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NCT Number: NCT07208396

Upper Cervical Mobilization Versus Integrated Neuromuscular Inhibition Technique in Patients With Levator Scapulae Syndrome

the study will be conducted to answer the following research question: is there a difference between the effect of upper cervical mobilization and integrated neuromuscular inhibition technique of levator scapulae muscle in patients with levator scapulae syndrome?

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Key information

Conditions

Levator Scapulae Syndrome

Age range

18 year–45 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

About this study

Neck pain might be usually provoked by TrPs in the upper trapezius and levator scapulae muscles The differentiation in levator scapulae MTrPs prevalence between the right and left sides may also indicate potential asymmetries in muscle use or stress, which could be relevant for diagnosis and treatment strategies.

Integrated treatment approach (INIT) for neck pain provides greater pain relief, reduces disability, improves functional ability, and improves quality of life than other treatments Cervical Spine Mobilization (CSM) by oscillatory movements and traction to the cervical segments helps to break adhesion and stretch the hypo-mobile shortened structures.

There is a gap in the available literature about the comparative effect of upper cervical mobilization and integrated neuromuscular inhibition technique (INIT) of levator scapulae muscle on neck pain, neck disability, range of motion, and cervical proprioception in levator scapulae syndrome.

60 Participants recruited from both genders will be assigned randomly into 3 equal groups Group A : will receive upper cervical mobilization plus conventional treatment .

Group B : will receive integrated neuromuscular technique, It is a technique which combines three methods (Ischemic compression- muscle energy technique- strain counter strain) plus conventional treatment .

Group C : will receive conventional physical therapy only in the form of: (superficial heat using hot pack for 10 minutes ,Isometric Neck Exercises and Dynamic Neck) .

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Patients with a primary complaint of chronic neck pain (assessed by VAS) for more than 3 months.
  • Subjects with pain provocation and reduced mobility at the upper cervical segment (assessed by passive accessory intervertebral movements (PAIVMs) and reduced mobility at cervical spine (assessed by CROM) will be included in the study.
  • Participants will be recruited from both genders with age ranged from 18 to 45 years old, and BMI from 18 to 30kg/m2

Exclusion criteria

  • 1) Previous spine surgery 2) Pregnant and breast feeding women 3) Diabetic patients 4) Hypertensive patients 5) Neck pain associated with cervical radiculopathy 6) Whiplash injuries 7) Cervical spine fracture 8) Vertebrobasilar insufficiency. 9) Red flags suggesting of cancer, infection, vascular insufficiency

Treatment and study plan

Upper cervical mobilization

Other

All patients in group A will receive Grades I and II mobilizations in the first two sessions to reduce pain. In subsequent sessions, patients will receive Grades III and IV mobilizations; typically will be utilized to stretch the joint capsule and passive tissues, which provide stability to the joint, thereby increasing ROM. Maitland usually performs treatment techniques in an oscillatory manner. These oscillations can be performed with different amplitudes in different positions in the range of movement.

The mobilizations will be delivered in the prone position. The duration of mobilization will be 30-s bouts given for three sets. The therapist places a hand dorsally at the level of the vertebral arch of C1 with the metacarpophalangeal and radial border of the index finger. The other hand will be placed posteriorly under the occiput, with the shoulder positioned anteriorly on the patient's forehead. The mobilization force will be directed dorsally from the shoulder until the therapist

Integrated Neuromuscular Inhibition technique

Other

An integrated approach to myofascial trigger point release is achieved by combining several manual therapy techniques under the name INIT (Integrated Neuromuscular Inhibition Technique). The technique combines MET and SCS with ischemic compression in one coordinated technique .

First, intermittent compression(IC) was initiated by using the thumb and index finger to apply a pincer grip to the TrP in the middle of the UT.

Second, the strain counter strain (SCS) began by applying pressure to the trigger point . The participants' heads were passively flexed laterally to the affected side. and then asked the patient about pain.

Third, the MET begins with one of the investigator's hands stabilizing the affected shoulder and the other on the head side. The participant was asked to move the stabilized shoulder and head in the direction of the other. This contraction lasted 7 seconds and had a maximum voluntary contraction of 20%. After that, the muscle was lengthened for 30 seconds

conventional treatment

Other
  • Hot packs Hot pack will be applied at the beginning of the treatment session for all patients participated in the study. The participants will be in prone lying position. The neck and upper thoracic region will be exposed. The hot pack then will be applied for 10 minutes on cervical and upper thoracic region.
  • Dynamic neck exercise: Dynamic neck exercises include lifting head up with the chin tucked in from supine lying for neck flexion, lifting head backwards in prone lying for neck extension lifting head sideways from pillow in side lying position for neck side flexion which will be also repeated for the other side.
  • Isometric Neck Exercises The exercises will be performed in sitting position, by holding the theraband directly forwards for neck flexion, backwards for neck extension and obliquely towards right and left and by crossing over the band for neck side flexion and rotation. All these will be done for all patients participated in the study for about 5-10 repetition

Primary outcomes

  1. pain pressure threshold of trigger points

    Time frame: up to 4 weeks

    The Pressure Pain Threshold (PPT) is defined as the point at which a non-painful pressure stimulus turns into a painful pressure sensation. Pressure algometry (PA) is a method described to objectify this PPT. This technique is a well-known and well-validated method to induce acute experimental pain. Different studies have been published about using this tool to evaluate pain in different locations of the body and showed high levels of reliability.

  2. Measurement of Neck Functional Disability Level using the Arabic Version of Neck Disability Index

    Time frame: up to 4 weeks

    The patient will be relaxed and asked to complete the NDI before treatment and after treatment, which consists of 10 items. Each item is scored from zero (no disability) to five (total disability), with the maximum possible total score being 50. For each item, the subject asked to choose one answer that best defined his/her neck functional disability level. Scores for each item tallied and the total score will be recorded. Mean duration of the test: 3 to 7.8 minutes. Vernon and Mior presented the following interpretation

Secondary outcomes

  1. Measurement of cervical proprioception

    Time frame: up to 4 weeks

    Most assessment techniques currently available evaluate the integrity and function of efferent pathways or the final outcome of skeletal muscle activation or a combination of both Joint position sense is one dimension of proprioception, classically assessed by the ability to accurately reproduce preselected target positions or a specific joint angle . The test usually involves some type of position matching procedure, in which a target joint position is presented and the subject must match that position. The absolute difference between the target and the matching joint positions is often used as a measure of position sense accuracy in terms of the repositioning error.

  2. Range of motion assessment of cervical spine

    Time frame: up to 4 weeks

    Cervical active range of motion (AROM) in flexion and extension, right/left side bending and right/left rotation will be measured for each subject.

Study contacts

Contact information is provided by the study sponsor or research team.

Amira E Sadek, master

CONTACT

[email protected]

01032808569

Sponsors and collaborators

Lead sponsor

Cairo University

Other

Registry information

Acronym: LSS

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Oct 6, 2025
Registry last updated
Oct 6, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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