Effects of Integrated Neuromuscular Inhibition Technique Combined with Neurodynamics on Pain, Range of Motion and Neck Disability in Patients with Cervical Radiculopathy
DOI:
https://doi.org/10.61919/fryxr291Keywords:
Cervical radiculopathy; Integrated Neuromuscular Inhibition Technique; Neurodynamic mobilization; Neck pain; Disability; RehabilitationAbstract
Background: Cervical radiculopathy is a disabling musculoskeletal condition arising from mechanical or inflammatory nerve root compromise, often leading to pain, reduced cervical mobility, and functional disability. Conventional physiotherapy and neurodynamic mobilization provide some benefit, but the optimal strategy for achieving sustained improvement remains uncertain. Integrated Neuromuscular Inhibition Technique (INIT), which combines ischemic compression, strain counterstrain, and muscle energy, has emerged as a promising intervention targeting myofascial contributors to pain. Objective: To evaluate the effectiveness of INIT combined with neurodynamic mobilization compared with neurodynamic mobilization plus conventional physiotherapy in patients with cervical radiculopathy. Methods: A randomized controlled trial was conducted at Ghurki Trust Teaching Hospital, Lahore, enrolling 74 patients aged 35–50 years with unilateral cervical radiculopathy. Participants were randomized to INIT plus neurodynamic mobilization or conventional physiotherapy with neurodynamics for eight weeks. Primary outcomes were pain intensity (Numeric Pain Rating Scale), cervical range of motion (goniometry), and disability (Neck Disability Index). Assessments were performed at baseline, 4 weeks, and 8 weeks. Statistical analysis employed repeated-measures ANOVA and non-parametric equivalents, with effect sizes and 95% confidence intervals. Results: The experimental group achieved significantly greater improvements in pain (-1.6 points), disability (-7.4 points), cervical flexion (+4.9°), and rotation (+7.6°) at 8 weeks compared to controls (p < 0.001). Effect sizes ranged from moderate to large, confirming clinical relevance. Conclusion: INIT combined with neurodynamic mobilization provides superior pain reduction, functional recovery, and cervical mobility improvements compared to conventional physiotherapy with neurodynamics, supporting its use as an effective non-invasive treatment for cervical radiculopathy.
References
1. Kazeminasab S, Nejadghaderi SA, Amiri P, Pourfathi H, Araj-Khodaei M, Sullman MJ, Kolahi AA, Safiri S. Neck pain: global epidemiology, trends and risk factors. BMC musculoskeletal disorders. 2022 Jan 3;23(1):26.
2. Ortego G, Lluch E, Herrero P, Boudreau SA, Doménech-García V. Profiling and association over time between disability and pain features in patients with chronic nonspecific neck pain: a longitudinal study. Journal of Clinical Medicine. 2022 Feb 28;11(5):1346.
3. Iqbal ZA, Alghadir AH, Anwer S. Efficacy of deep cervical flexor muscle training on neck pain, functional disability, and muscle endurance in school teachers: a clinical trial. BioMed research international. 2021;2021(1):7190808.
4. Holland AE, Spathis A, Marsaa K, Bausewein C, Ahmadi Z, Burge AT, Pascoe A, Gadowski AM, Collis P, Jelen T, Reilly CC. European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness. European respiratory journal. 2024 Jun 28;63(6).
5. Faten Omar FO. Chronic Neck Pain with Normal Imaging: Diagnostic and Management Challenges. Algerian Journal of Medical and Health Research. 2025;3(4):138-57.
6. Krasin E, Schermann H, Snir N, Tudor A, Behrbalk E. A quick and comprehensive guide to differential diagnosis of neck and back pain: a narrative review. SN Comprehensive Clinical Medicine. 2022 Oct 27;4(1):232.
7. Farhane-Medina NZ, Luque B, Tabernero C, Castillo-Mayén R. Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Science progress. 2022 Oct;105(4):00368504221135469.
8. De Hertogh W, Micarelli A, Reid S, Malmström EM, Vereeck L, Alessandrini M. Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications. Frontiers in Neurology. 2025 Mar 17;16:1545241.
9. Jajeh H, Lee A, Charls R, Coffin M, Sood A, Elgafy H. A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies. Journal of Spine Surgery. 2023 Dec 25;10(1):120.
10. Taçyıldız AE, İnceoğlu F. Classification of osteophytes occurring in the lumbar intervertebral foramen. Tomography. 2024 Apr 19;10(4):618-31.
11. Basu I, Perry M. Initial assessment of the “Head and Neck” patient. InDiseases and Injuries to the Head, Face and Neck: A Guide to Diagnosis and Management 2021 Feb 17 (pp. 57-134). Cham: Springer International Publishing.
12. Nicol V, Verdaguer C, Daste C, Bisseriex H, Lapeyre É, Lefèvre-Colau MM, Rannou F, Rören A, Facione J, Nguyen C. Chronic low back pain: a narrative review of recent international guidelines for diagnosis and conservative treatment. Journal of clinical medicine. 2023 Feb 20;12(4):1685.
13. Chaitow L, Fritz S. Integrated neuromuscular inhibition technique (INIT) and myofascial pain. Chaitow's Muscle Energy Techniques E-Book: Chaitow's Muscle Energy Techniques E-Book. 2023 Apr 11:364.
14. Mazza DF, Boutin RD, Chaudhari AJ. Assessment of myofascial trigger points via imaging: a systematic review. American journal of physical medicine & rehabilitation. 2021 Oct 1;100(10):1003-14.
15. Abdelrahman S, Abdelmegeed S, Shendy W, Salah H. Sustained natural apophyseal glide versus neurodynamic mobilization in the management of chronic unilateral discogenic cervical radiculopathy. Benha International Journal of Physical Therapy. 2024 Dec 1;2(2):6-13.
16. Hwang SJ, Park SI. Neurodynamic Techniques on Peripheral Nerve Entrapment Syndromes-A Systematic Review. PNF and Movement. 2025;23(1):1-5.
17. Lytras DE, Sykaras EI, Christoulas KI, Myrogiannis IS, Kellis E. Effects of exercise and an integrated neuromuscular inhibition technique program in the management of chronic mechanical neck pain: a randomized controlled trial. Journal of manipulative and physiological therapeutics. 2020 Feb 1;43(2):100-13.
18. Lytras D, Sykaras E, Christoulas K, Myrogiannis I, Kellis E. Effects of an integrated neuromuscular inhibition technique program on neck muscle strength and endurance in individuals with chronic mechanical neck pain. Journal of bodywork and movement therapies. 2019 Jul 1;23(3):643-51.
19. Hamdy HA, Grase MO, El-Hafez HM, Abd-Elazim AS. Instrument assisted soft tissue mobilization versus integrated neuromuscular inhibition technique in nonspecific chronic neck pain: single-blinding randomized trial. Journal of chiropractic medicine. 2023 Dec 1;22(4):247-56.
20. Halm MA, Lindquist RU. Heat and Cold Therapies. Complementary Therapies in Nursing: Promoting Integrative Care. 2022 Jun 22:413-25.
21. Kim MH, Martin W, Quarmby A, Stoll J, Engel T, Cassel M. Effects of sensorimotor. Human Movement Coordination in Healthy and Pathological Conditions: From Neuromuscular and Kinetic Principles to Muscle-tendon Function. 2025 Jun 9:69.
22. García-González J, Romero-del Rey R, Martínez-Martín V, Requena-Mullor M, Alarcón-Rodríguez R. Comparison of short-term effects of different spinal manipulations in patients with chronic non-specific neck pain: a randomized controlled trial. InHealthcare 2024 Jul 5 (Vol. 12, No. 13, p. 1348). MDPI.
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