Acute effects of transcutaneous electrical nerve stimulation on passive muscle stiffness and pain in patients with neck pain: a parallel-group randomised controlled trial

Year 2026, Volume: 7 Issue: 2, 408 - 414, 27.03.2026

Gökhan Yağız , Sena Adanır , Esedullah Akaras , Julian Owen , Aybike Şenel , Ahmet Emre Paksoy

https://izlik.org/JA87CH87DH

Abstract

Aims: Neck pain is a prevalent complaint often accompanied by increased cervical muscle stiffness. The aim of this study was to assess the immediate effects of transcutaneous electrical nerve stimulation (TENS), which is widely used for analgesia, on passive muscle stiffness and pain.
Methods: This randomised controlled trial was conducted according to CONSORT 2025 guidelines. Twenty-four adults (16 females, 8 males) with neck pain were randomly allocated to either the intervention group (IG) (n=12) or the control group (CG) (n=12). The IG received 20 minutes of bilateral TENS to the upper back and cervical region; the CG remained inactive for the same duration. The level of self-reported neck pain was measured using the Visual Analogue Scale (VAS). Muscle stiffness in the upper, middle, and lower trapezius, sternocleidomastoid (SCM), and cervical extensors was assessed with MyotonPro immediately before and after the intervention.
Results: The IG demonstrated significantly greater pain reduction than the CG (change in VAS:-2.83±0.58 vs -0.08±0.29; p<0.001). For muscle stiffness, the IG showed markedly larger decreases than the CG in the lower trapezius (-40.67±25.22 vs -5.17±8.00; p<0.001) and in the SCM (-29.42±18.03 vs -2.28±7.59; p<0.001). Changes in the middle trapezius (p=0.054) and cervical extensor (p=0.072), upper trapezius changes were not significant (p=0.846). Stiffness reductions in the SCM (r=0.722, R²=0.521) and lower trapezius (r=0.681, R²=0.464) strongly predicted pain improvement. Changes in the lower trapezius and SCM stiffness together explained 66.1% of the variance in pain reduction (p<0.001).
Conclusion: A single TENS session provides immediate pain relief and reduces stiffness of the SCM and lower trapezius.

Keywords

Neuromodulation , myofascial biomechanics , electrophysical agents , sensorimotor regulation , superficial tissue viscoelasticity

References

• Wu A-M, Cross M, Elliott JM, et al. Global, regional, and national burden of neck pain, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(3):e142-e155. doi:10.1016/S2665-9913(23)00321-1
• Taş S, Korkusuz F, Erden Z. Neck muscle stiffness in participants with and without chronic neck pain: a shear-wave elastography study. J Manipulative Physiol Ther. 2018;41(7):580-588. doi:10.1016/j.jmpt.2018. 01.007
• Analay Akbaba Y, Özdemir AE, Bali K, Yalçın E. Immediate effects of mobilization with movement technique on cervical muscle stiffness, pain, and range of motion in individuals with mechanical neck pain: a double-blind randomized controlled trial. Physiother Theory Pract. 2025;41(9):1783-1794. doi:10.1080/09593985.2025.2473471
• Opara M, Kozinc Ž. Which muscles exhibit increased stiffness in people with chronic neck pain? A systematic review with meta-analysis. Front Sports Act Living. 2023;5:1172514. doi:10.3389/fspor.2023.1172514
• Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022;12(2):e051073. doi:10. 1136/bmjopen-2021-051073
• Bilston LE, Bolsterlee B, Nordez A, Sinha S. Contemporary image-based methods for measuring passive mechanical properties of skeletal muscles in vivo. J Appl Physiol (1985). 2019;126(5):1454-1464. doi:10. 1152/japplphysiol.00672.2018
• Creze M, Nordez A, Soubeyrand M, Rocher L, Maître X, Bellin MF. Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives. Skeletal Radiol. 2018;47(4):457-471. doi:10.1007/s00256-017-2843-y
• Barrett JM, Malakoutian M, Fels S, Brown SHM, Oxland TR. Muscle short-range stiffness behaves like a maxwell element, not a spring: implications for joint stability. PLoS One. 2024;19(8):e0307977. doi:10. 1371/journal.pone.0307977
• Wiegner AW, Watts RL. Elastic properties of muscles measured at the elbow in man: I. normal controls. J Neurol Neurosurg Psychiatry. 1986; 49(10):1171-1176. doi:10.1136/jnnp.49.10.1171
• Marcucci L, Reggiani C. Increase of resting muscle stiffness, a less considered component of age-related skeletal muscle impairment. Eur J Transl Myol. 2020;30(2):223-233. doi:10.4081/ejtm.2020.8982
• Mirbagheri MM, Tsao CC, Rymer WZ. Abnormal intrinsic and reflex stiffness related to impaired voluntary movement. Conf Proc IEEE Eng Med Biol Soc. 2004;2004:4680-4683. doi:10.1109/iembs.2004.1404296
• Thomson A. The relationship between musculoskeletal stiffness and lower limb injury in athletes: a systematic review. British J Sports Med. 2014;48(7):665. doi:10.1136/bjsports-2014-093494.280
• Manduca A, Bayly PJ, Ehman RL, et al. MR elastography: principles, guidelines, and terminology. Magn Reson Med. 2021;85(5):2377-2390. doi:10.1002/mrm.28627
• Bizzini M, Mannion AF. Reliability of a new, hand-held device for assessing skeletal muscle stiffness. Clin Biomech (Bristol). 2003;18(5): 459-461. doi:10.1016/s0268-0033(03)00042-1
• Schneider S, Peipsi A, Stokes M, Knicker A, Abeln V. Feasibility of monitoring muscle health in microgravity environments using Myoton technology. Med Biol Eng Comput. 2015;53(1):57-66. doi:10.1007/s11517-014-1211-5
• Hopewell S, Chan A-W, Collins GS, et al. CONSORT 2025 statement: updated guideline for reporting randomised trials. PLOS Med. 2025; 22(4):e1004587. doi:10.1371/journal.pmed.1004587
• Association WM. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053
• Cerezo-Téllez E, Torres-Lacomba M, Fuentes-Gallardo I, et al. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial. Pain. 2016;157(9):1905-1917. doi:10.1097/j.pain.0000000000000591
• Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409-415.
• Michalsen A, Traitteur H, Lüdtke R, et al. Yoga for chronic neck pain: a pilot randomized controlled clinical trial. J Pain. 2012;13(11):1122-1130. doi:10.1016/j.jpain.2012.08.004
• Taddei U, Matias A, Ribeiro F, Bus S, Sacco I. Effects of a foot strengthening program on foot muscle morphology and running mechanics: a proof-of-concept, single-blind randomized controlled trial. Phys Ther Sport. 2020;42:107-115. doi:10.1016/j.ptsp.2020.01.007
• Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-1160. doi:10.3758/brm.41.4.1149
• Ahmad I, Altaf Hussain S, Ur Rehman M, Deen N, Uddin F, Miran S. The effectiveness of myofascial release versus transcutaneous nerve stimulation in patients with calf muscle soreness. Rehman J Health Sci. 2025;7(1):57-61. doi:10.52442/rjhs.v7i1.401
• Martimbianco ALC, Porfírio GJ, Pacheco RL, Torloni MR, Riera R. Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain. Cochrane Database Syst Rev. 2019;12(12):Cd011927. doi:10.1002/ 14651858.CD011927.pub2
• Paolucci T, Agostini F, Paoloni M, et al. Efficacy of TENS in cervical pain syndromes: an umbrella review of systematic reviews. Applied Sciences. 2021;11(8):3423.
• Taş S, Yaşar Ü, Kaynak BA. Interrater and intrarater reliability of a handheld myotonometer in measuring mechanical properties of the neck and orofacial muscles. J Manipulative Physiol Ther. 2021;44(1):42-48. doi:10.1016/j.jmpt.2020.08.002
• Trybulski R, Kużdżał A, Wilk M, Więckowski J, Fostiak K, Muracki J. Reliability of MyotonPro in measuring the biomechanical properties of the quadriceps femoris muscle in people with different levels and types of motor preparation. Front Sports Act Living. 2024;6:1453730. doi:10. 3389/fspor.2024.1453730
• Patel P, Green M, Tram J, et al. Latest advancements in transcutaneous electrical nerve stimulation (TENS) and electronic muscle stimulation (EMS): revisiting an established therapy with new possibilities. J Pain Res. 2025;18:137-153. doi:10.2147/JPR.S493162
• Travell J, Rinzler SH, Herman MN. Pain and disability of the shoulder and arm: treatment by intramuscular infiltration with procaine hydrochloride. JAMA. 1942;120:417-422.
• Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol. 1991;69(5):683-694. doi:10. 1139/y91-102
• Murray GM, Sessle BJ. Pain-sensorimotor interactions: new perspectives and a new model. Neurobiol Pain. 2024;15:100150. doi:10.1016/j.ynpai. 2024.100150
• Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther. 2017;47(7):A1–A83. doi:10.2519/jospt.2017.0302
• Dieterich AV, Yavuz U, Petzke F, Nordez A, Falla D. Neck muscle stiffness measured with shear wave elastography in women with chronic nonspecific neck pain. J Orthop Sports Phys Ther. 2020;50(4):179-188. doi:10.2519/jospt.2020.8821
• Haueise A, Le Sant G, Eisele-Metzger A, Dieterich AV. Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography. Clin Physiol Funct Imaging. 2024;44(3):187-204. doi:10.1111/cpf.12870
• Lederer AK, Maly C, Weinert T, Huber R. Tissue stiffness is not related to pain experience: an individually controlled study in patients with chronic neck and back pain. Evid Based Complement Alternat Med. 2019;2019:1907168. doi:10.1155/2019/1907168
• Ramezani E, Velayati M, Akbari M, Salehi R, Mohsenifar H. Neck muscle stiffness during craniocervical flexion under functional upper extremity conditions in patients with chronic non-specific neck pain: a shear-wave elastography study. Musculoskelet Sci Pract. 2024;74:103203. doi:10.1016/j.msksp.2024.103203
• Kocur P, Wilski M, Lewandowski J, Łochyński D. Female office workers with moderate neck pain have increased anterior positioning of the cervical spine and stiffness of upper trapezius myofascial tissue in sitting posture. Pmr. 2019;11(5):476-482. doi:10.1016/j.pmrj.2018.07.002
• Ley CD, Valdes EM, Murtagh CF, Power J, Nobes L, Drust B. MyotonPRO is not comparable to shear wave elastography in the measurement of rectus femoris muscle stiffness due to interference of subcutaneous adipose tissue. Scand J Med Sci Sports. 2025;35(8):e70095. doi:10.1111/sms.70095