Effects of Sub-Occipital Muscle Inhibition with and Without Hold Relax Agonist Contraction of Hamstrings on Pain, Disability and Craniovertebral Angle in Neck Pain Patients with Hamstring Tightness

Abstract

Background: Neck pain is a prevalent musculoskeletal disorder with significant impacts on individuals' daily functioning and quality of life. The Superficial Backline (SBL) concept suggests that muscles and fascial structures are interconnected, implying that addressing muscle tightness in one area can influence distant regions. This study explored the effects of sub-occipital muscle inhibition (SMI) with and without hold-relax agonist contraction (HR-AC) of the hamstrings on pain, disability, and craniovertebral angle in patients with neck pain and hamstring tightness. Objective: To determine the efficacy of SMI with and without HR-AC on pain relief, neck disability, and craniovertebral angle in patients suffering from neck pain and hamstring tightness. Methods: This randomized controlled trial included 34 participants aged 20-40 years with neck pain (NPRS ≥ 5) and hamstring tightness (≥ 30° extension lag). Participants were randomly assigned to two groups: Group A (SMI without HR-AC) and Group B (SMI with HR-AC). Interventions were administered three times per week for two weeks. Pain, craniovertebral angle, and neck disability were assessed using the Numeric Pain Rating Scale (NPRS), Bubble Inclinometer, Image J software, and Neck Disability Index (NDI). Data were collected at baseline and post-treatment. Statistical analysis was performed using SPSS version 25, with paired and independent t-tests used to compare outcomes within and between groups. Results: Significant reductions in NPRS scores were observed in both groups: Group A (mean pre-treatment: 6.25 ± 0.85, post-treatment: 3.18 ± 0.98) and Group B (mean pre-treatment: 6.40 ± 0.986, post-treatment: 2.133 ± 0.743). Craniovertebral angle improved significantly in both groups: Group A (mean pre-treatment: 41.25° ± 3.51, post-treatment: 45.48° ± 2.94) and Group B (mean pre-treatment: 40.99° ± 2.70, post-treatment: 49.02° ± 2.868). NDI scores also showed marked improvement: Group A (mean pre-treatment: 32.96 ± 3.04, post-treatment: 15.38 ± 3.39) and Group B (mean pre-treatment: 33.03 ± 2.89, post-treatment: 11.25 ± 3.27). Group B demonstrated more significant improvements in all measured outcomes compared to Group A (p < 0.05). Conclusion: Both interventions, SMI without HR-AC and SMI with HR-AC, significantly reduced pain, improved craniovertebral angle, and decreased neck disability. However, the combination of SMI with HR-AC was more effective, highlighting the importance of addressing both ends of the myofascial chain in managing neck pain and hamstring tightness.