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Research Article
Volume 1 Issue 1 - March 2017
DOI: 10.19080/JPFMTS.2017.01.555555
J Phy Fit Treatment & Sports
Copyright © All rights are reserved by Muhammad Atif Khan
Effects of Acupressure & TENS along with Hot Pack in
Neck Pain
Muhammad Atif Khan1*, Muhammad Asif2, Hira Islam Rajput3, Muhammad Azhar Mughal4, Khalid Aftab5 and
Muhammad Riaz Baig Chughtai6
1,2,3Isra Institute of Rehabilitation Sciences, Isra University, Pakistan
4,5Department of Pharmacology
Jinnah Sindh Medical University, Pakistan
6College of Physiotherapy, Jinnah Postgraduate Medical Centre, Pakisthan
Submission: March 08, 2017; Published: March 31, 2017
*Corresponding author: Muhammad Atif Khan, Assistant Professor, Isra Institute of Rehabilitation Sciences, Isra University, Karachi Campus,
Pakistan, E-Mail:
Introduction
The concept of Pain
International Association for the Study of Pain (IASP) as: “An
unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such
damage [1]. Neck pain is one of the most common musculoskeletal
disorders. The main feature of neck pain is pain in the cervical
J Phy Fit Treatment & Sportsl 1(1): JPFMTS.MS.ID.555555 (2017) 001
Abstract
Background: There are various therapeutic interventions to treat neck pain like rest, moist heat, cryotherapy, cervical collar, postural
education, neck exercises, strengthening exercises, ultrasound, TENS, IFT, SWD, US, PEME, EMS, cervical traction, cervical and thoracic spine
manipulation/mobilization, and acupressure. Manual therapy has been known to supplement and contribute to other medical specialties.
Apart from pain relief, TENS has been found to give rise to less pain interference with work, home and social activities, increased activity level
and pain management and decreased use of other therapies including pain medication. Acupressure is usually applied in the management of
pain, to balance body’s energy and to maintain good health. It decreases muscular tension, enhances circulation and promotes deep relaxation.
Acupressure also enhances body’s immunity and that ultimately promotes wellness. To determine the effects of acupressure and TENS along
with application of hot pack in neck pain.
Methodology
in the study. After taking informed consent from all the participants, the patients were randomly assigned into two groups, Group A and Group
B, 20 patients in each group.
i. Group A: TENS Group
ii. Group B: Acupressure Group
Both groups received interventions in 18 sessions over 6 weeks, 3 sessions per week. The pre-assessment was done at 1st day while post-
assessment was done at 6th week. Pre and Post treatment assessment parameters were taken through Numeric Rating Scale (NRS) and Neck
Disability Index (NDI) from both groups. NRS was used to measure the intensity of pain.
Results: Data was stored and analyzed through SPSS version 22.0, mean and standard deviation of the samples were estimated at pre and
post stage of study and to examined the effect of pre and post pain score paired sample t-test was used, p-value less than 0.05 were considered as
on pre and post pain score with p less than 0.01, the pre-treatment pain of Acupressure was 6.95 and TENS was 6.80. The post-treatment pain of
Acupressure was 3.60 and TENS was 5.0. Acupressure showed better effects in post pain score as compared to TENS.
Conclusion: At the end of 6th
compared to Acupressure i.e. Group A patients showed more improvement in post treatment than compare with Group B.
Keywords: Neck Pain; Pain; TENS; Acupressure; Neck Disability Index; Intensity; Numeric Rating Scale
Abbreviations: NRS: Numeric Rating Scale; NDI: Neck Disability Index; IASP: International Association for the Study of Pain; TENS:
Transcutaneous Electrical Nerve Stimulation
How to cite this article: Atif Khan M. Asif M, Rajput H I, Azhar Mughal M,Aftab K. Effects of Acupressure & TENS along with Hot Pack in Neck Pain. J
Phy Fit Treatment & Sports. 2017; 1(1): 555555. DOI: 10.19080/JPFMTS.2017.01.555555.
002
Journal of Physical Fitness, Medicine & Treatment in Sports
region which is often accompanied by other complaints as
restriction of the range of motion and/or functional limitations
[2]. Often the neck pain is precipitated or aggravated by neck
movements or sustained positions. Besides pain and stiffness,
symptoms as for example, headache, brachialgia or dizziness
may also be present. There is no conclusive evidence regarding
neck pain. The pain can originate from many structures in the
cervical region. Consequently, most cases are labelled as non-
gradually press key healing points, which stimulates the body’s
natural self-curative abilities. Acupressure was developed in
Asia over 5,000 years ago. Using the power and sensitivity of
the hand, Acupressure Therapy is effective in the relief of stress-
related ailments, and is ideal for self-treatment and preventive
health care for boosting the immune system. Acupressure
releases tension, increases circulation, reduces pain, and
develops spirituality and vibrant health [4]. Acupressure is a
noninvasive technique that may prove to be a useful adjunct
in the care of a wide variety of individuals with symptoms [5].
Acupressure points (also called potent points) are scattered on
the body that are especially sensitive to bioelectrical impulses
in the body and conduct those impulses readily. Traditionally,
Asian cultures perceived that acupoints are the junctions of
special pathways which are present in body that carried the
human energy. Chinese called this energy as “chi” whereas
Japanese called it as “ki”. The scientists have also mapped out
and proven the existence of this system of body points by using
sensitive electrical devices [6].
Stimulating these points with variable pressure triggers
the release of endorphins, which are the neurochemicals that
and oxygen to the affected area is increased. This causes the
muscles to relax and promotes healing. As acupressure inhibits
the pain signals sent to the brain through a mild, fairly painless
stimulation, it has been described as closing the “gates” of the
pain-signaling system, preventing painful sensations from
passing through the spinal cord to the brain [6]. Neck pain
is commonly associated with muscle spasm of musculature.
Acupressure is often successful in relieving neck pain [7]. Tender
points located on the trapezius muscles are consistent with local
acupuncture points such as “Jianjing” (GB 21), “Jianwaishu” (SI
14), and “Jianzhongshu” (SI 15) and are applied to massage
therapy in patients with chronic neck pain. On the other hand,
distal traditional acupuncture points, “Hegu” (LI 4), “Shousanli”
(LI 10), and “Quchi” (LI 11), are contained in the Large Intestine
Meridian of Hand-Yangming and are suggested to be the points
for improving neck-shoulder-arm disorders in the Chinese/
Japanese traditional medicine [8].
Acupressure alleviates wide range of conditions ranging from
immune ailments to emotional disorders. It is a complementary
treatment which effectively relieves diverse pain while
managing multiple symptoms in a variety of patient [9,10]. Both,
acupuncture and acupressure are effective, safe, simple and
economical therapies but acupressure is more easy and people-
compliant due to its non-invasive and needle free nature [11,12].
Acupressure is more compatible to pharmacotherapy due to ease
of self-administration. It plays a vital role in pain restoration,
promotion of psychological well-being as well as patients’
quality of life [13]. Those people who are not comfortable with
needles or when there is need of stimulating more delicate
acupoints, acupressure therapy is preferred. Acupressure
acupuncture with needle.
The best thing about acupressure is that it is safest, gentle
and emotional touch for promoting the wellbeing in human
population. From last few decades, CAM has fascinated the global
health practitioners as well as patients due to several reasons
including ease of application, effectiveness, economic aspects and
practiced throughout the world. Acupressure is a non-invasive
and non pharmacological intervention with multidimensional
traditional claims and validate use of acupressure for painless
treatment in numerous diseases. Present review appraised the
different patented devices and practices with applications in
the therapy of various acute and chronic ailments. With modern
devices, one can tune intensity of the pressure also. In addition
to pain-relief, acupressure devices offer generous advantage of
absence of drugs, and consequently, no after adverse effects. To
support acupressure (CAM) and to expand CAM therapies in the
near future and expand CAM therapies, we have to shed more
light upon therapeutic functionalities of acupressure and to
encourage its practice across the hospitals.
In the treatment of pain, Transcutaneous Electrical Nerve
Stimulation (TENS) has the advantage that it is easy to administer
- after instruction and a short trial period patients can apply
TENS themselves - and apart from (reversible) skin irritation
it has no serious side effects. TENS is a method of applying
low-voltage electrical current through the skin using surface
electrodes to achieve pain control [14]. The use of electricity
for pain control was documented in classical medicine by the
to treat a variety of diseases and pain [16]. After the interest in
electrical stimulation for pain control had dissipated in the early
part of the nineteenth century, a new interest in stimulation
emerged with the presentation of the gate control theory [17].
screening tool for spinal cord stimulation. Soon it became
1973 at the founding meeting of The International Association
for The Study of Pain [18]. Apart from pain relief, TENS has
How to cite this article: Atif Khan M. Asif M, Rajput H I, Azhar Mughal M,Aftab K. Effects of Acupressure & TENS along with Hot Pack in Neck Pain. J
Phy Fit Treatment & Sports. 2017; 1(1): 555555. DOI: 10.19080/JPFMTS.2017.01.555555.
003
Journal of Physical Fitness, Medicine & Treatment in Sports
also been found to give rise to less pain interference with work,
home and social activities, increased activity level and pain
management and decreased use of other therapies including
pain medication [19]. However the effects of TENS in chronic
pain still raise two important questions. Firstly, there are no
long-term placebo controlled studies and the results of short-
term controlled studies in the treatment of chronic pain are
assumed to decrease in time by long-term application of TENS
[13,16], thereby endangering the long term use of TENS in
chronic pain. The objective of this study was to determine the
effectiveness of acupressure and TENS along with hot pack in
neck pain.
Material and Methods
Total of 40 subjects were randomly assigned, 20 each to both
Group A (Acupressure group) and Group B (TENS Group) from
Mamji Hospital Karachi. The duration of the study was six months
from January 2016 to June 2016. Patients having neck pain from
six months were included in this study. In the questionnaire a
screening question was added that excluded those patients
who have neck pain less than 6 months, pregnancy, cervical
spine injections (steroidal) in past 2 week, any Cardiovascular
and Neurological disorders, history of previous cervical spine
surgery and patients who are taking any analgesic medication.
The informed consent was obtained from each subject and
the Ethical Clearance was obtained from the Central Ethical
committee of Isra University. Group A received acupressure with
hot pack. Group B received TENS with hot pack. Study continued
for 6 weeks and a total number of 18 treatment sessions were
given to each patient with 3 sessions per week on alternate days.
Patients followed up after completion of intervention.
Assessment of the patients was done at the beginning and at
the end of treatment. The Assessment was taken through NRS on
1st day and on 18th day as the study was for 18 days. Assessment
of all the participants was done as per the assessment form. The
intensity of pain was measured by Numeric Rating Scale. Group
A received the acupressure therapy with hot pack. Hot pack
was applied in supine lying for ten minutes. After that patient
sat comfortably, with close eyes and breathe when massaging
the active points. with three sets of acupressure by the pulp of
the thumb in a rotary fashion at 20–25 cycles per minute for
30 seconds on each point was administered at the GB 21, B10,
LI 4, GV 16, SI 14, and SI 15 consecutively. Group B received
the TENS with hot pack. Hot pack was applied in supine lying
for ten minutes. TENS was applied in prone position, pulsed
current with rectangular monophasic shape, pulse duration of
10-15 milliseconds with frequency of 40-70 Hz. The duration
of treatment was 20 minutes. t-test (paired) was used for intra
group comparison. The results were presented by using bar
charts and tables.
Results
The majority of participants for this study were males. The
mean age of Group B (TENS Group) was 28.60 years with the
standard deviation of 4.083. The mean of pain duration for this
group was 2.30 years and the standard deviation was 1.129. 6.80
mean of pain intensity with standard deviation of 1.005 was
found in TENS group, however, in the category of Neck Disability
Index (NDI), the mean of 26.20 with the standard deviation of
3.503 was found in (Pre-Treatment). Post Treatment of TENS
group two variables were found. The pain intensity showed
mean of 5.00 with the standard deviation of 1.170. However, the
Neck Disability Index showed the mean 19.50 and the standard
deviation of 2.875. In Acupressure Group (Pre-Treatment),
different variables were found the mean age of the participants
in this group was 27.95 years with the standard deviation
of 2.645. The mean of pain duration was 2.00 years with the
standard deviation was 0.973.
Pain intensity showed mean of 6.95 with standard deviation
of 0.945 was found in this group. However, in the category
of Neck Disability Index (NDI), the mean of 26.40 and the
standard deviation of 5.595 were found in Acupressure group
(Pre-Treatment). In Post-Treatment of Acupressure group, pain
intensity showed mean of 3.60 with the standard deviation of
1.046. However, the Neck Disability Index showed the mean 15.40
and the standard deviation of 2.257. In the comparison of Pre and
Post-Treatment among the TENS Group, mean of Pain intensity
in Pre-Treatment was 6.80 ±1.005, while in Post-Treatment it
was 5.00 ± 1.170 with the P-Value of 0.027. However, in Pre-
Treatment, the Neck Disability Index was 26.20 ± 3.503 and in
Post-Treatment, it was 19.50 ± 2.875 with the P-Value 0.002.
The comparison of Pre-Treatment and Post-Treatment among
the Acupressure Group, mean of Pain intensity in Pre-Treatment
was 6.95 ± 0.945, while in Post-Treatment it was 3.60 ± 1.046
with the P-Value of 0.001. However, in Pre-Treatment, the Neck
Disability Index was 26.40 ± 5.595 and in Post-Treatment, it was
15.40 ± 2.257 with the P-Value 0.001 (Tables 1 & 2), (Figures 1
& 2).
Table 1: TENS Group comparison.
Variable Pain Intensity Neck Disability Index
Pre-Treatment 6.80, ±1.005 26.20, ± 3.503
Post-Treatment 5.00, ±1.170 19.50, ± 2.875
P value 0.027 0.002
Table 2: Acupressure Group comparison.
Variable Pain Intensity Neck Disability Index
Pre-Treatment 6.95, ± 0.945 26.40, ± 5.595
Post-Treatment 3.60, ± 1.046 15.40, ± 2.257
P value 0.001 0.001
How to cite this article: Atif Khan M. Asif M, Rajput H I, Azhar Mughal M,Aftab K. Effects of Acupressure & TENS along with Hot Pack in Neck Pain. J
Phy Fit Treatment & Sports. 2017; 1(1): 555555. DOI: 10.19080/JPFMTS.2017.01.555555.
004
Journal of Physical Fitness, Medicine & Treatment in Sports
Figure 1: Bar chart showing TENS group comparison.
Figure 2: Accupressure group comparison.
Discussion
Neck pain is one of the conditions which can be treated
by a wide variety of Physical Therapy methods. Many studies
majority of researcher (84%) concluded that acupressure was
effective for pain management in adults. Most of these researchers
reported that acupressure did not have adverse effects [25].
alleviating low back pain than is physical therapy, as measured
by pain visual analogue scale, core outcome measures, Roland
and Morris disability questionnaire, and Oswestry disability
questionnaire [24]. The results of this study revealed that there
sessions within both groups. Both the groups obtained successful
Scale scores and Neck Disability Index. The results of this study
support the randomized controlled clinical trial of Hsieh LL on
low back pain treated by acupressure. Acupressure may thus
be useful for reducing pain and improving body’s function and
decreases level of disability in neck pain.
In most of the studies, different outcome measures were
used to distinguish the difference between the acupressure
group and the physical therapy group, irrespective of absolute
change or mean change from baseline at post-treatment and
six weeks follow-up assessments. The Roland and Morris
disability questionnaire has been considered an outcome
measure sensitive to changes in clinical status for the study of
low back pain [12,13]. In this study, results showed statistically
neck disability index. Results for the neck disability index score
also showed functional improvement with acupressure.
Roscoe et al. study results revealed that those patients who
treated by acupressure responded more positive effects than
those who treated by other physical therapy techniques [24].
However, Rosenberg et al. concluded that most of the chronic
pain patients treated with acupressure or alternative therapy in
addition to their traditional treatment. The traditional treatment
strategy was mostly preferred when given the option between
traditional treatment and alternative therapy [13]. Although in
our study, most of the patients preferred acupressure therapy
as compare to traditional treatment. Results showed most
effectiveness of acupressure in neck pain and increase the
functional activities of daily living. The results of this study
parameters of the pain-associated conditions and NDI whereas
reduces pain intensity and NDI. Satisfaction due to acupressure
continued until 1 day after treatment on the distal points as well
as the local points.
Conclusion
This study concluded that, individuals with neck pain who
received acupressure demonstrated better overall short-term
outcomes on Numeric Rating Scale compared to individuals
receiving TENS treatment. This study provides the clinicians with
further insight that manual techniques provide better effects as
individuals with chronic neck pain.
Acknowledgement
First of all I (M. Atif Khan) pay my thanks to almighty Allah
for giving me strength and determination to complete this work.
I pay my deepest gratitude to my supervisor Dr. Muhammad
Islam Rajput. Their vigilant supervision, encouragements,
positive criticism and guidance always acted as a beacon house
during my journey of learning and writing.
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How to cite this article: Atif Khan M. Asif M, Rajput H I, Azhar Mughal M,Aftab K. Effects of Acupressure & TENS along with Hot Pack in Neck Pain. J
Phy Fit Treatment & Sports. 2017; 1(1): 555555. DOI: 10.19080/JPFMTS.2017.01.555555.
005
Journal of Physical Fitness, Medicine & Treatment in Sports
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DOI:
10.19080/JPFMTS.2017.01.555555
