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

NCT06732700 | Recruiting DMC

• 1 other identifier: REC/01940 Iqra Rashid
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Forward Head Posture

Keywords

INIT, Forward Head Posture, Joint Position Error Test

Outcome Measures

Primary Outcomes (4)

• Numeric Pain Rating Scale

  The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. Where 0 means no pain and 10 means worst imaginable pain. NPRS was measured at Baseline, 1st Session, 2nd Week and 4th Week

  40 minutes session, thrice a week for 4 weeks.

• Cranio-vertebral Angle

  For measuring the angle, the reflective markers will be placed on the tragus of the ear and spinous process of the C7. The camera will be positioned on a tripod 50 cm away from the participant. The axis of the lens of the camera was placed at the level of the shoulder. The photos will be taken and the CVA angle will be calculated by Software Kinovea. CVA was measured at Baseline, 1st Session, 2nd Week and 4th Week

  40 minutes session, thrice a week for 4 weeks.

• Cervical Joint Position Error Test

  For measurement of proprioception, Joint Position Error Test is used. The distance/deviation will represent the proprioception deficit (JPE) of each participant. Angle is then calculated by taking arc tan of error distance divided by 90. A meaningful distance of 7.1cm or angle greater than 4.5 degree represents proprioception deficit. JPE Test was measured at Baseline, 1st Session, 2nd Week and 4th Week

  40 minutes session, thrice a week for 4 weeks.

• Cervical Range of Motion

  Cervical ROM will be measured by using an inclinometer for Flexion, Extension, Lateral Flexion and Rotation. The normal Range for Flexion is usually approximately 80º. Normal cervical extension is usually 50°, Value for Lateral Flexion is 45° and for rotation its approximately 80°. Cervical ROM were measured at Baseline, 1st Session, 2nd Week and 4th Week

  40 minutes session, thrice a week for 4 weeks.

Study Arms (2)

Experimental Group: 1

EXPERIMENTAL

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

Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

Control Group: 2

ACTIVE COMPARATOR

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).

Other: Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises.

Interventions

Integrated Neuromuscular Inhibition Technique and Posture Corrective Exercises. 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; Experimental Group: 1

Eligibility Criteria

• Age: 18 Years - 40 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• 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)

You may not qualify if:

• 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

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Riphah International University

Islamabad, Federal, 44000, Pakistan

RECRUITING

Related Publications (12)

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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.

  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.

  PMID: 25435690 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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 BACKGROUND

• 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.

  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.

  PMID: 32509702 BACKGROUND

• 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.

  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.

  BACKGROUND

Study Officials

• Lal Gul Khan, MScPT

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Imran Amjad, PhD

CONTACT

03324390125; imran.amjad@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Experimental Group: Group A INIT+ Posture Corrective Exercises Control Group: Group B Posture corrective exercise

Study Record Dates

• First Submitted: October 28, 2024
• First Posted: December 13, 2024
• Study Start: April 18, 2024
• Primary Completion: December 22, 2024
• Study Completion: December 22, 2024
• Last Updated: December 13, 2024

Record last verified: 2024-12

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)