This study aims to investigate the effects of the integrated neuromuscular inhibition technique on patients with upper trapezius myofascial trigger points by evaluating its impact on neck pain intensity, pressure pain threshold, hand grip strength, pinch grip strength, wrist joint range of motion, and upper extremity function.
Subjects will be selected from out patient clinic of Delta University hospital, Dakahlia, Egypt.
Subjects aged between 18 and 55 years.
Their body mass index (BMI) were ranged from 18-30 kg/m2.
Subjects diagnosed as myofascial pain syndrome with a unilateral upper trapezius myofascial trigger point on the dominant side by a physician.
A history of any major neurological or musculoskeletal disorders, cardiovascular or respiratory diseases.
Neck pain due to cervical spine pathology.
Any history of cervical trauma, fractures or dislocations, carcinoma.
Uncooperative behavior, and unwillingness to participate.
Parallel
Integrated Neuromuscular Inhibition Technique
Other interventionParticipants in the experimental group will receive the integrated neuromuscular inhibition technique three times per week for four consecutive weeks. The integrated neuromuscular inhibition technique protocol will include ischemic compression, strain-counterstrain (SCS), and muscle energy technique (MET).
Conventional Physical Therapy
Other interventionParticipants in the two groups will receive conventional physical therapy three times per week for four consecutive weeks. It consists of deep transverse friction massage (DTFM), passive stretching, and isometric strengthening exercises for the neck muscles.
Hand Grip Strength assessment
Hand grip strength will be assessed using a Baseline Digital Hand Dynamometer following the standardized guidelines of the American Society of Hand Therapists (ASHT). Participants will be seated comfortably with back support, shoulders abducted, elbows flexed to 90°, and forearms and wrists maintained in a neutral position. The contralateral hand will rest on the thigh during testing. Participants will be instructed to grip the dynamometer maximally for approximately 3 seconds after one practice trial for each hand. Grip strength values will be recorded in kilograms using the same device throughout the study.
Pinch Grip Strength assessment
Pinch grip strength will be assessed using a Baseline Digital Pinch Dynamometer according to the standardized posture recommended by the American Society of Hand Therapists (ASHT). Participants will be seated comfortably with the back straight and feet fully supported on the floor. The shoulders will remain stable without rotation, the elbow will be flexed to 90°, and the forearm will be maintained in a neutral position. The wrist will be positioned between 0-30° of extension and 15° of ulnar deviation, with the arm unsupported by the chair handle during testing.
Wrist Range of Motion assessment
It will be assessed by using Digital Goniometer. A goniometer was placed at the ulnar styloid next to the little finger and set the initial state as the zero-degree position for wrist flexion and extension measurements. The radial deviation and ulnar deviation were measured by placing the goniometer at the center of the hand and in the middle of the middle finger.
Pain Intensity Level assessment
Pain intensity level will be assessed using the Visual Analog Scale (VAS). Participants will be asked to mark a point on a 100 mm horizontal line that best represents their pain intensity. The examiner will measure the distance in millimeters from the "no pain" anchor to the marked point using a ruler, yielding a score ranging from 0 to 100.
Pressure Pain Threshold assessment
Pressure pain threshold will be assessed using a pressure algometer. Participants will be positioned comfortably, and the upper trapezius trigger point will be identified by palpation. Gradual vertical pressure will be applied at a rate of 1 kg/sec until slight discomfort is reported by the participant. The procedure will be repeated three times with 30-second rest intervals, and the mean value will be calculated as the pressure pain threshold. The pressure algometer is considered a reliable assessment tool for pressure pain threshold measurement.
Upper Extremity Function assessment
Upper extremity function will be assessed using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH). The questionnaire consists of 11 items scored on a five-point Likert scale, with total scores ranging from 0 to 100, where higher scores indicate greater disability. Item scores will be summed, averaged, and transformed into the final score according to the standardized scoring method. Scores below 15 will indicate minimal symptoms, whereas scores above 40 will reflect marked functional limitation and reduced work ability due to upper limb dysfunction.
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