{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:10:20Z","timestamp":1786122620512,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiotherapy Res Intl"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Purpose<\/jats:title>\n                    <jats:p>Shoulder pain during daily activities is a common musculoskeletal complaint affecting individuals across all age groups. Among its causes, Shoulder Impingement Syndrome (SIS) is one of the most prevalent. This study aimed to compare the effects of Visceral Manipulation (VM) and Integrated Neuromuscular Inhibition Technique (INIT) on pain intensity, shoulder function, and range of motion (ROM) in patients with upper trapezius trigger points associated with SIS, while considering the proposed role of VM in modulating musculoskeletal conditions through viscerosomatic interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This randomized controlled trial included (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a075) patients aged 20\u201340\u00a0years with SIS and trigger points in the superior trapezius region were recruited. Participants were randomly assigned to three groups. Group A (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a025) received VM combined with traditional physical therapy modalities, including Transcutaneous Electrical Nerve Stimulation (TENS), hot pack application, ultrasound therapy, and therapeutic exercises. Group B (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a025) received INIT in addition to the same traditional physical therapy regimen. Group C (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a025), the control group, received only traditional physical therapy. Interventions were delivered over a 4\u2010week period, and all outcomes were reassessed immediately following completion of the intervention. All participants were assessed using the Visual Analog Scale (VAS), pressure algometer, standard goniometer, and the Shoulder Pain and Disability Index (SPADI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Post\u2010treatment analysis revealed statistically significant improvements across all groups in pain intensity, shoulder flexion and abduction range of motion (ROM), and functional level (SPADI) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Group A (VM) and Group B (INIT) showed greater reductions in VAS scores (MD\u00a0=\u00a03.96 and 4.00, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), increases in pressure pain threshold (PPT) (MD\u00a0=\u00a06.88 and 7.34 lb;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), and improvements in shoulder abduction (MD\u00a0=\u00a098.40\u00b0 and 99.68\u00b0;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001) and flexion ROM (MD\u00a0=\u00a0103.48\u00b0 and 103.16\u00b0;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001) compared to Group C. SPADI scores decreased significantly in Groups A and B (MD\u00a0=\u00a027.24 and 23.40;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), indicating enhanced functional recovery. Between\u2010group comparisons confirmed that Groups A and B were significantly superior to Group C (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01), with no significant difference between Groups A and B (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&gt;\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings should be interpreted cautiously, as the exploratory nature of the comparison and the limited evidence base supporting VM preclude definitive conclusions regarding its conceptual or mechanistic superiority compared to standard physiotherapy alone in managing pain, improving shoulder function, and increasing ROM in patients with upper trapezius trigger points associated with SIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      CkinicaTrials.gov (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT06271720\">https:\/\/clinicaltrials.gov\/study\/NCT06271720<\/jats:ext-link>\n                      )\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pri.70253","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T18:08:55Z","timestamp":1781374135000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Visceral Manipulation Versus Integrated Neuromuscular Inhibition Technique in Shoulder Impingement Syndrome"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7435-8780","authenticated-orcid":false,"given":"Noha S.","family":"Elserty","sequence":"first","affiliation":[{"name":"Department of Basic Sciences Faculty of Physical Therapy Benha University  Benha Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5963-1569","authenticated-orcid":false,"given":"Dina O.","family":"Shokry","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Orthopedic and Orthopedic Surgery Faculty of Physical Therapy Badr University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7919-3171","authenticated-orcid":false,"given":"Shaimaa A.","family":"Altoury","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Burn &amp; Surgery Faculty of Physical Therapy Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7013-2605","authenticated-orcid":false,"given":"Efrem","family":"Kentiba","sequence":"additional","affiliation":[{"name":"Department of Sports Science College of Natural and Computational Sciences Arba Minch University  Arba Minch Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1354-1992","authenticated-orcid":false,"given":"Rania R.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Basic Science Faculty of Physical Therapy Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067\u2010006\u20100464\u20102"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3109\/09593980802662145"},{"key":"e_1_2_11_4_1","first-page":"155","volume-title":"Modern Neuromuscular Techniques","author":"Chaitow L.","year":"2010"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2147\/orr.s157864"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2008.048074"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.58962\/HSR.2025.11.2.105\u2010114"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtumed.2020.01.006"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1155\/bmri\/5328365"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.47176\/mjiri.35.59"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2024.12126"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3758\/bf03193146"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijosm.2020.03.003"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010015\u20102308\u20105"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.07.019"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010015\u20102331\u20106"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.09.022"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.3238\/arztebl.2017.0765"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1142\/S1013702523500117"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.17267\/2238\u20102704rpf.v10i4.3292"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2025.10.009"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbmt.2017.10.012"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2022.12.001"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010136\u201010\u2010200205210\u201000006"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.21649\/akemu.v22i1.792"},{"issue":"1","key":"e_1_2_11_26_1","first-page":"309","article-title":"The Effect of Neck Endurance Training as a Component of an Exercise Program for Chronic Non\u2010Specific Neck Pain","volume":"13","author":"Ismail M.","year":"2008","journal-title":"Bulletin of Faculty of Physical Therapy, Cairo University"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1123\/jsr.2017\u20100207"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.55095\/achot2020\/051"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2008.06.004"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.5152\/eurasianjmed.2018.17421"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2007.07.003"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.3892\/br.2024.1778"},{"key":"e_1_2_11_33_1","volume-title":"Orthopedic Physical Assessment","author":"Magee D. 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