Effect of Integrated Neuromuscular Inhibition Technique on Scapular Dyskinesia Type 2

NCT07232316 | Completed

• 1 other identifier: 9050824SWPT
• Study Type: interventional
• Target: 82
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial is to learn whether the Integrated Neuromuscular Inhibition Technique (INIT) can influence shoulder motion, muscle strength, and scapular positioning in young adults with Scapular Dyskinesis Type II. This study will also compare INIT with a conventional exercise program. The main questions the study aims to answer are:

• Does INIT affect shoulder range of motion compared with conventional exercise?
• Does INIT affect shoulder-girdle muscle strength?
• Does INIT influence scapular deviation as measured by a palpation meter? Participants will receive either INIT or conventional exercises three times per week for six weeks. Assessments will occur at baseline, week 4, and week 6 using a goniometer, dynamometer, and palpation meter. A physiotherapist that is the Principal Investigator and supervisor will monitor participants throughout the study.

Conditions

Scapular Dyskinesis

Keywords

scapular dyskinesis, shoulder rehabilitation, integrated neuromuscular inhibition technique

Outcome Measures

Primary Outcomes (9)

• Range of motion

  The shoulder range of motion (flexion, abduction and external and internal rotation) will be using a goniometer with a reliability ICC=0.94.

  Baseline

• Range of motion

  The shoulder range of motion (flexion, abduction and external and internal rotation) will be using a goniometer with a reliability ICC=0.94.

  4 week

• Range of motion

  Shoulder range of motion (flexion, abduction, and external and internal rotation) will be using a goniometer with a reliability ICC=0.94.

  6 week

• Muscular strength

  The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98

  Baseline

• Muscular strength

  The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98

  4 week

• Muscular strength

  The strength of spino scapular muscles will be measured by using hand-held dynamometer That measures peak isometric force generated by muscle groups with an inter-rater reliability ICC=0.98

  6 week

• Scapular deviation

  PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99

  Baseline

• Scapular deviation

  PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99

  4 week

• Scapular deviation

  PALM meter (performance Attainment Associate, St. Paul, MN, USA) will be used to measure Upward scapular deviation. It has calipers and an analogue inclinometer that can be used to calculate the horizontal distance between the scapula position and spine in scaption and coronal plane with an inter-rater reliability ICC=0.90-0.99

  6 week

Study Arms (2)

Group A

EXPERIMENTAL

Group A receives integrated neuromuscular inhibition technique. The total time commitment encompasses these assessment points spanning six weeks with each session lasting 45 minutes occurring three consecutive days a week.

Other: Intigrated Neuromuscular Inhibition Technique

Group B

EXPERIMENTAL

Group B receives conventional exercise. The total time commitment encompasses these assessment points spanning six weeks with each session lasting 45 minutes occurring three consecutive days a week.

Other: Conventional Exercise

Interventions

Intigrated Neuromuscular Inhibition Technique OTHER

The integrated Neuromuscular Inhibition Technique (INIT) combines ischemic compression, strain-counter strain, and muscle energy techniques. The practitioners first identified the latent trigger points to be treated using the palpation method and treated with ischemic pressure. This technique will be done for 90 seconds and repeated 3 to 5 times. After the ischemic compression therapist, the position of ease will be attained by maintaining the part of the desired muscle in the shortened position. It will be maintained for 20-30 sec. MET is a soft tissue manipulation technique in which an individual actively performs muscle contraction in a controlled manner. In this study, isometric contraction using post-isometric relaxation technique with stretching is used

Group A

Conventional Exercise OTHER

Group B receives conventional exercise that includes stretches and strengthening exercises of muscles involved in SD. For stretching: Should repeat 2-4 times increasing gradually with a 15-30 second hold. For strengthening: Active exercise for ten reps in 3 sets gradually increases for 15 reps in 3 stages. The intensity of exercise will be determined by the RM method using a yellow Thera band with an elastic range of 70%-80% that is i.50 kilograms per unit

Group B

Eligibility Criteria

• Age: 20 Years - 40 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• ● Both male and female participants aged between 20-40 years will be diagnosed by an orthopedic consultant and screened by a physiotherapist through Scapular Assistant Test and a PALM meter.
• Individuals presenting with scapular malposition and inferior medial border prominence, scapular dyskinesia type II with nonspecific symptoms.

You may not qualify if:

• Any diagnosed neurological deficit, i.e., hemiplegic limb, winged scapula due to lesions of the long thoracic or spinal accessory nerve.
• Diagnosed Cervical related pathologies such as stenosis, myelopathy, and prolapsed intervertebral disk.
• Diagnosed Shoulder-related pathology such as AC joint instability, rotator cuff pathology, history of shoulder surgery, and recent upper limb fracture.
• Individual with neurovascular deficit and rib fracture.
• Diagnosed chest deformity and scoliosis

Sponsors & Collaborators

• Ziauddin University: lead

Study Sites (1)

Ziauddin University, College of Physical Therapy

Karachi, Sindh, 75950, Pakistan

Location

Related Publications (14)

• Tang L, Chen K, Ma Y, Huang L, Liang J, Ma Y. Scapular stabilization exercise based on the type of scapular dyskinesis versus traditional rehabilitation training in the treatment of periarthritis of the shoulder: study protocol for a randomized controlled trial. Trials. 2021 Oct 18;22(1):713. doi: 10.1186/s13063-021-05654-2.

  PMID: 34663424 RESULT

• Roche SJ, Funk L, Sciascia A, Kibler WB. Scapular dyskinesis: the surgeon's perspective. Shoulder Elbow. 2015 Oct;7(4):289-97. doi: 10.1177/1758573215595949. Epub 2015 Jul 16.

  PMID: 27582990 RESULT

• Saadat Z, Hemmati L, Pirouzi S, Ataollahi M, Ali-Mohammadi F. Effects of Integrated Neuromuscular Inhibition Technique on pain threshold and pain intensity in patients with upper trapezius trigger points. J Bodyw Mov Ther. 2018 Oct;22(4):937-940. doi: 10.1016/j.jbmt.2018.01.002. Epub 2018 Jan 17.

  PMID: 30368338 RESULT

• Lytras D, Sykaras E, Christoulas K, Myrogiannis I, Kellis E. Effects of an integrated neuromuscular inhibition technique program on neck muscle strength and endurance in individuals with chronic mechanical neck pain. J Bodyw Mov Ther. 2019 Jul;23(3):643-651. doi: 10.1016/j.jbmt.2019.01.004. Epub 2019 Jan 28.

  PMID: 31563383 RESULT

• Saglam G, Telli H. The prevalence of scapular dyskinesia in patients with back, neck, and shoulder pain and the effect of this combination on pain and muscle shortness. Agri. 2022 Apr;34(2):100-108. doi: 10.14744/agri.2022.87059.

  PMID: 35848815 RESULT

• Kolber MJ, Hanney WJ. The reliability and concurrent validity of shoulder mobility measurements using a digital inclinometer and goniometer: a technical report. Int J Sports Phys Ther. 2012 Jun;7(3):306-13.

  PMID: 22666645 RESULT

• Kibler WB, Sciascia A. Evaluation and Management of Scapular Dyskinesis in Overhead Athletes. Curr Rev Musculoskelet Med. 2019 Dec;12(4):515-526. doi: 10.1007/s12178-019-09591-1.

  PMID: 31760624 RESULT

• Kheradmandi A, Kamali F, Ebrahimian M, Abbasi L. Comparison between dry needling plus manual therapy with manual therapy alone on pain and function in overhead athletes with scapular dyskinesia: A randomized clinical trial. J Bodyw Mov Ther. 2021 Apr;26:339-346. doi: 10.1016/j.jbmt.2020.11.017. Epub 2020 Nov 24.

  PMID: 33992267 RESULT

• Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018 Jan;52(2):102-110. doi: 10.1136/bjsports-2017-097559. Epub 2017 Jul 22.

  PMID: 28735288 RESULT

• Gorji SM, Kazemi O, Shahrzad P, Marchetti PH. Efficacy of Six Weeks Stability Exercises on the Glenohumeral Joint of Female Tennis Players with Scapular Dyskinesia. Int J Exerc Sci. 2022 Jul 1;15(3):962-973. doi: 10.70252/RGVB2654. eCollection 2022.

  PMID: 36158226 RESULT

• Amorim CS, Gracitelli ME, Marques AP, Alves VL. Effectiveness of global postural reeducation compared to segmental exercises on function, pain, and quality of life of patients with scapular dyskinesis associated with neck pain: a preliminary clinical trial. J Manipulative Physiol Ther. 2014 Jul-Aug;37(6):441-7. doi: 10.1016/j.jmpt.2013.08.011. Epub 2014 Aug 3.

  PMID: 25092553 RESULT

• Chitale N Jr, Patil DS, Phansopkar P. Integrated Neuromuscular Inhibition Technique Versus Mulligan Mobilization on Functional Disability in Subjects With Nonspecific Low Back Pain: A Comparative Study. Cureus. 2022 Oct 13;14(10):e30253. doi: 10.7759/cureus.30253. eCollection 2022 Oct.

  PMID: 36381847 RESULT

• Okezue OC, Anamezie TH, Nene JJ, Okwudili JD. Work-Related Musculoskeletal Disorders among Office Workers in Higher Education Institutions: A Cross-Sectional Study. Ethiop J Health Sci. 2020 Sep;30(5):715-724. doi: 10.4314/ejhs.v30i5.10.

  PMID: 33911832 RESULT

• Baschung Pfister P, de Bruin ED, Sterkele I, Maurer B, de Bie RA, Knols RH. Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: An intra- and interrater reliability and validity study. PLoS One. 2018 Mar 29;13(3):e0194531. doi: 10.1371/journal.pone.0194531. eCollection 2018.

  PMID: 29596450 RESULT

Study Officials

• Amna Aamir Khan, PhD - PT

  Ziauddin University

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: A simple random technique will be used with the envelope method for randomization. Two sets of envelopes entitled groups A and B will be presented to the participant before recruitment in the study so that 2 sets of envelopes are mutually exclusive and cannot be replaced in the set again.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Group A: INIT group The practitioners first identified the latent trigger points to be treated within the using the palpation method and treated with ischemic pressure that the participant can tolerate. Pressure will be maintained at a participant-tolerated level, following standard ischemic compression procedures.. It will be continued until referred or local pain diminishes. This technique will be done for 90 secs and repeated 3 to 5 times After the ischemic compression therapist, the position of ease will be attained by maintaining the part of the desired muscle in the shortened position. MET is a soft tissue manipulation technique in which an individual actively performs muscle contraction in a controlled manner Group B receives conventional exercise that includes stretches and strengthening exercises of muscles involved in SD: For stretching: Should repeat 2-4 times increasing gradually with a 15-30 second hold. For strengthening: Active exercise for ten reps in 3 sets.

Study Record Dates

• First Submitted: September 23, 2025
• First Posted: November 18, 2025
• Study Start: January 27, 2025
• Primary Completion: August 15, 2025
• Study Completion: August 15, 2025
• Last Updated: November 18, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)