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

Официальное название

The Effect of Integrated Neuromuscular Inhibition Technique on Cervical Proprioception in Patients With Forward Head Posture

Обзор

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.

Подробное описание

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.

Вмешательства

• Другое 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

Первичные конечные точки

• Numeric Pain Rating Scale [Срок оценки: 40 minutes session, thrice a week for 4 weeks.]
• Cranio-vertebral Angle [Срок оценки: 40 minutes session, thrice a week for 4 weeks.]
• Cervical Joint Position Error Test [Срок оценки: 40 minutes session, thrice a week for 4 weeks.]
• Cervical Range of Motion [Срок оценки: 40 minutes session, thrice a week for 4 weeks.]

Критерии участия

Критерии включения

• 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)

Критерии исключения

• 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

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Пакистан · 1 центр

• Riphah International University — Islamabad

Публикации

• 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. PMID 33250012
• 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. PMID 9086879
• 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. PMID 30584494
• 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.
• 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. PMID 25435690
• 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. PMID 36951194
• 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. PMID 29761537
• 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. PMID 33536860

Идентификаторы

NCT: NCT06732700 · REC/01940 Iqra Rashid

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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