Effect of Integrated Neuromuscular Inhibition Technique on Patients With Non-Specific Neck Pain

Non-specific mechanical neck pain (NSNP) is one of the most prevalent musculoskeletal disorders worldwide and is associated with pain, reduced cervical mobility, functional limitations, decreased work productivity, and impaired quality of life. The condition is commonly related to myofascial trigger points, altered neuromuscular control, muscle imbalance, postural dysfunction, and restricted cervical joint mobility. Although conventional physiotherapy, including electrotherapy and cervical mobilization, has demonstrated beneficial effects, many patients continue to experience persistent symptoms and recurrent episodes.

Integrated Neuromuscular Inhibition Technique (INIT) is a multimodal manual therapy approach that combines muscle energy technique (MET), strain-counterstrain, and ischemic compression to address both myofascial and neuromuscular dysfunction. These techniques are intended to reduce pain, deactivate myofascial trigger points, improve muscle extensibility, restore neuromuscular control, and increase cervical range of motion. Previous studies have demonstrated promising results for INIT; however, evidence regarding its effectiveness when combined with cervical mobilization remains limited.

This study is a prospective, randomized, parallel-group controlled trial conducted at the Physiotherapy Outpatient Department of Fauji Foundation Hospital, Rawalpindi, Pakistan. Forty-two participants diagnosed with non-specific mechanical neck pain will be allocated equally to either an experimental group receiving INIT combined with cervical mobilization or a control group receiving cervical mobilization with conventional physiotherapy. Each participant will complete five treatment sessions.

The primary outcome measures include pain intensity assessed using the Numeric Pain Rating Scale (NPRS), neck-related disability assessed using the Neck Disability Index (NDI), and cervical range of motion measured with a universal goniometer. Assessments will be performed at baseline and immediately after completion of the treatment protocol.

The study aims to determine whether the addition of INIT to cervical mobilization results in superior improvements in pain, cervical mobility, and functional disability compared with conventional physiotherapy. The findings are expected to provide high-quality evidence regarding the clinical effectiveness of this multimodal manual therapy approach and may contribute to improving rehabilitation strategies and clinical practice guidelines for the management of non-specific mechanical neck pain.

Inclusion criteria

• Adults aged 30 to 60 years.
• Clinical diagnosis of non-specific mechanical neck pain.
• Neck pain duration of less than 6 months.
• Painful cervical extension and rotation.
• Negative Sharp-Purser test.
• Negative vertebral artery insufficiency test.
• No history of whiplash injury.
• Able and willing to provide written informed consent and comply with the study protocol

Exclusion criteria

• Specific causes of neck pain (e.g., fracture, infection, tumor, inflammatory disease, or cervical myelopathy).
• History of cervical spine surgery.
• Positive Sharp-Purser test or vertebral artery insufficiency test.
• History of whiplash injury.
• Neurological disorders affecting the cervical spine or upper extremities.
• Pregnancy.
• Receipt of physiotherapy or manual therapy for neck pain within the previous 4 weeks.
• Any medical condition that would prevent safe participation in the intervention or outcome assessment.