Comparative Evaluation of Effectiveness of Percutaneous Electrical Nerve Stimulation (PENS) and Dry Needling on ph of trigger point, Pain Pressure Threshold and Quality of Life as against Conventional Treatment in patients with Levator Scapulae Trigger Point in Medical Professionals: A Three Arm Parallel Study

Myofascial pain, which is brought on by myofascial trigger points, is a typical source of musculoskeletal pain (MTrPs). Myofascial pain symptoms are caused by MTrPs, which are described as excruciatingly sensitive places in discrete taut bands of stiffened muscle. MTrPs can be deactivated by manual methods, spray and stretch, and trigger point needling. When necessary, MTrPs inactivation may be supplemented with ergonomic guidance, active workouts, posture correction, and relaxation. Rarely do comprehensive assessments of the effectiveness of conservative therapies in individuals with neck pain include the treatment of MTrPs. Although well-designed controlled studies are lacking, a few of case studies have suggested that treating MTrPs in patients with neck discomfort may be useful.

Chronic nerve pain, including headaches and post-operative pain, is also treated using percutaneous electrical nerve stimulation (PENS) which is a skilled technique where electrical stimulation is applied via small needles which penetrate the skin.

Intra muscular manual therapy or Dry Needling (DN) is an adept intervention used by physical therapists that treats neuromusculoskeletal pain and mobility problems by inserting a small filiform needle into the skin and stimulating the underlying myofascial trigger points, muscles, and connective tissues.

Trigger points have the potential to refer pain to far-off areas of the body. To release/inactivate the trigger points and alleviate pain, physical therapists use Dry Needling. Dry Needling, according to preliminary study, enhances pain management, lessens muscular tension, normalizes biochemical and electrical dysfunction of motor endplates, and speeds up the transition back to active rehabilitation.

There is limited evidence that compare the efficacy of the two therapy modalities, even though all the above-mentioned procedures are successful in managing myofascial pain. As a result, this study proposes to compare the effects of Percutaneous Electrical Stimulation and Dry Needling in the Management of Levator scapulae Trigger point in Dental Students.

After the ethical clearance from the University, participants with chronic neck pain with myofascial trigger point in Levator scapulae muscle will be recruited from Physiotherapy OPD of Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha and OPD of Ravi Nair Physiotherapy College, Salod, Wardha. Once given consent and assent, these participants will be divided into two groups by simple random sampling by chit method.

All the patients will be initially questioned about age, gender, and duration of pain. Then all subjects will be evaluated for ph of trigger point, Pain Pressure threshold and Quality of life method will be used on session 1 pre-treatment and on session 9 post-treatment.

The treatment procedure will be conducted 3 times a week excluding weekends, for total of 9 sessions for 15-20 mins per session.

 **GROUP A:**In the group A, Percutaneous electrical nerve stimulation will then applied to the trigger point in Levator scapulae muscle. Patient will be in prone position lying with both arm in abduction and head resting over the hands to relax the muscle that enables easy palpation of the muscle bulk. Head will be in neutral position. The needle of 40-50mm will be inserted. The needle Probe were connected to the alligator electrodes, with each lead connected to one positive and one negative probe. The leads were connected to the electrical generator with frequency of 15Hz and 30 Hz. After the treatment session, stretching to the Levator scapulae muscle and icing will be given to avoid muscle soreness.

  **GROUP B:**In the group A, Dry Needling will then applied to the trigger point in Levator scapulae muscle. Patient will be in prone position lying with both arm in abduction and head resting over the hands to relax the muscle that enables easy palpation of the muscle bulk. Head will be in neutral position. The needle of 40-50mm will be inserted. The patient will be aware that Levator scapulae muscle will respond strongly and strong twitch response will be felt. After the treatment session, stretching to the Levator scapulae muscle and icing will be given to avoid muscle soreness.

 Patient will be advised not to take any analgesics during the treatment session. The pre and post treatment ph of Trigger point, Pain Pressure Threshold and Quality of Life measurements will be analyzed statistically.