Comparison Between Deep Dry Needling and Muscle Energy Technique on Chronic Non-specific Neck Pain Patients.

Study Overview
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Brief Summary
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The goal of this clinical trial is to compare between applying deep dry needling and muscle energy technique in chronic non-specific neck pain patients. Researchers will compare between deep dry needling group, muscle energy technique group and control group to see if there are change in pain, range of motion or function.

Official Title
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Deep Dry Needling Versus Muscle Energy Technique on Chronic Non-specific Neck Pain; a Randomized Controlled Trial.

Conditions
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Neck Pain

Intervention / Treatment
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* Procedure: Deep dry needling
* Procedure: Muscle energy technique
* Procedure: Neck stability exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 and 40 years. Current neck pain. Presence of at least one or two trigger points . Patients are diagnosed and referred from orthopedist complaining from chronic neck pain for at least 12 weeks. No clinical treatment for neck pain within the past month. lacked a history of neck and shoulder myopathy, neuropathy, myelopathy and neck, torso and shoulder surgery. Patients with body mass index less than 30 kg/m2. Exclusion Criteria: Patients outside the target range. Neck pain associated with vertigo. Osteoporosis. Diagnosed psychological disorders. Fibromyalgia syndrome. Vertebral fractures. Spinal stenosis. Tumors. Previous neck surgery. Red flags (night pain, severe muscle spasm, loss of involuntary weight, symptom mismatch). Physiotherapeutic treatment continued in the last 3 months. Any contraindications for deep dry needling such as anticoagulants, infections and bleeding.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A<br>In addition to Transcutaneous Electrical Nerve Stimulation (TENS) (typical,100 Hz, 20 mins), Infrared (7 mins), and Exercises (Cervical Stability Exercises through activation of deep neck flexors), patients received deep dry needling on active trigger points in selected muscles (upper trapezius, levator scapulae, and sternocleidomastoid ), 3 sessions/week, for 4 weeks period. | Procedure: Deep dry needling<br>* Method to decrease pain and improve function in musculoskeletal disorders.<br>|
| Active Comparator: Group B<br>In addition to Transcutaneous Electrical Nerve Stimulation (TENS) (typical,100 Hz, 20 mins), Infrared (7 mins), and Exercises (Cervical Stability Exercises through activation of deep neck flexors), patients received muscle energy technique (post isometric relaxation) in selected muscles (upper trapezius, levator scapulae, and sternocleidomastoid ), 3 sessions/week, for 4 weeks period. | Procedure: Muscle energy technique<br>* Method to decrease pain and improve function in musculoskeletal disorders.<br>* Other names: Post isometric relaxation;|
| Placebo Comparator: Group C<br>Patients receive Transcutaneous Electrical Nerve Stimulation (TENS) (typical,100 Hz, 20 mins), Infrared (7 mins), and Exercises (Cervical Stability Exercises through activation of deep neck flexors) , 3 sessions/week, for 4 weeks period. | Procedure: Neck stability exercise<br>* Method to decrease pain and improve function in musculoskeletal disorders.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in pain intensity from baseline to 4 weeks after. | Visual Analogue scale (VAS) A value of 0 denotes no pain, whereas a value of 1 to 3 indicates mild pain. 4 to 6 denotes moderate pain. 7 to 10 denotes intense pain. | at baseline and after 4 weeks from the baseline. | 
| Change in function from baseline to 4 weeks after. | The Neck Disability Index (NDI) The NDI questionnaire (scored out of 50) was used to measure the patient's perceived disability resulting from their neck pain. The score for each section was from 0 to 5, with 0 represented the highest level of function and 5 represented the lowest level of function. Total NDI scores were shown as a percentage. A high score corresponded to a higher degree of disability. 0-4points (0-8%) no disability. 5-14points (10 - 28%) mild disability. 15-24points (30-48%) moderate disability. 25-34points (50- 64%) severe disability. 35-50points (70-100%) complete disability. | at baseline and after 4 weeks from the baseline. | 
| Change in cervical range of motion (ROM) in sagittal, coronal and transverse planes from baseline to 4 weeks after. | AcuAngle® Inclinometer: (Baseline® AcuAngle Inclinometer; Elmsford, NY, U.S. PAT 2194335, 2-D Functions) | at baseline and after 4 weeks from the baseline. | 
| Change in pain threshold from baseline to 4 weeks after. | Pain Pressure Algometer: (BASELINE 22-POUND DOLORIMETER). | at baseline and after 4 weeks from the baseline. |