Effect of Integrated Neuromuscular Inhibition Technique on Subjects with Neck Pain and Forward Head Posture

Forward head posture (FHP) is one of the most common types of postural abnormality, and it is generally described as an anterior position of the head in relation to the vertical line of the body's center of gravity. Many researchers have reported that several factors, including headache, neck pain, and musculoskeletal disorders such as temporomandibular disorders or rounded shoulders, are related to FHP . It is associated with shortening of the upper trapezius, the posterior cervical extensor muscles, the sternocleidomastoid muscle and the levator scapulae muscle Forward head posture (FHP) is a forward inclination of the head with cervical spine hyperextension and is associated with shortening of the upper trapezius, the splenius and semispinalis capitis and crevice's, the cervical erector spinae and the levator scapulae musculature . A significant number of the population experiences neck related musculoskeletal problems caused by abnormal forward head posture. Forward Head Posture (FHP) is a common postural deviation reported in the literature, and has been considered as a risk factor for the development of neck pain. Around 61.3% adults with neck pain, working using computers were reported to have FHP In addition, patients with chronic neck pain demonstrated weakness in their deep neck flexors and presented with FHP when distracted. Neck pain is a common disorder characterized by pain, discomfort or soreness experienced in a region between the inferior margin of the occipital bone and T1. Prevalence of neck pain in employees is not the same all over the world. In western countries it has been reported to be between 34% and 54%.As neck pain could become a chronic and disabling symptom, discovering and controlling risk factors seems to be a reasonable prevention strategy. Improper posture could be improved by education and proper reminders to decrease the prevalence of neck pain and increase the quality of life. It is thought that adolescents or patients with neck pain (NP) have a more forward head posture, thus a smaller craniovertebral (CV) angle than age-matched pain-free participants. It was concluded that the CV angle is negatively correlated with the disability of patients with neck pain. So, patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability

Inclusion criteria

• - Adolescent Female physical therapy students between 18-23 years old
• BMI between 18.5-25 kg/m²
• Symptomatic forward head posture with CVA 49° or less.
• Latent trigger point
• Neck pain more than 3 months

Exclusion criteria

• Cervical disc
• Myelopathy or cervical radiculopathy
• Cervical spine surgery in the past
• Having received physical therapy in the three months prior to the study
• Non- rheumatologic diseases as multiple sclerosis, thyroid dysfunction and chronic infection.
• Rheumatologic condition as poly-articular osteoarthritis, rheumatoid arthritis and advanced cervical spine degenerative diseases. -