Integrated Neuromuscular Inhibition Technique (INIT)

Integrated Neuromuscular Inhibition technique is Manual Physiotherapy Technique used for Acute and Chronic Pain, Sports Condition, Spasm, for Trigger Point and Tender point release, for weaker muscle, to strengthen muscle, to realease tightness of muscle, . this includes Muscle energy technique, Positional Release Technique/ srain-counterstrain and Ischemic Contraction.

1. By - Dr. Anjali Parmar
(MPT-MSSS,PGDYN,GPC,CFT,DFT)
physio_rehab_ap
INTEGRATED NEUROMUSCULAR
INHIBITION TECHNIQUE
INIT

2. physio_rehab_ap
INTEGRATED
NEUROMUSCULAR
INHIBITION
TECHNIQUE
Chitow described an integrated
sequence in which, after location of an
active trigger points, this receives
ischemic compression, followed by
positional release, followed by imposition
of isometric contraction which is either
stretched subsequently (post-
fascilitation stretch) or simultaneously
isolytic stretch.
This method is effectively deactivates
trigger points.

3. TECHNIQUE
Locate the trigger points
Inhibitory pressure
SCS
20 -30 second hold
Isometric contraction and
hold for 7-10 seconds
Post isometric relaxation
Gently stretch

4. Back to Agenda
Integrated Neuromuscular
Inhibitory Technique
Integrated Neuromuscular Inhibitory Technique
(INIT) is a therapeutic approach used in physical
therapy and sports medicine to alleviate pain and
improve muscular function. The technique
combines various elements from different
therapeutic modalities to achieve muscle
relaxation, reduce tension, and improve overall
neuromuscular efficiency.

5. ISCHEMIC
COMPRESSION
Ischemic compression is a manual therapy technique used to alleviate pain and muscle tension
by applying sustained pressure to specific points in the muscle, known as trigger points. This
technique aims to temporarily reduce blood flow (ischemia) to the targeted area, which can help
in releasing the muscle knot and reducing pain.
POSITION
RELEASE
TECHNIQUE
The Positional Release Technique (PRT), also known as Strain-Counterstrain, is a manual
therapy technique used to alleviate pain and muscle tension by placing the body in a position of
comfort to release tension in the affected tissues. This method was developed by Dr. Lawrence
Jones in the 1950s and has since become a widely used technique in physical therapy and
osteopathic medicine.
MUSCLE
ENERGY
TECHNIQUE
Muscle Energy Technique (MET) is a form of manual therapy used to treat musculoskeletal
dysfunction by using the patient's own muscle contractions against a controlled counterforce
applied by the therapist. This technique is aimed at improving joint mobility, lengthening
shortened muscles, and reducing pain. MET was first developed by osteopathic physician Fred
Mitchell in the mid-20th century and has since become a widely utilized method in physical
therapy and osteopathy.
Here’s a breakdown of the key components
and principles involved in INIT:

6. BENIFITS OF INIT
Pain Relief: Helps in reducing acute and chronic
pain by addressing underlying muscular and fascial
restrictions.
Improved Flexibility and Range of Motion:
Techniques like PNF and myofascial release enhance
muscle extensibility and joint mobility.
Enhanced Muscle Function: By addressing
neuromuscular imbalances and improving muscle
activation patterns.
Holistic Approach: Integrates multiple therapeutic
approaches for a comprehensive treatment plan.

7. SPORTS INJURIES
Chronic pain conditions like fibromyalgia
POST-SURGICAL REHABILITATION
Musculoskeletal disorders such as tendinitis or
bursitis
GENERAL MUSCLE STIFFNESS
AND TENSION
INIT is commonly used in the treatment of:
INDICATION:
Back to Agenda

8. IC 2. PRT/SCS 3. MET
INTEGRATED NEUROMUSCULAR INHIBITION TECHNIQUE
INIT
ischemic compression position release
technique
/ strain/counterstrain
muscle energy technique

9. ISCHEMIC
COMPRESSION
1.

10. Back to Agenda
applying sustained pressure to specific points in the muscle, known as trigger points
ISCHEMIC COMPRESSION
Principles of Ischemic Compression
Identification of Trigger Points: Trigger points are hyperirritable spots within a taut band of skeletal muscle that are
painful upon compression and can refer pain to other areas. These are identified through palpation and patient
feedback.
Application of Pressure: Once the trigger point is located, the therapist applies firm, sustained pressure directly onto
the point. The pressure should be enough to elicit a mild to moderate discomfort but should not cause excessive
pain.
Duration: The pressure is maintained typically for 30 seconds to 2 minutes. The goal is to hold the pressure until a
decrease in pain or a softening of the muscle knot is felt.
Release and Reassessment: After the pressure is released, the therapist reassesses the trigger point and surrounding
tissues to evaluate the reduction in tension and pain.

11. ASSESSMENT: A practitioner identifies the trigger point or tight area in the muscle. Trigger points
are hyperirritable spots within a taut band of skeletal muscle that can cause
referred pain and discomfort.
PREPARATION: Using fingers, knuckles, or an appropriate tool, the practitioner applies firm pressure
directly on the trigger point. The pressure is typically maintained for 30 seconds to 2
minutes.
APPLICATION: Use your thumb, fingers, knuckles, or a specialized tool to apply direct pressure to the trigger
point.
Increase the pressure gradually until the patient feels mild to moderate discomfort.
Hold this pressure steady, ensuring that it remains within the patient’s pain tolerance..
The aim is to reach a point where the muscle begins to relax.
RESTORATION
OF BLOOD
After releasing the pressure, blood flow returns to the area, bringing oxygen and nutrients that help
in the healing process and in reducing muscle tightness.
Steps in Ischemic
Compression

12. Benefits of Ischemic Compression
PAIN RELIEF: Helps reduce pain associated with trigger points by disrupting the pain
cycle.
DECREASED
MUSCLE TENSION
Aims to relax tight muscles and reduce spasms.
IMPROVED RANGE
OF MOTION:
Alleviating trigger points can enhance flexibility and joint mobility.
ENHANCED
BLOOD FLOW
Once the pressure is released, there is often an increase in blood flow to the
area, promoting healing.
https://drive.google.com/file/d/15sefJe_qDAPva4sIPA-
-2YT25uN2nHwd/view?usp=drive_link

13. Ischemic compression is commonly used to
treat various conditions, including:
INDICATION:
Myofascial pain syndrome
Chronic muscle tension
Headaches related to
muscle tension
Neck and back pain
Sports injuries
Fibromyalgia

14. Ischemic compression is not used to treat
various conditions, including:
CONTRAINDICATIONS:
open wounds,
infections,
severe vascular diseases.
It is also contraindicated
in patients with certain
circulatory conditions,
such as deep vein
thrombosis.

15. Patient
Comfort
Always ensure the
pressure applied is
within the patient’s
tolerance to avoid
causing excessive
pain.
Considerations
Gradual
Increase of
Pressure:
Start with light pressure
and gradually increase to
the desired level.

16. POSITION RELEASE
TECHNIQUE
/ STRAIN/COUNTERSTRAIN2.

17. Back to Agenda
used to alleviate pain and muscle tension by placing the body in a position of comfort to release tension in the
affected tissues.
POSITIONAL RELEASE TECHNIQUE
Principles of Positional Release Technique:
Finding the Tender Point: The therapist identifies specific tender points or areas of hypertonicity in
the muscle. These points are typically associated with discomfort or pain.
1.
Position of Ease: The therapist then moves the patient's body or limb into a position where the tender
point is least painful or the muscle feels most relaxed. This position is known as the position of ease.
2.
Holding the Position: The position of ease is held for a specific duration, usually between 90 seconds
to 3 minutes. During this time, the muscle and associated tissues are allowed to relax and release
tension.
3.
Gentle Return: After holding the position, the therapist gently and slowly returns the body part to a
neutral position. This is done carefully to avoid reactivating the muscle tension.
4.
Reassessment: The therapist reassesses the tender point to determine if there has been a reduction in
pain and tension. If necessary, the technique can be repeated or adjusted.
5.

18. Steps in Positional
Release Technique:
ASSESSMENT: Conduct a thorough assessment to identify the tender points and areas of
discomfort.
POSITIONING
:
Move the patient's body part to find the position of greatest comfort and
minimal pain at the tender point.
MONITORING
:
Continuously monitor the patient's response to ensure the position
remains comfortable.

19. Steps in Positional Release Technique:
HOLDING: Maintain the position of ease for 90 seconds to 3 minutes,
allowing the muscle fibers to relax and reset.
RELEASE: Slowly and gently return the body part to its neutral position.
REASSESSMENT
:
Check the tender point and overall muscle tension to evaluate
the effectiveness of the technique.
https://drive.google.com/file/d/15EPDzQMVucZxPovPHrfXFNky-
wrOAjbD/view?usp=drive_link

20. Benefits of Positional Release
Technique:
PAIN RELIEF: Reduces acute and chronic pain by decreasing muscle tension and spasm.
INCREASED
RANGE OF
MOTION:
Enhances flexibility and joint mobility by relieving muscle tightness.
IMPROVED
CIRCULATION:
Promotes better blood flow to the affected area, aiding in healing.
NON-INVASIVE: A gentle and non-invasive technique suitable for a wide range of patients,
including those with acute pain.

21. PRT is effective for treating various
conditions, including:
INDICATION:
Muscle strains and sprains
Fibromyalgia
Tendinitis
Back and neck pain
Post-surgical rehabilitation
Chronic pain syndromes

22. PRT is not used to treat various conditions,
including:
CONTRAINDICATIONS:
Fracture
Severe Osteoporosis
Malignancy
Acute Infection
Severe Rheumatiod
Arthritis
Severe Vascular
Disorders

23. MUSCLE
ENERGY
TECHNIQUE3.

24. Back to Agenda
to treat musculoskeletal dysfunction by using the patient's own muscle contractions against a controlled
counterforce applied by the therapist post isometric relaxation technique is used.
MUSCLE ENERGY TECHNIQUE (MET)
Principles of Post isometric relaxation
Voluntary Muscle Contraction: The patient actively contracts their muscle or muscle group against a
resistance provided by the therapist.
Controlled Counterforce: The therapist applies a specific counterforce that matches the patient’s effort,
ensuring the contraction is isometric (meaning the muscle length doesn’t change).
Gentle Stretching: Following the muscle contraction, the muscle is gently stretched to a new length.
Repetition and Relaxation: The technique typically involves several repetitions, with brief periods of
relaxation between each contraction and stretch.

25. Principle of MET
Post
Isometric
Relaxation
Reciprocal
Inhibition

26. Isometric contraction- using PIR(with and
without stretch):
Indications
- Relaxing acute muscular spasm or contraction
- Mobilizing restricted joints
- Preparing joints for manipulation
Contraction Starting Point
- At easy restriction barrier
Mode
- Agonist used in isometric contraction to treat affected muscle via Post-Isometric
Relaxation (PIR), allowing for easier stretching.
Force
- Subject's effort; initially 20%
Duration of Contraction
- Initially 7-10 seconds, gradually increasing to 20 seconds

27. Isometric contraction- using PIR(with and
without stretch):
Action Following Contraction
- Rest interval of 5 seconds
- Stretch held for 10-30 seconds (painless)
Stretching
- For chronic or subacute restricted, fibrotic, contracted soft tissues (fascia, muscle)
or tissues with active myofascial trigger points
Repetitions
- 3-5 times until no further gain in Range of Motion (ROM)

28. Isometric contraction- using RI(with and without
stretch):
Indications
- Stretching chronic or subacute restricted, fibrotic, contracted soft tissues (fascia,
muscle) or tissues with active myofascial trigger points
- Chosen when agonist contraction is contraindicated due to pain
Contraction Starting Point
- Slightly short of restriction barrier
Mode
- Antagonist is used in isometric contraction, treating muscle via Reciprocal Inhibition
(RI) for easier stretch

29. Isometric contraction- using RI(with and without
stretch):
Force
- Subject's effort; initially 30%, gradually increasing to 50%
Duration of Contraction
- Initially 7-10 seconds
Action Following Contraction
- Rest for 5 seconds
- Stretch held for 10-30 seconds (painless)
- Repeat without stretch and relaxation
Repetitions
- 3-5 times until no further gain in Range of Motion (ROM)

30. VARIATIONS
ISOMETRIC ISOTONIC
ISOKINETIC
PIR
ACUTE
(Without
stretch)
RI
CHRONIC
(With
stretch)
concentric
muscle
contraction
slow eccentric
muscle
contraction
eccentric
muscle
contraction
combination of
isomonic and
isometric
muscle
contraction

31. ASSESSMENT
:
he therapist assesses the patient to identify the dysfunction, such as reduced
range of motion or muscle tightness.
POSITIONIN
G:
The patient is positioned comfortably, and the affected muscle or joint is taken
to the initial point of restriction (the barrier).
PATIENT
CONTRACTIO
N:
The patient is instructed to gently contract the targeted muscle against the
therapist's resistance, typically at 20-30% of their maximum effort. The contraction
is held for 5-10 seconds
Steps in Muscle Energy
Technique

32. Steps in Muscle Energy Technique
RELEASE AND
RELAXATION:
The patient is asked to relax the muscle completely. After relaxation,
the therapist gently stretches the muscle to a new barrier.
REPETITION: This process is repeated 3-5 times, each time stretching a bit further,
until optimal lengthening or range of motion is achieved.
https://drive.google.com/file/d/17BGLqMKHeHSGYhY7Fw3Cl_
eUV85pcaQv/view?usp=drive_link

33. Benefits of Muscle Energy Technique
IMPROVED JOINT
MOBILITY:
Helps restore normal joint function by increasing the range of motion.
DECREASED
MUSCLE TENSION:
Reduces hypertonicity and muscle spasm.
PAIN REDUCTION: Alleviates pain by addressing the underlying muscle imbalances and joint
restrictions.
ENHANCED
CIRCULATION:
Promotes better blood flow and nutrient delivery to the affected areas.
INCREASED
STRENGTH:
Helps in strengthening muscles through controlled isometric contractions.

34. MET can be used to treat a variety of conditions,
including:
INDICATION:
Back and Neck Pain: Helps to relieve tension in the paraspinal muscles and
improve spinal mobility.
Joint Dysfunctions: Particularly effective for sacroiliac joint dysfunctions and rib
dysfunctions.
Muscle Strains and Sprains: Aids in the recovery by gently stretching and
strengthening the affected muscles.
Postural Imbalances: Corrects muscle imbalances that contribute to poor
posture.
Sports Injuries: Assists in the rehabilitation of injuries by improving flexibility and
muscle function.

35. Muscle energy technique is not used to
treat various conditions, including:
CONTRAINDICATIONS:
acute injuries,
severe osteoporosis,
other conditions where
muscle contractions may
be contraindicated.

36. Patient
Comfort
Ensure the patient is
comfortable and that
contractions are within
their pain tolerance.
Considerations
Gradual
Increase of
Pressure:
Increase the stretch
gradually to avoid
overstretching and causing
discomfort.

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