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.
Presence of active trigger points in the upper trapezius muscle.
Forward Head Posture (measured by craniovertebral angle).
Pain duration less than 3 months.
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
Parallel
Group A
Other interventionParticipants 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.
Group B
Other interventionParticipants 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.
Goniometer (Range of Motion)
The Universal Goniometer (UG) will be used to assess Active Cervical Range of Motion (ACROM) in multiple planes. This reliable tool allows physical therapists to measure joint angles accurately, both with and without assistance. In this study, it will be employed to evaluate cervical spine movement as an objective outcome measure of participants' range of motion.
Numeric Pain Rating Scale (NPRS)
The NPRS questionnaire is composed of an 11-point scale from 0 to 10. The patient chooses the most compatible value for the force of pain they have experienced in the last 24 h, with "0" meaning no pain and "10" meaning intense pain. The patient has to mark the score on the questionnaire according to the pain intensity he/she is experiencing.
Neck Disability Index (NDI)
The Neck Disability Index (NDI) is a ten-item questionnaire that assesses disability associated with neck pain and whiplash. There are four items that relate to subjective symptomatology (pain intensity, headache, concentration, and sleeping) and six items that relate to activities of daily living (lifting, work, driving, recreation, personal care, and reading). The questionnaire requires only 5-10 minutes to complete and score, and requires no special training to administer.
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