Effects of therapeutic exercise plus capacitive-resistive radiofrequency therapy and percutaneous ultrasound-guided neuromodulation on non-specific chronic neck pain.

Participants will only receive the assigned treatment; they may not combine treatment with medication or other physiotherapy treatment. Any interference with treatment will be grounds for exclusion. Group 1. RESISTIVE-CAPACITIVE RADIOFREQUENCY THERAPY AND THERAPEUTIC EXERCISE. The medical device to be used will be a Winback BACK1S. The data analysis will be independent of Winback and will be performed by Dr. Rodríguez Blanco, Cleofás. The device is a high frequency therapy device, registered and marketed exclusively by Winback, France and produced by Daeyang, South Korea, in accordance with 93/42/EEC under the number 1984-MDD-14- 108 314). The Back1S device used for the clinical study has 3 frequencies: 300KHz, 500KHz and 1MHz. Each frequency is supposed to allow targeting the depth of action: the lower the frequency, the deeper the action. Two frequencies (300 and 500 KHz) will be used during this study. The capacitive mode (CET) is an application mode that has a superficial action (2 to 3 cm) on soft tissues (high water content). The resistive (RET) is an application mode that allows to cross the total depth of the tissues and acts on all fibrous tissues (low water content). The dynamic function used within this protocol allows the device to automatically switch from 300 KHZ to 500 KHz frequency every 3 seconds. The device will be used with a power of 12 watts. The 60 mm diameter movable capacitive electrode and a 60 mm diameter movable resistive electrode will be used on the bilateral cervical paravertebral musculature from C0 to C7 and a planar electrode as a return electrode on the abdomen. The cream to be used is a conductive, conditioning and skin-preparing cream with no therapeutic effect. The dose to be used will be 5 ml which will be applied directly on the electrode and will then come into contact with the skin. The intervention will be administered by the principal investigator, a physiotherapist, and will be done as follows: with the patient in prone position; cream will be applied on the capacitive and resistive electrode and the electrical dose will be increased by moving the mobile electrode within the patient's tolerance level, while controlling the skin temperature tolerable for the patient. The therapy application time will be 10 minutes (5 minutes of application with the capacitive electrode and 5 minutes of application with the resistive electrode). The duration and frequency of administration of the capacitive-resistive radiofrequency therapy will be 10 minutes, one day a week during the 8 weeks of treatment. The administration of radiofrequency will be performed together with therapeutic exercises during the 8 weeks. Follow-up and adherence to treatment will be recorded in a Microsoft Excell template designed for the study. The day of treatment and the treatment performed will be noted. In the same way, a daily record will be kept in a Microsoft Excell template where the exercises performed by the patient will be noted and reported to us through the Whatsapp application. GROUP 2. THERAPY BY MEANS OF PERCUTANEOUS NEUROMODULATION AND THERAPEUTIC EXERCISE. The subjects in the second group will receive therapy by means of percutaneous ultrasound-guided percutaneous neuromodulation of the spinal nerve bilaterally. Using an Esaote Mylab Gamma ultrasound machine with a linear musculoskeletal probe and the patient in the supine position, the spinal nerve will be located in the anteroinferior area of the upper trapezius bilaterally. The intervention will be administered by the principal investigator, Physiotherapist. The physiotherapist will previously disinfect the area to be treated with chlorhexidine and the puncture will be performed with a 30X40mm acupuncture needle perpendicular to the right and left upper trapezius muscle, visualizing it in the ultrasound machine to avoid puncturing the pulmonary pleura. The needle tip will stop when it has contacted the epineurium of the accessory nerve. The needle will be the negative electrode. A second adhesive electrode will be placed 1 cm laterally to each of the negative electrodes. The parameters used will be set to low frequency (2 Hz) compensated symmetrical pulsed biphasic symmetrical pulsed current and a pulse width of 120 µs applied over a period of 10 minutes. The patient will be asked to indicate when the current intensity is tolerated and not painful. The administration of percutaneous neuromodulation therapy will be performed together with therapeutic exercises during the 8 weeks. The duration and frequency of administration of the percutaneous neuromodulation therapy will be 10 minutes, one day a week during the 8 weeks of treatment. Follow-up and adherence to treatment will be recorded in a Microsoft Excell template designed for the study. The day of treatment and the treatment performed will be noted. In the same way, a daily record will be kept in a Microsoft Excell template where the exercises performed by the patient will be noted and reported to us through the Whatsapp application. THERAPEUTIC EXERCISE. The three designated groups will perform the same TE sequence for 8 weeks. The physiotherapist will instruct the patient to perform them correctly. The first two weeks of therapeutic exercise will last 19 minutes, one session per week. The third and fourth week the duration will be 23 minutes, adding two more exercises, one session per week. From week 5 to week 8 the duration will be 25 minutes, when adding the last exercise, one session per week. It is detailed below. 1st and 2nd WEEK: exercises 1 and 2. 1. Craneocervical flexion (CCF) in supine position with a towel on the back of the neck, the patient is asked to push the towel (3 series, 10 repetitions, 8s of contraction each repetition and 8s of rest between repetitions, with 30 s of rest between series). 2. Sitting CCF (3 series, 10 repetitions, 8s of contraction each repetition and 8s of rest between repetitions, with 30s of rest between series). 3rd AND 4th WEEK: exercises 1, 2, 3 and 4. 3. Co-contraction of deep and superficial neck flexors in supine position (10 repetitions, 8 seconds of contraction with 8 seconds of rest between repetition). 4. Sitting. Flexors, rotators and co-contraction inclinations. The patient will perform craneal flexion, while the physiotherapist asks the patient to bend, turn and look to the same side while the same patient opposes a resistance with the hand (5 repetitions to the right and 5 repetitions to the leftalternatively, 8 seconds of contraction) 5th, 6th, 7th and 8th WEEK: exercises 1, 2, 3, 4 and 5. 5. Excentric for extensors. With the patient seated, he should perform a cervical extension, then he should perform a CCF and then finish doing a cervical flexion (10 repetitions, 8 seconds of contraction with 8 seconds of rest between repetition). Individuals with CNNP will be recruited through a text message broadcast on social networks in the province of Almeria (Andalusia - Spain) and will be selected based on the eligibility criteria listed below. The study will be conducted at the Fisiosur Physiotherapy Clinic facilities in the town of Garrucha (Almeria).