Effect of dry needling on hamstring for mechanical neck pain in chronic seated postural strain: A randomized controlled trial

Title: EFFECT OF DRY NEEDLING ON HAMSTRING FOR MECHANICAL NECK PAIN IN CHRONIC SEATED POSTURAL STRAIN: A RANDOMIZED CONTROLLED TRIAL

Introduction: "Work-related musculoskeletal disorders" (WRMSD) encompass injuries or diseases linked to work-related risk factors, also known as overuse or repetitive strain injuries. Among computer users, neck pain is prevalent, with 43.3% reporting work-related neck pain (WRNP). Prolonged forward bending and static posture can lead to neck pain, decreased job satisfaction, hypertension, and symptoms in the shoulders, lower back, and knees. Forward head posture straightens the cervical spine, causing discomfort in the trapezius area. Long sitting times also contribute to hamstring tightness, which is associated with chronic neck pain. Decreased muscle flexibility reduces range of motion and affects motor control, leading to tight muscles compressing blood vessels and impairing function.

The superficial fascia, composed of loose connective tissue, contrasts with the deep fascia, which surrounds muscles, nerves, and organs with dense connective tissue. Fascia, now recognized as an active structure containing nerves, arteries, and contractile cells, plays a role in mechanical function and physiological activities. Muscle chains, like the superficial back line (SBL), connect fascia and muscles, aiding in postural support by maintaining upright extension and countering flexion. The hamstring, a major muscle in the SBL, can lead to posture issues like swayback or flat back when stressed. Dry needling, a technique for myofascial pain, uses a needle to target trigger points, stimulating pain suppression via A-delta fibers and encephalins.

Purpose: Studies on dry needling on the neck muscles for mechanical neck pain exist but there is limited research on the role of hamstring in individuals with mechanical neck pain. Hence the need arises.

Aim: To determine the effect of dry needling on hamstrings for mechanical neck pain in chronic seated postural strain.

Objective: To evaluate and compare the effect of dry needling with conventional physiotherapy and conventional physiotherapy for neck pain, pain pressure threshold and range of motion using visual analogue scale, pain catastrophizing scale, algometer and goniometer respectively.

INCLUSION CRITERIA

• Participants aged between 25-40 years.

•      Participants willing to participate.

•      Consistently sitting for a minimum of 6 hours a day for at least 2 years

•      Neck pain > 3 months with VAS ≥ 3.

•      Hamstring tightness assessed with active knee extension test.

 EXCLUSION CRITERIA

•      Surgeries/fractures in the past 6 months at the spine, hip, knee

•      Taking medications for neck pain

•      Orofacial pain and temporomandibular disorders, tension type headache, migraine.

•      Systemic diseases such as fibromyalgia, systemic erythematous lupus, and psoriatic arthritis.

•      Pregnancy, infection, sensitivity to metals, allergies, bleeding disorders.

OUTCOME MEASURES

vVisual Analogue Scale

vPain Catastrophizing Scale

vNeck Disability Index

vPain Pressure Threshold

vNeck Range of Motion

vActive knee extension test: with a lag of 200 from full extension**.**

PROCEDURE

Group 1: The participants will receive conventional physiotherapy for 30 mins. It will include hot moist pack for 10 mins , neck isometrics, stretching and active cervical range of motion exercise. They will receive 6 sessions and each session will be for 30-40 mins for 2 weeks.

Group 2: The participants will receive  dry needling on hamstring muscle along with conventional physiotherapy .  They will receive 6 sessions and each session will be for 30 mins for 2 weeks.

After 6 sessions pre and post data will be collected tabulated and analysed.