This study aims to compare between the effectiveness of Acupuncture-Like Transcutaneous Electrical Nerve Stimulation (Acupuncture-like TENS) and dry needling on pain intensity, Pressure pain threshold (PPT) of upper trapezius myofascial trigger points, neck range of motion, and neck function in patients with non specific chronic neck pain.
The presence of a palpable taut band in the skeletal muscle.
The presence of a hypersensitive spot in the taut band.
Local twitch response provoked by snapping palpation.
Production of a typical referred pain pattern in response to the compression of tender spots.
Existence of cervical disc hernia, advanced cervical osteoarthritis, radiculopathy, or myelopathy.
Having trigger point injection or physical therapy in the last 6 months.
Having a rheumatologic disease, such as fibromyalgia, rheumatoid arthritis, or a hormonal disease, such as hypothyroidism, hyperthyroidism or hyperparathyroidism.
Existence of kyphosis, scoliosis, forward head posture or cervicogenic headache.
Parallel
Acupuncture-like TENS
Other interventionThe first experimental group will receive 20-minute sessions of TENS, where participants adjust the amplitude to achieve strong muscle twitching beneath the electrodes at an intensity below the pain threshold. Acupuncture-like TENS uses high-frequency pulsed currents at two trains per second with an internal pulse frequency of 100 pps. The pulse pattern is set to "burst," with an asymmetrical biphasic waveform and a pulse duration of 200 µs. Minor fluctuations in pulse rate between 100 and 104 pps were noted using a cathode ray oscilloscope before the experiment.
Dry needling
Other interventionThe second experimental group will receive 20-minute sessions of dry needling. Patients will be positioned in a prone, relaxed position, and the overlying skin will be cleaned with alcohol. The muscle will be palpated to locate the trigger point (MTrP), with the muscle grasped between the thumb, index, and middle fingers. A solid filiform needle within a guide tube will be inserted into the MTrP using a tapping motion at an oblique angle. The upper trapezius muscle will be palpated for trigger points, with needle insertion depths ranging from 10-15mm. After obtaining a local twitch response, the needle will be moved vertically 3-5mm until no more twitch responses occur. This group will also receive 20 minutes of conventional physical therapy.
Conventional treatment
Other interventionAll participants in the three groups will receive conventional treatment in the form of hot pack treatment followed by active range of movement (AROM) exercises. A hot pack will be placed on the patients cervical, paraspinal, and upper thoracic areas (including the upper trapezius muscle with aMTrP) for 20 minutes. This will be followed by AROM exercise for cervical spine joints. Participants were asked to actively flex the neck so that the head dropped toward the contralateral trapezius muscles. Patients then rotated the head toward ipsilateral side. This exercise will be repeated five times.
Assessment of neck pain intensity
The Visual Analogue Scale (VAS) will be used to evaluate pain intensity. It is a horizontal line whose length is 10 cm; its left end (zero) indicates no pain, while its right end (ten) reveals the worst imaginable pain. Each subject will be in relaxed position and will be asked to mark the point on the line that exactly corresponded to his/her pain.
Assessment of pressure pain threshold (PPT)
The pressure pain threshold (PPT) will be assessed by positioning the tip of the algometer on the trigger point and increasing the pressure by 1 kg per second. When the patient indicates discomfort, the pressure value will be recorded in kg/cm. The procedure will be repeated three times at 60 s intervals, and the mean pressure value will be recorded as the PPT.
Measurement of cervical flexion range of motion (ROM)
It will be measured for all participants in the three groups pre- and post-treatment, using the CROM device. Each participant will asked to perform cervical flexion three times and the mean value will be recorded.
Measurement of cervical extension ROM
It will be measured for all participants in the three groups pre- and post-treatment, using the CROM device. Each participant will asked to perform cervical extension three times and the mean value will be recorded.
Measurement of cervical lateral flexion to the right ROM
It will be measured for all participants in the three groups pre- and post-treatment, using the CROM device. Each participant will asked to perform cervical lateral flexion to the right three times and the mean value will be recorded.
Measurement of cervical lateral flexion to the left ROM
It will be measured for all participants in the three groups pre- and post-treatment, using the CROM device. Each participant will asked to perform cervical lateral flexion to the left three times and the mean value will be recorded.
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