this study will be conducted to investigate the impact of adding integrated neuromuscular inhibition technique to mulligan therapy in symptomatic forward head posture.
CVA equal or less than 50
Had cervical pain for more than three months and had visited an orthopedist clinic
cervical spine spondylosis
fractures or cervical spinal surgery
Cervical or shoulder neurological movement disorder.
Temporo-mandibular surgery, (5) Pathologic trauma
Parallel
Integrated Neuromuscular Inhibition Technique and mulligan therapy
Other interventionpatients will receive Integrated Neuromuscular Inhibition Technique in the form of intermittent ischemic compression, strain counter strain and muscle energy technique and mulligan therapy for limited cervical range of motion
Integrated Neuromuscular Inhibition Technique
Other interventionpatients will receive Integrated Neuromuscular Inhibition Technique in the form of intermittent ischemic compression, strain counter strain and muscle energy technique
mulligan therapy
Other interventionpatients will receive mulligan therapy for limited cervical range of motion
postural correction exercises
Other interventionthe patients will receive two strengthening exercises (deep cervical flexors and scapular retractors) and two stretching: cervical extensors (sub-occipital muscles) and pectoral muscles). The program was based on a program by Harman and Kendall
pain intensity
visual analogue scale will be used to asses pain intensity which patient will be instructed to put point on line from no pain to tolerable pain. The scale consists of a line, usually 100 mm long, ranging from no pain or discomfort (zero) , to the worst pain that could possibly feel
neck disability
will be measured by Arabic neck disability index. It contains ten category/classes. Each category contains six choices (zero-five).Score from zero to four no disability, from five to 15 this is mild, From 15 to 24 this is moderate, from 25 to 34 this is severe, more than 34 this is a complete disability
pressure pain threshold
pressure pain threshold pressure pain threshold will be assessed by commander algometer
cervical range of motion
range of motion will be measured by inclinometer CROM. The CROM (deluxe version - Performance Attainment Associates, Roseville, MN, USA) measures the cervical range of motion5- for fexion, extension, lateral fexion, and rotation using separate inclinometers. These inclinometers are attached to a frame similar to that for eyeglasses one in the sagittal plane for fexion - extension, second in the frontal plane for lateral fexion and a third in the horizontal plane for rotation.
craniovertebral angle
The craniovertebral angle is identified as the intersection of a horizontal line passing through the C7 spinous process and a line joining the midpoint of the tragus of the ear to the skin overlying the C7 spinous process. it measured by photogrametric methods. when the angle less than or equal 50 degree
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