Abstract
________________________________________________________________________________ A comparative study on the adequacy of transcutaneous electrical nerve stimulation and traction devices in patients with cervical spondylosis. Eiman Saeida Saleh A*1, Azeezah Jumma Abdulsamia 2* *1 Department of physiotherapy, Faculty of Medical Technology, Tripoli University Libya. 2*Department of physiotherapy, Faculty of Medical Technology, Tripoli University, Libya. *Corresponding author: E-mail addresses: dreimanelhawat@gmail.com Volume : 2 Issue: 1 Page Number: 48 - 62 Keywords: Cervical Spondylosis, Transcutaneous Electrical Nerve Stimulation ABSTRACT Background: This paper was planned to assess and compare the adequacy of t ranscutaneous electrical nerve incitement (TENS) and footing gadget in quiet wi th cervical spondylosis for diminishes torment concentrated and Increments run o f movement cervical spondylosis. Strategies: Six of females' members with neck torment was arbitrarily apportioned to two bunches, treated with either TENS (n = 6) or fake treatment (n = 6). These patients were chosen from the outpatient of Tripoli therapeutic center healing centerin Tripoli. Patients were isolated arbitrar ily by basically strategy into break even with group's number. Bunch A - compris e of 3 subjects with cervical spondylosis who will be given restorative cervical f ooting and physical treatment program (Manual rub, Works out) for 3 sessions – weeks for 4weeks.Group B - comprise of 3 subjects with cervical spondylosis w ho will be given restorative transcutaneous electrical nerve incitement (TENS) a nd physical treatment program (Manual knead, Works out) for 3 sessions – week s for 4 weeks. Gather A and Gather B subjects will be compared to know which t reatment is more successful. Results: The evaluations were compared and utiliz ed to degree result treatment. Advancement in their condition was measured in te rms of a lessening within the individual's level of torment amid the week after th e conclusion of the primary session there was a significant difference between be fore and after treatment for left ROM because the mean value of pre-treatment w as (40) and post-treatment was (43.3) where the percentage improvement was (9 6, 29%). There was a significant difference between before and after treatment f or right ROM rotation because the mean value of pre-treatment was (43.3) and p ost-treatment was (70) where the percentage improvement was (95, 83%). Conclusions: Within the limitations of the study, the following conclusion was t hat adding TENS therapy to a physical therapy program (manual massage, exerc ise) would be more effective in managing symptoms of osteoarthritis.Cervical v ertebrae, relieve neck and arm pain, reduce neck crippling, and improve equipme nt traction of activities of daily life. Licensed under a Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0). Received : 11\12\2023 Accepted: 20\12\2023 Published: 07\02\2024 https://doi.org/........../.........vxix.x xxx 49 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly 1. INTRODUCTION Spondylosis is characterized as an incendiary preparation happening basically because of disk degeneration around the a mphiarthrodial joint shaped by connecting vertebral bodies and the disk between them. Disk degeneration and advancem ent of spondylosis are portions of the ordinary maturing handle. Around 95% of individuals by age 65 have cervica l s pondylosis to a few degrees. The degeneration can inevitably compound and cause either compression of leaving cervica l spinal nerves or of the cervical spinal cord.(SR, 2000), Cervical spondylosis presents itself in three symptomatic sha pes neck Torment, cervical radiculopathy, and cervical myelopathy. Neck torment and cervical radiculopathy (nerve root inclusion) can be intense, sub-acute, or unremitting conditions. Cervical myelopathy is less visited within the spondylitis understanding and happens in more seasoned patients with indications such as neck, subscapular, or bear torment, cause d by shock sensations and deadness within the limits. Cervical myelopathy includes engine and reflex changes demonstr ative of a more unremitting condition and can in the long run result in spastic shortcoming and deadness of the limits, m isfortune of adroitness, spastic walk, dorsal column work misfortune, and difficult bracket. These unremitting indication s can inevitably have gotten to be lasting with the destitute forecast. (Shedid, 2007), The re are different treatment altern atives utilized to treat neck torment, for case, warm, rub, control, cervical footing and supply of a cervical collar due to musculoskeletal disarranges. Among them, transcutaneous electrical nerve incitement (TENS) is broadly accessible in W estern constant torment clinics. Subjects may encounter a little help from torment from these modalities but this advance ment is seldom supported, since subjects as often as possible return to the doctors without the issue illuminated. There w ould hence show up to be a requirement for a implies of controlling incessant neck torment (Barlas P &Ting SLH, 2006) . TENS could be a basic, noninvasive methodology in physiotherapy that's commonly utilized to control both intense an d inveterate torment emerging from a few conditions. It was presented into clinical hone in 1972 as an aide to other torm ent treatments. The component of the activity of TENS is still not caught on. The absence of pain may be delivered by th e tweak of nociceptive input in the dorsal horn of the spinal cord by peripheral electrical incitement of expansive tactile afferent nerves. This can be the 'gate control theory' of torment. On the other hand, electrical incitement of certain recept or destinations within the dorsal horn of the spinal line may discharge endorphin, in turn, creating an absence of pain tha t can be turned around by naloxone (Johnson M. 2002). A few things about inspecting the adequacy of TENS in muscul oskeletal disarranges have been distributed. Since the 1970s, TENS has been picked up ubiquity and utilized as a treatm ent of intense and persistent torment (Osiri M &Welch V, 2004) transcutaneous electrical nerve incitement now is one of the foremost commonly utilized shapes of electro absence of pain. In medicine, TENS is the foremost habitually utilized electrotherapy for creating torment help (Itoh K &Itoh S, Katsumi Y, 2009). Many clinical ponders exist concerning the utilisation of TENS for different sorts of disarranges such as moo back torment, Myofascia l and joint torment, thoughtfu lly interceded torment, bladder incontinence, neurogenic torment, visceral torment, postsurgical torment, constant muscu loskeletal pain. The chief advantage is that it may be a non-invasive and nontoxic frame of torment administration, whic h is based, in portion, on the Door Control Hypothesis of torment. It is thought to enact the huge distance across, myelin ated A-beta strands which have a moo limit for electrical incitement (Johnson M. 2002), (Osiri M &Welch V, 2004). The major hazard figure that contributes to the onset of cervical spondylosis is maturing. A few intense and inveterate indicat ions can happen, that begin with neck torment and may advance into cervical radiculopathy. It is exceptionally common in individuals over 50 a long time of age and those who have a history of injury and who ought to do work like writing o r people who need to keep their neck in one position as in perusing, composing and other table works. The locale of torm ent depends on the location where the cervical spine is influenced by the pathology in upper cervical spine-headache, mi d-cervical spine-neck torment and Region from C4 toT2- transmitting torment in bear and arm either one-sided or two-s ided. (TENS) could be a commonly utilized non-pharmacologic and noninvasive treatment for torment. The utilize of el ectric current created by a gadget to fortify the nerves for restorative purposes. The unit is more often than not associate d with the skin utilizing two or more anodes (Robinson &Mackler, 2007). Cervical footing treatment alludes to any thera peutic strategy that applies drive along the inferior-superior hub of the spine to expand the cervical spine vertebrae. Its r eason is frequently to rectify the back, to calm weight on the spine and to extend the bloodstream to the harmed region. For decades, footing treatment has been broadly utilized in nonsurgical treatments and recovery to treat persistent neck t orment caused by herniated circles and other wounds at the cervical spine region (Savva C, 2013). The Cervical Spine N eck is a portion of a long adaptable column, known as the spinal column or spine, which amplifies through most of the b ody. It is composed of vertebrae that start within the upper middle and conclude at the base of the cranium. The neck bac ks the weight of the head and ensures the nerves that carry tangible and engine data from the brain down to the rest of th e body. In expansion, the neck is exceedingly adaptable and permits the head to turn and flex in all headings. (Dr Edwar d Crowther, 2010), (figure1). 50 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly Figure 1- The bones of the cervical spine. Numerous therapies are available to address neck discomfort, including cervical traction, heat therapy, manipulation, massage, and cervical collars for musculoskeletal conditions. Transcutaneous electrical nerve stimulation is one of Western chronic pain clinics' most widely utilised therapies (TENS) therapies. While some pain relief may be obtained with these therapies, it is usually just brief, and patients typically return to doctors with the same issue. Thus, a more potent method of managing persistent neck discomfort is required. TENS is a popular non-invasive physiotherapy technique for managing both acute and chronic pain from a range of illnesses. It was initially made available in 1972 as a supplement to conventional painkillers. TENS's mode of operation still needs to be better understood. According to the "gate control theory" of pain, analgesia may be brought on by peripheral electrical stimulation of big senso ry afferent neurons, which modifies nociceptive information in the spinal cord's dorsal horn. On the other hand, endorphins, which cause analgesia that may be counteracted by naloxone, may be released by electrical stimulation of certain receptor sites in the spinal cord's dorsal horn (Johnson M. 2002). 2. METHOD Subjects Outpatients with neck pain were recruited from the Applied Health Sciences Physiotherapy Laboratory of Jordan Univ ersity of Science and Technology. Subjects were clinically and radiologically diagnosed with neck pain due to a muscul oskeletal disorder. Other inclusion criteria for the study were ages 20 to 75, and neck pain that persisted most days of th e past month. Subjects received no treatment for neck pain other than oral analgesics for one week after the end of the fi rst course of treatment. In addition, the subject received no prior TENS treatment. Patients were excluded if they had any of the following: with pacemakers, as TENS electromagnetic pulses can inhibit activity; have a history of malignancy, which may be the cause of the current bone pain. On arrival at the ward, the stud y was explained to eligible subjects with neck pain and written informed consent was obtained and allowed to participat e in individual subjects. According to the block randomization table (generated by sample size 2.0 Int), registered subjec ts were allocated to either the TENS group or the placebo group. This study was conducted to investigate The effect of T ENS and traction devices in patients with cervical spondylosis for reducing pain intensity, and increased range of motio n and comparison of the outcomes of the 2 groups. Study Duration: An experimental study was conducted at the outpatient Tripoli Medical Centre Hospital in Tripoli, Libya between Oct ober 2017 and January 2018. The study involved six female patients who were selected from the hospital's outpatient department. 51 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly The patients were divided randomly into two groups of three each. Group A consisted of subjects with cervical spond ylosis who received therapeutic cervical traction and a physical therapy program (manual massage and exercises) for t hree sessions per week over four weeks. Group B consisted of subjects with cervical spondylosis who received therap eutic transcutaneous electrical nerve stimulation (TENS) and a physical therapy program (manual massage and exerci ses) for three sessions per week over four weeks. The study aimed to compare the effectiveness of the two treatments. Instrument for treatment: · Transcutaneous electrical nerve stimulation (TENS). · Traction. Tools of study: Jell, oil, gloves, Libra, scale length. Sheets. Procedure: The pain intensity level was measured by visual analogue scale (VAS) and the range of motion of cervical Spain wa s measured by Goniometer. All these variables were measured during pretreatment and after 6 weeks of treatment in b oth groups. The measurements were taken and recorded. Instrument for evaluation: Range of Motion: Range of motion (ROM) is a description of how much movement exists at a joint. The most com mon way is by using a double-armed goniometer. (Luttgens,1997). Figure 2- double-armed goniometer. Visual analogue Scale: The Visual Analog Scale (VAS) is a tool used to measure the intensity level of pain. It consists of a 10cm line with two points at either end representing 'no pain' and 'pain as bad as it could be'. Patients are asked to mark the line corre sponding to their current level of pain. The distance measured from the 'no pain' marker to the marked point on the lin e gives a pain score out of 10. This method was first introduced by Scott in 1976.ore out of 10. This method was first introduced by Scott in 1976. Figure 3 - visual analogue Scale 52 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly Instrument for treatment: Transcutaneous electrical nerve stimulation (TENS Traction: Figure 4- Transcutaneous electrical nerve stimulation (TENS). Figure 5-traction device Treatment procedure: Selected physical therapy program: Manual massage: The Application of an accurately determined and specifically directed manual force to the body, in order to improve mobility in areas that are restricted; in joints, in connective tissues or in skeletal muscles. Figure 6- Application Manual massage Exercises: 1- Static stretching: - Are held for a predetermined length of time and can be classed as maintenance or developmental. Maintenance stretches are held for 10 to 20 seconds. Figure 7 -static stretching Figure8- Rotation of the neck 53 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly 2- Strengthening exercises: - Isometric Neck Exercises apply enough resistance with hands without head move and hold for at least 5 seconds per exercise. Mechanical Traction: Applied 7% of the body weight for 10 min. The program has been applied to the patients for 3 weeks. The Physiotherap y treatment were given three sessions per week. Figure 9- Application mechanical traction Figure 10 -Application of TENS TENS therapy: TENS current was delivered by means of two carbon electrodes one electrode Para vertebral on the main pain spot, the o ther electrode laterally reversed on the opposite side in the irradiating pain area with parameters of (pulse width Frequen cy: 5Hz Intensity: high Pulse duration: 300 Micro sec. Duration: 20 minutes, 3 sessions/week over upper trapezium muscle. Data analysis: The following statistical procedure was performed as the following descriptive statistic including mean and percentage difference after treatment and data compared with before treatment. 3. RESULT General characteristics of the subjects: In this study, the women of 6 cervical spondylosis patients were divided into two equal groups. Pain intensity and range of motion from the cervical reading for each patient were recorded and tabulated in the measurement instrument (table 1). Table 1: General characteristics of patients in both groups (A and B) Cases information Group A patients Height Age Sex Weight Patient 1 1.67 48 Female 95 Patient 2 1.60 52 Female 67 Patient 3 1.70 48 Female 85 Group B Patient 1 1.70 52 Female 82 Patient 2 1.65 47 Female 67 Patient 3 1.59 61 Female 79 54 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly Pain intensity Table 2- Shows pretest and posttest pain scales for (group A) The figure below represents the values and scores that have been analyzed in diagrams showing the difference between the values pain intensity pre and post treatment. Figure 2: The difference between pre and post pain scale for (group A) Flexion and Extension of cervical: Table 3- Shows pre-test and post-test pain flexion and extension for (group A) Pain level intensity characteristics Pre treatment Post treatment Patient 1 8 1 Patient 2 8 2 Patient 3 9 2 Mean 8.3 2 Percentage 83.33% 16.66% Flexion and Extension of cervical Characteristics Pre treatment Post treatment ROM Flexion Extension Flexion Extension Patient 1 40 20 40 40 Patient2 45 20 45 40 Patient 3 15 45 45 45 Mean 33.3 28.3 43.3 41.6 Percentage 74% 62.9% 96% 92.5% 55 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly The figure below represents the values and scores analyzed in the diagram showing the difference between the Cervical and Enlarged values before and after the treatment. Figure 3: The difference between pre and post flexion and extension for (group A) ROM. Lateral Flexion for right and left side: Table 4- Shows pre-test and post-test ROM lateral flexion for right and left Side for (group A) Lateral Flexion Characteristics Pre treatment Post treatment ROM right left right Left Patient 1 20 40 40 45 Patient 2 20 40 40 45 Patient 3 30 45 45 45 Mean 23.3 41.6 41.6 45 Percentage 51.85% 92.59% 92.59% 100% The figures below represent the values and scores that have been analyzed in diagrams showing the difference between the values Lateral Flexion (R and L) of cervical pre and post treatment. Figure 4: The difference between pre and post ROM lateral flexion for right and left side for (group A). 56 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly ROM Rotation right and left side: Table 5- Shows pre-test and post-test ROM rotation right and left side for (Group A) ROM Rotation characteristics Pre treatment Post treatment ROM right left Right Left Patient 1 40 70 65 80 Patient 2 40 70 70 70 Patient 3 40 60 60 70 Mean 40 66.6 65 73.3 percentage 50% 83.33% 81.25% 91.66% The figure below represents the values and scores that have been analyzed in diagrams showing the difference between the values ROM Rotation R and L of cervical pre and post treatment. Figure 5: The difference between pre and post ROM lateral flexion for right and left side for (group A). In this research, there was a noteworthy distinction between some time recently and after treatment in torment concentrated since the cruel esteem of pre-treatment was and post-treatment (Binder AI, 2007) where the rate advancement was (16.66) %). There was a noteworthy contrast between pre-and post-treatment for flexion as the cruel of pre-treatment and post-treatment where the rate change was (96). %). In terms of examination, there was a noteworthy distinction between some time recently and after treatment to grow since the cruel esteem of pre-treatment (Binder Pet.al., 2000) and post-treatment where the rate enhancement is (92.5%). There was a noteworthy contrast between some time recently and after treatment for right ROM since the cruel esteem of pre-treatment and post-treatment where the rate advancement was (92.59%). Agreeing with the factual investigation, there was a noteworthy distinction between some time recently and after treatment for cleared out ROM since the cruel esteem of pre-treatment and post-treatment where the rate enhancement is (100 %). There was a critical distinction between some times recently and after treatment for right ROM turn since the cruel esteem of pretreatment was (40) and post-treatment where the rate advancement was (81.25%). There's a critical distinction between preprocessing and post-preparing for cleared-out ROM revolution since the cruel for preprocessing is (66.6) and for post-handling is (73.3) where the rate enhancement was (91.66%). (Garfin SR, 2000). 0 10 20 30 40 50 60 70 80 90 1 2 3 Pre - t - R- Rotation moveament pre - t - L - Rotation moveament Post - t - R - Rotation moveament Post - t -L - Rotation moveament 57 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly 4-3-Data analysis (Group B) TENS: pain intensity Table 6- Shows pre-test and post-test pain scales for (group B) Pain level intensity characteristics Pre treatment Post treatment Patient 1 9 2 Patient 2 9 2 Patient 3 4 0 Mean 7.33 1.33 percentage 73.33% 13.3% The figures below represent the values and scores that have been analyzed in diagrams showing the difference between the values pain intensity pre and post treatment. Figure 6: The difference between pre and post pain scale for (group B) Flexion and Extension of cervical: Table 7- Shows pre-test and post-test pain flexion and extension for (Group B) 0 1 2 3 4 5 6 7 8 9 10 1 2 3 Pre - t - pain intensity post - t - pain intensity Flexion and Extension of cervical characteristics Pre treatment Post treatment ROM Flexion Extension Flexion Extension Patient 1 30 25 40 45 Patient 2 15 45 45 45 Patient 3 35 40 45 45 Mean 26.6 36.6 43.3 45 percentage 59.25% 81.48% 96.29% 100% 58 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly The figures below represent the values and scores that have been analyzed in diagrams showing the difference between the values Flexion and Extension of cervical pre and post treatment . Figure 7: The difference between pre and post flexion and extension for (Group B) ROM. Lateral Flexion for right and left side: Table 8- Shows pre-test and post-test ROM lateral flexion for right and left side for (group B) Lateral Flexion characteristics Pre treatment Post treatment ROM right left Right left Patient 1 25 35 40 40 Patient 2 30 45 45 45 Patient 3 35 40 45 45 Mean 30 40 43.3 43.3 percentage 66.66% 88.88% 96.29% 96.29% The figure below represents the values and scores analyzed in the diagram showing the difference between the R and L lateral flexion values of the cervix before and after treatment. Figure 8: the difference between pre and post ROM lateral flexion for right and left side for (group B) 0 5 10 15 20 25 30 35 40 45 50 1 2 3 pre - t - Flexion moveament pre - t - Extension moveament post - t - Flexion moveament post - t - Extension moveament 0 5 10 15 20 25 30 35 40 45 50 1 2 3 pre - t - R- Lateral Flexion pre - t - L- Lateral Flexion Post - t - R- Lateral Flexion Post - t - L - Lateral Flexion 59 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly ROM Rotation right and left side: Table 9- Shows pre-test and post-test ROM rotation right and left side for (group B) The figure below represents the values and scores analyzed in the diagram showing the difference between the cervical R and L Rotary values of the cervix before and after treatment. Figure9: The difference between pre and post ROM rotation right and left side for (group B) Related to examination, there was a noteworthy contrast between some time recently and after treatment in torment concentrated since the cruel esteem of pre-treatment was (Hoppenfeld S.,2009) and post-treatment was where the enhancement rate was (Ozer AF. Et.al, 2009). ,3%). There was a critical contrast between pre-and post-treatment for flexion as the cruel esteem of pre-treatment was and post-treatment was (43. Barlas P. et.al., 2006) where the rate change was (96.29%). Agreeing with the information investigation, there was a noteworthy contrast between pre-and posttreatment to expand since the cruel of pre-treatment and post-treatment was where the rate change was (100%). There was a critical contrast between some time recently and after treatment for right ROM since the cruel esteem of pretreatment and post-treatment was where the rate enhancement was (96, 29%). According to statistical analysis, there was a significant difference between before and after treatment for left ROM because the mean value of pre -treatment was (40) and post-treatment was (43.3) where the percentage improvement was (96, 29%). There was a significant difference between before and after treatment for right ROM rotation because the mean value of pre -treatment was (43.3) and posttreatment was (70) where the percentage improvement was (95, 83%). 0 10 20 30 40 50 60 70 80 90 1 2 3 pre - t- R-Rotation moveament pre - t- L-Rotation moveament Post - t- R-Rotation moveament Post - t- L-Rotation moveament Rotation characteristics Pre treatment Post treatment ROM right left Right left Patient 1 35 65 60 70 Patient 2 50 70 80 80 Patient 3 45 65 70 80 Mean 43.3 66.6 70 76.6 percentage 54.16% 83.33% 87.5% 95.83% 60 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly 4-4 The compression between two groups: Table 10- compression between two groups Figure 18: shows compression between two groups From analysis, there was a significant difference between group A using the traction treatment and group B using the TENS treatment in pain intensity when the mean value for group A was (Binder AI., 2007) and that of group B. There was a significant difference between group A using the traction treatment and group B using the TENS treatment for bending because the mean value of group A was and that of group B was. From data analysis, there was a significant difference between group A using the traction treatment and group B using the TENS treatment in pain intensity when the mean value for group A was and that of group B. There was a significant difference between group A using the traction treatment and group B using the TENS treatment for bending because the mean values of group A were and those of group B were (Tetreault L &Goldstein CL et.al, 2015). From investigation, there was a noteworthy contrast between bunch A utilizing the footing treatment and gather B utilizing the TENS treatment in torment escalated when the cruel esteemfor bunch A was which of bunch B was. There was a noteworthy distinction between gatherA utilizing the footing treatment and gather B utilizing the TENS treatment for twisting since the cruel esteem of group A which of gather B . According to statistical analysis, there was a significant difference between group A using the traction treatment and group B using the TENS treatment for stretching because the mean value of group A and after treatment. There was a significant difference between group A using the traction treatment and group B using the TENS treatment for the right ROM because the mean value of group A was and that of group B. There was a significant difference between group A using traction treatment and group B using TENS treatment for left ROM because the mean value of group A and group B. There is a significant difference between group A using traction processing and group B using TENS processing to rotate the right ROM because the mean value of group A is and that of group B (Osiri M et.al., 2004). Variable Group A Group B Pain 2 1.33 Flexion 43.3 43.3 Extension 41.6 45 ROM Lateral Flexion R 41.6 43.3 ROM Lateral Flexion L 50 43.3 ROM Rotation R 65 70 61 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly 4. DISCUSSION The purpose of this study was to investigate and compare the efficacy of TENS and Traction devices in patients with cervical spondylosis for reduced pain intensity and increased range of motion of cervical. (Ross J, 2005). The results of the present study showed a decrease in pain intensity in both groups. This suggests the existence of a difference between scores of sessions before and after treatment, in patients in group B (who received TENS) after treatment sessions was 13.3%. On the other hand, the percentage of improvement was higher in group A (traction treated) at 16.66%. The application of a range of motion showed that there existed a difference between the pre-and post-treatment sessions for the movements (flexion, extension), (lateral flexion) and (rotation) right and left in the following sessions. Treatment of patients in group A, the improvement rate was (96%, 92.5%) respectively (right 96%, left 100%) (right 81.25%, left 91.66%), and for group B, the rate of improvement after the treatment session was 96.29%. 100% extensor, right flexion 96.29% left 96.29% right rotation 87.5% left 95.83% these results are explained in the table between them after the treatment sessions. In comparing the outcome of our experimental study in agreement with the (of Himanshi Sharma, and Nirali Patel,2014). Effectives of TENS versus intermittent cervical traction patients with cervical radiculopathy. Their results showed that TENS therapy was more effective than Traction Divac in patients with cervical spondylosis. 5. CONCLUSION Within the limitations of the study, the following conclusion was that adding TENS therapy to a physical therapy program (manual massage, exercise) would be more effective in managing symptoms of osteoarthritis. cervical vertebrae, relieve neck and arm pain, reduce neck crippling, and improve equipment traction of activities of daily life. 6. REFERENCES Akoury Gourang Sinha. principles and practice of Therapeutic Massage, second edition 2010. Binder AI. Cervical spondylosis and neck pain: clinical review. BMJ 2007:334:527. Barlas P, Ting SLH, Chesterton LS, Jones PW, Sim J. Effects of intensity of electro acupuncture upon experimental pain in healthy human volunteers: a randomized, double-blind, placebo-controlled study. Pain 2006;122(1):81-9. Edward Crowther, D.R.G., Gary Lee and Moez Rajwani, The Bone and Joint Decade Task Force on Neck Pain. The Inst itute for Work & Health (IWH), 2010: 33(4). Ferrara LA. The biomechanics of cervical spondylosis. Advances in orthopedics. Feb 1;2012 Garfin SR. Cervical degenerative disorders: Etiology, presentation, and imaging studies. Instr Course Lects, 2000; 49:355- 8. Hoppenfeld S. Surgical exposures in orthopedics: the anatomic approach, 4th ed. Lippincott Williams & Wilkins. Int J Rheum Dis. 2009;12(3):207-10. Itoh K, Itoh S, Katsumi Y, Kitakoji H. A pilot study on using acupuncture and transcutaneous electrical nerve stimulatio n to treat chronic non-specific low back pain. Complement There Clin Pract 2009;15(1):22-5. Johnson M. Transcutaneous electrical nerve stimulation (TENS). Electrotherapy 2002:259-86. Kalb S and Zaidi HA et.al. Associated with Spinal Cord Dysfunction and Imaging Characteristics of Spinal Cord Damage among Patients with Cervical Spondylosis. World Neurosurg: 2015; 84: 351-357. McCormick, W.E. et.al. Cervical spondylitis myelopathy: make the difficult diagnosis then refer for surgery. Cleve Clin J Med, 2003; 70:899–904. Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G. Transcutaneous electrical nerve stimulation f or knee osteoarthritis. Cochrane Database Syst Rev 20004:CD002823. 62 Derna Academy Journal for Applied Sciences (DAJAS) - Legal Filing Number (2023-133), Email: Jas@lad.edu.ly Ozer AF, Oktenoglu T and Cosar M, et al. Long-term follow-up after open window corpectomy in patients with advance d cervical spondylosis and/or ossification of the posterior longitudinal ligament. J Spinal Disorder Tech: 2009, 22(1):14 - 20. Philadelphia Panel. Evidence based clinical guidelines on selected rehabilitation interventions for n eck pain. P hys Ther e: 2001; 81:1701-17. Robinson, Andrew J and Lynn Snder-Mackler. clinical Electrophysiological Testing, 2007, Third edition: chapter 2, page 117. Ross J, Brant-Sawadzki M, Moore K, et al (2005). Diagnostic Imaging: Spine Amuses, pp. II:2:64-68. Savva, C. and Giakas, G. The Effect of Cervical Traction Combined with Neural2013: 18, 443-446. Shedid and E. C. Benzel “Cervical spondylosis anatomy: pathophysiology and biomechanics, “Neurosurgery, 2007: vol. 60, no. 1, supplement 1, pp. 7–13. Sluka KA (2008). The Neurobiology of pain and foundations for electrical Stimulation In: Robinson AJ, Snyder-Mackle r L, editors. Clinical Electrophysiology. Lippincott Williams & Wilkins; Philadelphia:2008. pp. 107–149. Tetreault L and Goldstein CL et.al. Degenerative Cervical Myelopathy: A Spectrum of Related Disorders Affecting the Aging Spine. Neurosurgery; 2015: 77 Suppl 4: S51-67.