Social media: danazumiEffectIntegratedNeuromuscular2021
Subtitle
Doctor of Physical Therapy
What Manual Therapy technique is best for Sciatica?
Can the traditional PRT treatment beat the new maximalist approach of INIT?
Danazumi et al set out to find an answer in 2021
Is positional release technique or integrated neuromuscular inhibition technique better for improving pain, symptoms, and quality of life for patients with Piriformis Syndrome?
Piriformis Syndrome
Piriformis Syndrome:A neuromuscular array of symptoms characterized by a constellation of symptoms that includes hip and buttock pain with or without sciatica
Piriformis Syndrome can result in sciatica by directly compressing the sciatic nerve
Positional Release Technique
Positional Release Technique (PRT): An osteopathic manipulation where trigger points are identified, compressed to ischemia until pain is produced, the muscle is slackened, which deactivates the trigger point
Integrated Neuromuscular Inhibition Technique
Integrated Neuromuscular Inhibition Technique (INIT) uses a maximalist approach by attempting to combine the muscle energy technique and the PRT to reap the benefits of both.
Integrated Neuromuscular Inhibition Technique (INIT):
- Neuromuscular technique for deactivating trigger points in muscles involving ischemic compression of a trigger point, while bringing the muscle into a slackened positioned, followed by an isometrically enhanced stretch1
INIT has a three pronged approach:
- Inhibition/ischaemic compression
- Positional release
- Isometrically enhanced stretch
- inhibitory (ischaemic) compression until a change is reported or noted
- placing of the tissues into a position of ease, to encourage a muscle spindle release of excessive tone (see descriptions of ‘positional release’ below)
- introduction by the patient of an isometric contraction of the precise tissues housing the trigger point
- passive stretching of the local tissues active and passive stretching of the entire muscle (subsequent to another isometric contraction) (see notes on muscle energy technique (MET) below)
- activation of antagonists to muscle housing the trigger point may be used to complete the sequence.
PRT vs INIT: Treatment Approach
| PRT | INIT |
|---|---|
| Ischemic compression | Ischemic compression |
| Slacken muscle | Slacken Muscle |
Piriformis Technique
| PRT | INIT |
|---|---|
| 60-90° hip flexion and abduction | 60-90° hip flexion and abduction |
| Light trigger point compression | 20-60s trigger point compression |
| Wait until pain subsides | Wait until pain subsides |
| Actively move away from restriction barrier with 20% strength to create isometric contraction 7-10s | |
| Rapid pulsating contractions 20x in 10s |
Dosage
| PRT | INIT |
|---|---|
| 3 reps | 3 reps |
| 10min | 10min |
Sampling
Danazumi took 48 adults from Nguru, Nigeria
- Mostly between 18-35
- Male > Female
Eligibility
Methods
- Single blind
- RCT
- 2 sessions/week for 8 weeks
Treatment
2x/wk for 8 weeks
2 physiotherapists
- PT#1 6 years of experience
- PT#2 10 years of experience
PTs switch after 4 weeks
Patients received stretching exercises at the clinic and given an HEP to take home
Piriformis muscle trigger point: Piriformis muscle belly (halfway between inferior lateral angle of sacrum and greater trochanter)
3 repetition of treatment over 10min
Stretching
The stretching exercises consisted of 3 repetitions of each exercise for 5 minutes at the end of each clinical visit.
The exercises were provided as an HEP for prescribed at 2x/wk.
Piriformis, hamstring, and calf stretching.
Demographics
n=48
age: 25-47
Between-group: p>0.05
Results
Repeated measures ANOVA
- Time-effect for all outcomes: Significant (p<0.001)
- In short: everyone improved
But what is better, PRT or INIT?
- Between group Time and Intervention effects via Bonferroni post hoc analyses:
- Post treatment
- 4mo follow-up
Limitations
- No control group
- Did stretching have an impact?
