Mechanical neck pain is one of the most common musculoskeletal disorders among adults. It is characterized by pain and stiffness in the cervical region, often related to poor posture, repetitive movements, or prolonged sitting. The condition can lead to functional limitations and decreased quality of life.

This randomized controlled clinical trial aims to evaluate the effectiveness of dry needling therapy on pain intensity, cervical range of motion, and functional ability in patients with mechanical neck pain. Forty participants aged 25 - 65 years will be randomly assigned to two groups. Group A will receive dry needling combined with neck exercises, while Group B will receive transcutaneous electrical nerve stimulation (TENS), ultrasound, and the same neck exercise program. Both groups will undergo treatment three times per week for four weeks.

Primary outcomes include changes in the Neck Disability Index (NDI), pressure pain threshold (PPT) measured by algometer, and cervical range of motion (CROM). The study will determine whether dry needling provides superior clinical improvement compared with conventional electrotherapy and exercise.

Mechanical neck pain (MNP) affects a large proportion of adults between 25 and 65 years of age. It is commonly associated with sustained poor posture, repetitive movement, or prolonged sitting, leading to muscular tightness and joint stiffness in the cervical region. Patients typically present with pain, limited cervical mobility, and decreased ability to perform daily activities.

Dry needling is a minimally invasive technique that involves inserting fine monofilament needles into myofascial trigger points to reduce muscle tension, improve circulation, and alleviate pain. It is increasingly used in physiotherapy practice as a targeted intervention for musculoskeletal pain conditions. By releasing taut muscle bands, dry needling is believed to normalize muscle tone and restore normal movement patterns.

The current randomized controlled trial is designed to assess the effectiveness of dry needling combined with therapeutic exercise compared with conventional physiotherapy including TENS, ultrasound, and the same exercise regimen. Forty participants with mechanical neck pain will be randomly allocated into two equal groups (n = 20 per group).

Group A (Experimental): Dry needling will be applied to the upper trapezius and deltoid muscles under aseptic technique. Each needle will be inserted 5 - 10 mm deep and retained for approximately 30 seconds. This intervention will be combined with a neck exercise program consisting of chin-in exercises (3 sets × 10 repetitions, 5-second hold) and a muscle-energy technique for the upper trapezius (3 repetitions per side, 5 - 10 second holds).

Group B (Active Comparator): Participants will receive TENS at 80 - 100 Hz frequency, 100 µs pulse duration for 20 minutes, and pulsed ultrasound at 1 MHz, 1.0 - 1.5 W/cm² for 5 minutes. The same chin-in and muscle-energy exercise protocol will be applied.

Both groups will receive three sessions per week for four weeks. Assessments will include:

Pain and disability using the Neck Disability Index (NDI).

Pressure pain threshold (PPT) using a handheld algometer.

Cervical range of motion (CROM) using a cervical range-of-motion device.

Outcomes will be recorded at baseline and after four weeks of treatment. It is hypothesized that dry needling will produce greater reductions in pain and disability and larger improvements in cervical motion compared with conventional therapy.

Inclusion Criteria:

• Medically stable individuals who provide written informed consent to participate in the study.
• Age between 25 and 65 years.
• Both male and female participants.
• Patients diagnosed with mechanical neck pain lasting more than three months.
• Presence of myofascial trigger points in the upper trapezius or cervical muscles confirmed by palpation.
• Ability to follow treatment instructions and attend all scheduled sessions.

Exclusion Criteria:

• History of neck surgery or cervical spine fracture.
• Previous dry needling or invasive therapy for neck pain in the past six months.
• History of neurological disorders (e.g., cervical radiculopathy, myelopathy).
• Current acute infection, skin disease, or open wound in the neck or shoulder region.
• Use of anticoagulant medication or any bleeding disorder.
• Pregnancy or suspected pregnancy.
• Any systemic illness (e.g., diabetes mellitus, rheumatoid arthritis) that may affect healing or pain perception.

This is an open-label study. Both participants and care providers are aware of the assigned interventions due to the physical nature of the treatments.