Perez-Martinez C, Gogorza-Arroitaonandia K, Heredia-Rizo AM, et al. INYBI: A New Tool for Self-Myofascial Release of the Suboccipital Muscles in Patients With Chronic Non-Specific Neck Pain: A Randomized Controlled Trial. Spine (Phila Pa 1976). 2020 Nov 1;45(21):E1367-E1375. doi: 10.1097/BRS.0000000000003605. (Original study)

STUDY DESIGN: A randomized, single-blinded (the outcome assessor was unaware of participants' allocation group) controlled clinical trial.

OBJECTIVE: To investigate the effects of myofascial release therapy (MRT) over the suboccipital muscles, compared with self-MRT using a novel device, the INYBI tool, on pain-related outcomes, active cervical mobility, and vertical mouth opening, in adults with chronic non-specific neck pain (NSNP).

SUMMARY OF BACKGROUND DATA: MRT is used to manage chronic musculoskeletal pain conditions, with purported positive effects. The efficacy of self-MRT, compared with MRT, has been scarcely evaluated.

METHODS: Fifty-eight participants (mean age of 34.6?±?4.7 yrs; range 21-40 yrs; 77.6% females, 22.4% males) with persistent NSNP agreed to participate, and were equally distributed into an INYBI (n?=?29) or a control group (n?=?29). Both groups underwent a single 5-minutes intervention session. For participants in the control group, MRT of the suboccipital muscles was performed using the suboccipital muscle inhibition technique, while those in the INYBI group underwent a self-MRT intervention using the INYBI device. Primary measurements were taken of pain intensity (visual analogue scale), local pressure pain sensitivity, as assessed with an algometer, and active cervical range-of-movement. Secondary outcomes included pain-free vertical mouth opening. Outcomes were collected at baseline, immediately after intervention and 45?minutes later.

RESULTS: The analysis of variance (ANOVAs) demonstrated no significant between-groups effect for any variable (all, P?>?0.05). In the within-groups comparison, all participants significantly improved pain-related outcomes, and showed similar positive changes for mouth opening. Cervical range-of-movement- mainly increased after intervention for participants in the control group.

CONCLUSION: Both, MRT and self-MRT using the INYBI, are equally effective to enhance self-reported pain intensity, and local pressure pain sensitivity in chronic NSNP patients. For cervical mobility, MRT appears to be slighlty superior, compared with the INYBI, to achieve improvements in this population.


Discipline Area Score
Physician 4 / 7
Rehab Clinician (OT/PT) 4 / 7
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Comments from MORE raters

Physician rater

This is a new idea, I think. I would look at recommending this in the clinic.

Rehab Clinician (OT/PT) rater

I would be hesitant to describe this as a 'new tool'. Variations on this mechanical tool theme have existed since 'inhibitive' treatment to the 'myofascia' of the sub-occipital region have been utilised as an approach to neck pain and headache, and described over a century ago. It may find its proponents for an augmented clinical approach as opposed to one seen an alternative approach.

Rehab Clinician (OT/PT) rater

The suboccipital region is a key issue when it comes to managing those with cervicogenic headaches. Having additional options for self management is promising. The issue remains that this study only looked at immediate effects and no long term effect. This tool could be useful for those clinicians using this in a multimodal interventional approach with an augmented exercise approach to support the change in myofascial tone.

Rehab Clinician (OT/PT) rater

There is a small trial size. The study compared doing myofascial release with and without a device. It does not make the case that there is any evidence or strong rationale for this in the first place but then compares 2 methods of doing something with no known proven efficacy. It would have been far more helpful for trial of intervention versus control.

Rehab Clinician (OT/PT) rater

This is fine work promoting the work with patients so that they become more active using capacitiy building. Future research should investigate the longterm efficacy of using the INYBI, alone or within a multimodal approach, compared (....) and in combination with specific exercise for the neck.
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