this study will be conducted to compare INIT versus IASTM on neck disability, cervical muscle endurance and proprioception, cervical alignment, pain intensity, pressure pain threshold in patients with neck pain
All participants ages will range from 18 to 50 years.
BMI ranged from 18.5 to 30.
have TrPs in their UT muscle, pain at rest, a jump sign when pressure is applied, limited range of motion (ROM), and referred pain.
The participants will report pain in the posterior or posterior lateral aspect of the neck in the previous 3 months
Participants of cervical spine disorders (cervical disc disease, cervical spondylitis, cervical myelopathy.
Participants with musculoskeletal conditions.
Pregnant women.
Participants with congenital postural deformities.
Parallel
Integrated Neuromuscular Inhibition Technique
Other interventionFor the integrated neuromuscular inhibition technique, the participant will be in a supine lying position. During the PPT evaluation process, the site of the TrP will be determined and will be marked. First, intermittent IC will be initiated by using the thumb and index finger to apply a pincer grip to the TrP in the middle of the UT. Second, applying pressure to the trigger point and asking the participants how much pain they will experience. The participants' heads will passively flexed laterally to the affected side. The therapist then will hold the participant's forearm and passively will move the shoulder to about 90° of abduction while monitoring the discomfort induced by the TrP, and then will ask the patient about the intensity of pain. If the pain will decrease by 70% from the start, the position will be held for 30 seconds and repeated 2 to 3 times. Then muscle energy technique is applied plus tradional therapy.
Instrument-Assisted Soft Tissue Mobilization
Other interventionFor IASTM, the M2T blade will be used to identify specific parts of the limitation on the right UT. After that, treatment planes 1-2-3 will be used. Prior to treatment, Vaseline will be applied as a lubricant to the skin around the neck area, and an alcohol pad will be used to clean the instrument. Then, using an M2T blade at a 45° angle, long, slow strokes over the muscle will be performed, beginning at its insertion and ending at its origin, for 2 to 3 minutes . If the participant felt a burning sensation, it will be instructed to apply an ice pack plus tradional therapy.
tradional therapy
Other interventionthe patients will receive tradional therapy in the form of 10 minutes of moist heat (hot pack) isometric strengthening exercises for all cervical muscles by applying manual resistance on the side of the head for side bending, the occiput for extension, and the forehead for flexion.The resistance will be sustained for 10 seconds and repeated 10 to 15 times, then they will receive stretching exercises for extensor muscles for 30 seconds and repeated 3 times in every session. Finally, active ROM exercises for the neck and chin will be performed
neck disability
The arabic version of Neck Disability Index (NDI) will be used. it is a 10-item, self-administered questionnaire measuring neck pain-related disability, with scores ranging from 0-50 or 0-100%. Higher scores indicate greater disability.
pain intensity
visual analogue scale will be used to assess pain intensity. The most simple VAS is a straight horizontal line of fixed length, usually 100 mm. The ends are defined as the extreme limits of the parameter to be measured (symptom , pain ,health) orientated from the left (worst) to the right (best).
cervical range of motion
cervical range of motion device will be used to assess cervical range of motion
joint position error (cervical proprioception)
Proprioception is the ability to sense the position and movement of our body without visual feedback. The cervical spine works as a sensory system that relies heavily on mechanoreceptors, like muscle spindles, that detect mechanical changes within tissue. cervical proprioception will be measured by cervical range of motion device.
pressure pain threshold
pressure algometer device will be used to assess pressure pain threshold
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