Effect of Integrated Neuromuscular Inhibition Technique on Scapular Dyskinesia Type 2

Effect of Integrated Neuromuscular Inhibition Technique (INIT) Versus Conventional Exercise on Muscular Strength, Shoulder ROM and Scapular Deviation Among Young Adults With Scapular Dyskinesia II.

The goal of this clinical trial is to learn whether the Integrated Neuromuscular Inhibition Technique (INIT) can influence shoulder motion, muscle strength, and scapular positioning in young adults with Scapular Dyskinesis Type II. This study will also compare INIT with a conventional exercise program.

The main questions the study aims to answer are:

• Does INIT affect shoulder range of motion compared with conventional exercise?
• Does INIT affect shoulder-girdle muscle strength?
• Does INIT influence scapular deviation as measured by a palpation meter? Participants will receive either INIT or conventional exercises three times per week for six weeks. Assessments will occur at baseline, week 4, and week 6 using a goniometer, dynamometer, and palpation meter. A physiotherapist that is the Principal Investigator and supervisor will monitor participants throughout the study.

A total of 82 participants will be recruited using a multifaceted approach through pamphlets, emails, and WhatsApp groups. After enrollment, candidates will be screened by the principal investigator and re-evaluated by a clinical co-supervisor. Informed voluntary consent will be obtained before participation. Participants will be randomly allocated via the envelope method into:

• Treatment group: Integrated Neuromuscular Inhibition Technique (INIT)
• Control group: Conventional therapy Assessments will occur at baseline, week 4, and week 6 using a palpation meter (PALM), goniometer, and hand-held dynamometer. Each session will last 45 minutes and will be conducted three times per week for six weeks. The Scapular Assistance Test will be used initially to identify scapular dyskinesis, followed by PALM measurements-where positive values indicate upward and negative values indicate downward movement. The dynamometer will record peak force (Newtons) in a gravity-eliminated position. An orthopedic surgeon will monitor participant safety and manage any adverse events.

Integrated Neuromuscular Inhibition Technique (INIT):

INIT combines ischemic compression, strain-counter strain, and muscle energy technique (MET).

• Ischemic Compression: Latent trigger points in the upper trapezius, levator scapulae, rhomboids, and serratus anterior are palpated and compressed for 90 seconds, repeated 3-5 times based on participant tolerance.
• Strain-Counter Strain: The muscle is placed in a position of ease. For the upper trapezius and levator scapulae, the head is side-bent 10°-20° toward the affected side with the ipsilateral arm in abduction or flexion, held for 20-30 seconds.
• Muscle Energy Technique: Using post-isometric relaxation, participants perform gentle isometric contractions of the same muscles, followed by stretching.

Conventional Therapy (Control Group):

Participants perform stretching and strengthening for the same muscles.

• Stretching: Upper trapezius and levator scapulae-2-4 repetitions, holding 15-30 seconds each.
• Strengthening: Rhomboids and serratus anterior-10 repetitions × 3 sets, progressing to 15 repetitions × 3 sets using a yellow TheraBand (70-80% elasticity, approximately 1.5 kg/unit).

This six-week protocol will provide a standardized framework for comparing the two interventions using planned assessments

Inclusion Criteria:

• ● Both male and female participants aged between 20-40 years will be diagnosed by an orthopedic consultant and screened by a physiotherapist through Scapular Assistant Test and a PALM meter.

  • Individuals presenting with scapular malposition and inferior medial border prominence, scapular dyskinesia type II with nonspecific symptoms.

Exclusion Criteria:

• Any diagnosed neurological deficit, i.e., hemiplegic limb, winged scapula due to lesions of the long thoracic or spinal accessory nerve.

  • Diagnosed Cervical related pathologies such as stenosis, myelopathy, and prolapsed intervertebral disk.
  • Diagnosed Shoulder-related pathology such as AC joint instability, rotator cuff pathology, history of shoulder surgery, and recent upper limb fracture.
  • Individual with neurovascular deficit and rib fracture.
  • Diagnosed chest deformity and scoliosis