Efficacy Comparison between the Strengthening Exercises and Transcutaneous electrical nerve stimulation (TENS) in Chronic Non-Specific Neck Pain patients

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Dr Mahnoor Bugti, Porf. Dr Basit Ansari, Dr. Raheela Rahmat Zohra, Dr. Mahnaz Ahmad, Dr Muhammad khan, Dr Ruqaya Nangrejo, Dr Nazia Jameel


Tens, neck pain, cervical pain, pain, Theraband, isometric exercises RESULTS: The TENS is more effective in non-specific neck pain than the strengthening exercise


The mechanism of the underlying study was to choose the best treatment for the chronic non-specific neck pain but it is not clear nonspecific neck pain is associated with the deficit and alteration of the muscles proprioception that play role in the cervical joint position, motor control of the head, and postural stability. Countless treatments for the chronic non-specific neck pain which are approved by the many specialists which have good influence on the non-specific neck pain 

Aim: The aim of our study is to analyze the difference in the between two treatments which treatment is best for the non-specific neck pain the relation between them produced by treatment based on the strengthening exercise which was provided by the theraband and TENS to stimulate muscles deeply and activate proprioception 

Methodology: It was an experimental RTC study which was conducted in the OPD of Karachi. Age criteria 18-60, with non-specific chronic neck pain. The sample size of 24 subjects which are divided into two groups, group A group B comprising, the duration of the study is 4 months neck pain continue for at least the last 3 months. As depend on NDI the variables of the study we will take pain based on the visual Analog scale the findings will be analyzed statistically considering a % significance level p 0.333

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1) deligneLDMC, Rocha MCB, MaltaDC et.al . The burden of neck pain in Brazil: estimates from the global burden of disease study 2019. BMC Musculoskelet Disord. 2021;22(833): 21-46.
2) MalikA et.al Comparison between myofascial release technique (MRT) and Transcutaneous electrical nerve stimulation (TENS) toward pain level in nonspecific neck pain patients. J. Phys. Conf. Ser.2020 ; 15(29) : 32-43.
3) de Zoete RMJ, et al. The comparative effectiveness of physical exercise interventions in individuals with chronic non-specific neck pain: protocol for a network meta analysis. BMJ 2020;10(5) 346-348
3) Kazeminasab, S., Nejadghaderi, S.A., Amiri, P. et al. Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord 2022 ; 23(26) : 891-957
4) Safiri S, Kolahi AA, Hoy D, et al. Global, regional, and national burden of neck pain in the general population : systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020: 368-791.
5)Roesch ZK, Tadi P. Anatomy, Head and Neck, Neck. In: StatPearls StatPearls Publishing; 2022.

6)Sethi D, Gofur EM, Munakomi S. Anatomy, head and neck, carotid arteries. In: StatPearls [Internet]. StatPearls Publishing; 2022.
7)Hidalgo B, Hall T, Bossert J, Dugeny A, Cagnie B, Pitance L. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskelet Rehabil . 2018 ; 30(6):1149–1169.

8) Independent Nurse. Non-specific neck pain .Independentnurse.co.uk.

9)Medical definition of neck pain [Internet]. RxList. [cited 2022 Dec 2].
Available from: https://www.rxlist.com/neck_pain/definition.htm

10)What can you do about non-specific neck pain? Institute for Quality and Efficiency in Health Care (IQWiG); 2019.

11) de Zoete RM, McAuley JH, Armfield NR, Sterling M. The comparative effectiveness of physical exercise interventions in individuals with chronic non-specific neck pain: protocol for a network meta-analysis. BMJ Open .

12) Mäkelä M, Heliövaara M, Sievers K,et.al . Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol

13) Jin Z, Wang D, Zhang H, Liang J, Feng X, Zhao J, et al. Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: results from the global burden of disease study 2017. Ann Rheum Dis 2020;79(8):1014–1022.

14)Shivum S, Sakshi T, Ibtahaj-ul-islam A, Sidra N, Aadil Ameer A. Prevalence of neck pain among the undergraduate physical therapy students of university of Balochistan, Quetta, Pakistan. J Nov Physiother Phys
Rehabil. 2021;8(1):020–030

15)Basson CA, Olivier B, Rushton A. Neck pain in South Africa: An overview of the prevalence, assessment and management for the contemporary clinician. S Afr J Physiothe. 2019;75(1):13-32

16)Org.pk. [cited 2022 Dec 2]. Available from:
https://www.pjmr.org.pk/index.php/pjmr/article/view/216#:~:text=In%20an other%20study%20conducted%20in,84%25%20which%20is%20exception ally%20high.&text=In%20another%20study%20on%20167,were%20suffer ing%20from%20musculoskeletal%20pain.

17)Avondtroodt J-P, Baeyens R, De Ridder O, De Stexhe P, Degadt D, Devos
J-N, et al. Actual members : Pierre Gillet (president), dirk Cuypers (vicepresident), Jo DE cock (vice-president), Frank van massenhove (vicepresident), Yolande Fgov.be. [cited 2022 Dec 2]. Available from:

18)Gross A, Kay TM, Paquin J-P, Blanchette S, Lalonde P, Christie T, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev.2015;1(1): 42-50.

19)Martimbianco ALC, Porfírio GJ, Pacheco RL, Torloni MR, Riera R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain.
Cochrane Database Syst Rev 2019;12(12):119 127

20) Pancholi P, Yadav J, Kalra S. Effect of resistance band exercises on neck pain, disability and forward head posture in dentists with chronic neck pain. Journal of Physiotherapy and Rehabilitatio ;2018

21) https://www.researchgate.net/publication/282863850_Effects_of_neck_s tabilization_and_dynamic_exercises_on_pain_disability_and_fear_avoidan ce_beliefs_in_patients_with_nonspecific_neck_pain_a_randomized_clinical_trial

22) Suvarnnato T, Puntumetakul R, Uthaikhup S, Boucaut R. Effect of specific deep cervical muscle exercises on functional disability, pain intensity, craniovertebral angle, and neck-muscle strength in chronic mechanical neck pain: a randomized controlled trial. J Pain Res. 2019

23) Https://bcmjorg/worksafebc/what’s-new-literature-nonspecific-neckpain. [Online]. Available from: https://bcmj.org/worksafebc/what’s-newliterature-nonspecific-neck-pain
24) https://www.coastalorthoteam.com/blog/chronic-neck-pain-commoncauses-and-reasons
25) https://www.sralab.org/rehabilitation-measures/neck-disability-index

27) Bernal-Utrea C, Gonzalez-Gerez JJ, Anarte-Lazo E, Rodriguez-Balance C. Manual Therapy versus Therapeutic exercise in non-specific chronic neck pain: A randomized controlled trial. Trials. 2020;21

28) Saeterbakken AH, Nordengen S, Andersen V, Fimland MS. Nordic walking and specific strength training for neck and shoulder pain in office workers: A Pilot-Study.European Journal of Physical and Rehabilitation

29) Arsh A, Darain H, Iqbal M, Rahman M, Ullah I, Khalid S. Effectiveness of manual therapy to the cervical spine with and without manual therapy to the upper thoracic spine in the management of non-specific neck pain; a randomized controlled trial. Journal of the Pakistan Medical Association.2017:1
30) Chiu TTW, Hui-Chan CWY, Cheing G.A randomized clinical trial of TENS and exercise for patients with chronic neck pain. Clinical Rehabilitation. 2015;19(8):850-60.
31) Paolucci T, Agostini F, Paoloni M, de Sire A, Verna S, Pesce M, et al.
Efficacy of tens in cervical pain syndromes: An Umbrella Review of Systematic Reviews. Applied Sciences. 2021;11(8):3423.
32) Akodu A, Ajepe T, Sorunke Ms. Effects of neck stabilization and isometric neck exercises on non-specific chronic neck pain: A pilot study. Physiotherapy.2021;113.
33) Coulter ID. Manipulation and mobilization fortreating chronic nonspecific neck pain: A systematic review and meta-analysis for an appropriateness panel. Pain Physician. 2019;2(22.2).
34) Bernal-Utrera C, Anarte-Lazo E, Gonzalez-Gerez JJ, SaavedraHernandez M, De-La-Barrera-Aranda E, Serrera-Figallo MA, et al. Effect of combined manual therapy and therapeutic exercise protocols on the postural stability of patients with non-specific chronic neck pain. A secondary analysis of randomized controlled trial. Journal of Clinical Medicine. 2021;11(1):84.
35) Bertozzi L, Gardenghi I, Turoni F, Villafañe J, Capra F, Guccione A, et al. Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain: Systematic review and meta-analysis of Randomized Trials. Physical Therapy. 2013;93(8):1026–36.
36) Ghodrati M, Mosallanezhad Z, Shati M, Rastgar Koutenaei F, Nourbakhsh M R, Noroozi M. The Effect of Combination Therapy; Manual Therapy and Exercise, in Patients With Non-Specific Chronic Neck Pain: A Randomized Clinical Trial. PTJ 2017; 7 (2) :113-121.
37) Groisman S, Malysz T, de Souza da Silva L, Rocha Ribeiro Sanches T, Camargo Bragante K, Locatelli F, et al. Osteopathic manipulative treatment combined with exercise improves pain and disability in individuals with nonspecific chronic neck pain: A pragmatic randomized controlled trial. Journal of Bodywork and Movement Therapies. 2020;24(2):189–95.
38) Skillgate E, Pico-Espinosa OJ, Côté P, Jensen I, Viklund P, Bottai M, et al. Effectiveness of deep tissue massage therapy, and supervised strengthening and stretching exercises for subacute or persistent disabling neck pain. The Stockholm Neck (stone) randomized controlled trial. Musculoskeletal Science and Practice. 2020;45:102070.
39) Beltran-Alacreu H, López-de-Uralde-Villanueva I, Fernández-Carnero J, La Touche R. Manual therapy, Therapeutic Patient Education, and therapeutic exercise, an effective multimodal treatment of Nonspecific Chronic Neck Pain. American Journal of Physical Medicine & Rehabilitation. 2015;94(10S):887–97.
40) Groeneweg R, van Assen L, Kropman H, Leopold H, Mulder J, SmitsEngelsman BC, et al. Manual therapy compared with physical therapy in patients with non-specific neck pain: A randomized controlled trial. Chiropractic & Manual Therapies. 2017;25(1).
41) Kashfi P, Karimi N, Peolsson A, Rahnama L. The effects of deep neck muscle-specific training versus general exercises on deep neck muscle thickness, pain and disability in patients with chronic non-specific neck pain: Protocol for a randomized clinical trial (RCT). BMC Musculoskeletal Disorders. 2019;20(1).
42) Celenay ST, Akbayrak T, Kaya DO. A comparison of the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone in patients with nonspecific mechanical neck pain: A randomized clinical trial. Journal of Orthopaedic & Sports Physical