck Disability Index (NDI) [Time frame: Assessment at baseline, after 3rd and 6th weeks.]

Eligibility criteria

Inclusion criteria

• Presence of active trigger points in the upper trapezius muscle.
• Forward Head Posture (measured by craniovertebral angle).
• Pain duration less than 3 months.

Exclusion criteria

• History of trauma or surgery involving the cervical spine or shoulder
• Neurological disorders (e.g., cervical radiculopathy)
• Systemic conditions like diabetes or rheumatoid arthritis
• Use of corticosteroids
• Fibromyalgia, Thoracic Outlet Syndrome, Temporomandibular Joint Disorders

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

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Sadria G, Hosseini M, Rezasoltani A, Akbarzadeh Bagheban A, Davari A, Seifolahi A. A comparison of the effect of the active release and muscle energy techniques on the latent trigger points of the upper trapezius. J Bodyw Mov Ther. 2017 Oct;21(4):920-925. doi: 10.1016/j.jbmt.2016.10.005. Epub 2016 Oct 21. PMID 29037649
• Nayak PP. A Study to Find Out the Efficacy of Init (Integrated Neuromuscular Inhibition Technique) with Therapeutic Ultrasound Vs Init with Placebo Ultrasound in the Treatment of Acute Myofascial Trigger Point in Upper Trapezius: Rajiv Gandhi University of Health Sciences (India); 2013.

Identifiers

NCT: NCT07395154 · UBAS/ERB/FoRS/25/023

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗