TENS Versus Ultrasound With Exercise for Mechanical Neck Pain.

Mechanical Neck Pain is described as immediate or prolonged discomfort in cervical and shoulder regions, starting from the base of skull to the spine of scapula, this discomfort may extend down the arms and leading to reduction in the range of motion in the neck region and it occurred without any prior history of trauma, infection or systematic issues like fractures. Nonspecific neck pain is because of postural and mechanical reasons also known as Mechanical Neck Pain. Neck problems are not dangerous but these issues may cause discomfort and firmness. Much of the time neck pain is because of poor posture and flawed ergonomics at work area. Across various countries including Pakistan, Australia, the USA (New York), China, Brazil, and Central Saudi Arabia studies have identified neck pain prevalence among medical students ranging from 8.23% to 65%. Neck pain prevalence most commonly increases with age and greater among women as compared to men. According to studies 30%, 43% men and women respectively once in their lifetime experience neck pain, out of them10% men and 17% women experience chronic pain. Studies reported the 2nd most common musculoskeletal cause of disability globally. It is estimated that there are approximately 12 cases of Mechanical Neck Pain (MNP) per 1000 individuals seeking medical attention per year. Neck pain is a most frequent reason to seek medical attention from healthcare providers. Across the general population, neck pain affects 14% to 71% adults at various stages in their lives, among north Europeans 1-year greater prevalence as compared to Asian population. In general, worldwide population, 25% women and 16% men in Sweden experience neck pain annually. Iran reported 15% prevalence of neck pain in adults. While the exact cause of neck pain remains unclear, it is widely recognized as having a miscellaneous origin. Research indicates a strong correlation with factors such as depression, anxiety, migraines, sedentary lifestyle, disrupted sleep patterns, and smoking. The rising interest in neck pain because of its global prevalence which is 4.9%. Neck pain holds the 4th positions among condition causing disability when assessed in terms of years lived with some sort of pain and disability. Neck pain is responsible for causing disabilities of various severities and major cause of substantial medical expenses, productivity losses and economic burden.

Methodology:

Participants who are diagnose and referred to the Physiotherapy Outpatient Department (OPD) of the DOW Institute of Physical Medicine \& Rehabilitation at Dow University of Health Sciences, OJHA Campus, will be included in the study. All eligible participants will be thoroughly informed about the study through a structured Informed Consent Form. The researcher will introduce herself, explain the purpose, procedures, potential risks, and benefits of the study.

Participants will be allowed ample time to read the form, ask questions, and clarify any doubts. Those willing to participate will be asked to sign the consent form or provide a thumb impression. The screening and initial identification of eligible participants will be supervised by a senior physiotherapist. The informed consent process ensures compliance with ethical principles including autonomy, confidentiality, and the right to withdraw at any stage of the study without any penalty or impact on their ongoing care.

Sample size of 44 participants will be divided into two equal groups through simple random sampling technique through number generator table to ensure each participant has an equal chance of being selected and reduce selection biasness. The method used in the study comprise single blinded methodology.

Group A include 22 participants both male and females, will receive TENS (15 min), heating pad (10 min), followed by cervical active stretching (\~4 min) and isometric exercises (\~3 min), making a treatment subtotal of \~30 minutes, with the remaining time used for supervision, education, rest, and documentation (total 45 min/session).

Group B also include 22 participants, will receive therapeutic Ultrasound (10 min), heating pad (10 min), the same stretching (\~4 min) and isometric exercises (\~3 min), totaling \~27 minutes of treatment plus \~15 minutes for supervision and documentation (45 min/session).

Both groups will undergo 9 sessions over 2 weeks (6 consecutive sessions in week 1 and 3 alternate-day sessions in week 2).

• Muscle strength measured using Manual Muscle Testing (MMT) [Срок оценки: Baseline and after 2 weeks of treatment.]
• Pressure pain threshold measured using an algometer [Срок оценки: Baseline and after 2 weeks of treatment.]
• Neck disability measured using the Neck Disability Index (NDI) [Срок оценки: Baseline and after 2 weeks of treatment.]