Role of Integrated Neuromuscular Inhibition Technique in Managing Upper Trapezius Trigger Points in Non-Specific Neck Pain: A Randomized Controlled Trial

Abstract

Background: Non-specific neck pain is a prevalent musculoskeletal disorder that imposes a substantial burden on individuals and healthcare systems. Myofascial trigger points (MTrPs), particularly in the upper trapezius, are a common contributor to such pain. Although various conventional treatments are used, integrated neuromuscular inhibition techniques (INIT) offer a combined therapeutic approach that may enhance clinical outcomes but remain underutilized and under-researched. Objective: To evaluate the effectiveness of the Integrated Neuromuscular Inhibition Technique (INIT) in reducing pain and disability associated with upper trapezius trigger points in patients with non-specific neck pain. Methods: A single-blinded randomized controlled trial was conducted at the Physical Therapy Department of JIMS Hospital, Jacobabad, over a duration of nine months. A total of 58 participants (n=58), aged 18–55 years, with active upper trapezius trigger points were enrolled through purposive sampling and randomly allocated into two groups: Group A received conventional physical therapy, and Group B received conventional therapy plus INIT. Both groups received 30-minute sessions, five times per week, for eight weeks. Outcome measures included the Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI), assessed at baseline and after intervention. Ethical approval was obtained in accordance with the Helsinki Declaration, and data were analyzed using SPSS v24 with non-parametric tests (Wilcoxon, Mann-Whitney U) based on the normality assessment. Results: Statistically significant improvements were observed in both groups post-treatment (p<0.05), but Group B demonstrated superior outcomes. The mean rank of post-treatment NPRS and NDI scores in Group B was significantly lower than in Group A (NPRS: Group A = 44.00, Group B = 15.00; NDI: Group A = 41.62, Group B = 17.38). Wilcoxon signed-rank tests also revealed significant intra-group improvements (Z = -6.835 for NPRS, Z = -6.765 for NDI; p = 0.000), indicating enhanced clinical recovery in patients treated with INIT. Conclusion: The integrated neuromuscular inhibition technique, when added to conventional physiotherapy, is significantly more effective in reducing pain and disability in patients with non-specific neck pain associated with upper trapezius trigger points. This approach offers a promising, clinically applicable strategy for optimizing rehabilitation outcomes in musculoskeletal disorders.