Neck pain is a common disorder with a reported 6 month prevalence rate of 54% [1, 10,11].In the majority of cases, the patho-anatomical source of an individual’s pain cannot be identified and is therefore called as Nonspecific, primarily defined as non-articular & non systemic in nature [1, 10]. Although there are many potential contributing factors to non-specific neck pain, one area that has received scientific emphasis is the trigger point (which will be referred as TrP). Myofascial trigger points, are referred to as hyperirritable areas in the fascia surrounding skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers which lead to referred pain beyond the area of contact. Trp may refer pain both in the local area and/or to other areas of the body, and common patterns have been well-documented and diagramed. These are called "referral patterns”. Although, the etiology of TrP development is currently unknown, recent studies have hypothesized that the pathogenesis results from the overloading and injury of muscle tissue, leading to involuntary shortening of localized fibers [20, 21].The areas of stressed soft tissue receive less oxygen, glucose, and nutrient delivery, and subsequently accumulate high levels of metabolic waste products. The end result of this cascade of events is the creation of altered tissue status, pain, and the development of TrPs [20, 21]. TrPs have been found to frequently occur in individuals with mechanical neck pain as compared to their age matched controls. TrPs have been associated with hyper algesia and limited range of motion (ROM) and are therefore clinically important to identify as these possess the potential to restrict functional activities [16, 20, 21].

Identification is accomplished through the recognition of a pattern of clinical signs on physical examination. Signs that may include the presence of a taut band in a skeletal muscle, the presence of a tender spot within the taut band, a palpable or visible local twitch response upon palpation, and/or needle inspection of the TrP (called a jump sign), the presence of a typical referred pain pattern, and restricted ROM of the affected tissues [6,8]TrPs have the potential to create pain, limit ROM and restrict functional activities and should therefore be addressed as part of a comprehensive physical therapy program [6, 8, 10].

A trigger point could be active one causing local tenderness and agonizing pain or a latent one producing painless restriction of movement and distortion of posture [2, 7].

From all the muscles of the upper limb the trapezius muscle (particularly the upper fibers of trapezius) is the most common to develop trigger points. The trapezius is a wide triangular muscle which has its attachment to the base of the skull, and lies at the back of the neck, over the upper shoulders and extends down your upper back to your mid back [1].The most vital reason for development of Trp over this muscle is the continuous stress that this muscle is subjected to while performing the upperlimb movements particularly the scapular and the neck movements. Symptoms particularly include severe neck pain a stiff neck, limited range-of-motion, intolerance to weight on your shoulders when particularly the upper fibers of trapezius muscle are involved [2, 3].

For the treatment of trigger point particularly involving the trapezius muscle, the Integrated Neuromuscular Inhibition Technique (which will be called as INIT from here on) has shown to be beneficial [1, 2, 3].The technique involves the combined use of MET, ischemic compression and SCS (Strain Counter Strain technique) The INIT approach ensures for the application of all techniques in a single coordinated manner [24, 26]. The second technique which has shown to be beneficial is Muscle energy technique (which will be called as MET from here on.) METs are a commonly utilized method for achieving tonus release (inhibition)in a muscle before stretching [24, 26]. The approach involves the introduction of an isometric contraction to the affected muscle producing post-isometric relaxation through the influence of the Golgi tendon organs (autogenic inhibition [23, 26]. Chaitow feels that the combination of MET, is chemic compression and SCS produces the most effective, targeted approach to TrP release [1].This method is termed the integrated neuromuscular inhibition technique (INIT). He has suggested that the benefit of the technique lies in its multifaceted approach. The INIT approach allows for delivery of the techniques in a single coordinated manner. Although randomized clinical trials exist studying the efficacy of ischemic compression and SCS in neck pain and chronic myofascial pain syndromes, there is a lack of evidence regarding the integration of these techniques in individuals with non-specific neck pain [20].For this reason, additional research examining the effectiveness of this regimen should be warranted. The purpose of this study was to compare the effect of two treatment approaches, MET, and the INIT, in deactivating upper trapezius TrPs as measured by an improvement in pain (VAS) and range of motion (ROM).

The study procedure was conducted by assessing the subject’s initial recording and final recording. The patients were chosen according to inclusion and exclusion criteria. All the patients were divided into two groups group A and group B. Group A received Muscle energy technique (MET) and group B received Integrated Neuromuscular Inhibitory technique (INIT)

A comparative experimental study was conducted MVP College, hospital and research center, Nashik, India. After obtaining an informed consent, subjects diagnosed with nonspecific neck pain were randomly divided in two groups of 15 each and were assigned to group A (MET) & group B (INIT) respectively as and how they came to Physiotherapy OPD. Prior to the treatment, subjects were advised to grade their pain intensity using a visual analog scale (VAS).Cervical lateral flexion motion was assessed using a cervical range of motion (CROM) goniometer. Subjects were asked to sit upright and laterally flex their head towards one side. The motion was stopped once the available ROM was completed and care was taken to disallow shoulder elevation. Once the degree of lateral flexion was recorded, the motion was repeated towards the opposite side. Similarly, Cervical rotation on the contralateral side was measured. Both the outcome measures were taken at baseline (pre-Rx) and at the end of 2 weeks after the treatment [1].