Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials

Efficacy of dry needling with the fascial winding technique in reducing the percentage of surgery in carpal tunnel syndrome: A randomized clinical trial

INTRODUCTION

Numerous techniques for the treatment of carpal tunnel syndrome (CTS) have been described. The present study aims to determine the proportion of wrists with CTS in which the application of DN avoids surgery.

METHODS

An assessor-blind randomized clinical trial clinical trial was performed. Eighty-six wrists with diagnosis of mild or moderate CTS and indication for surgery were recruited from a hospital traumatology service. The intervention group was treated with DN, with a frequency of one session/week over six weeks, while the control group did not follow any specific treatment, remaining on the waiting list for the surgery. The main variable was the recommendation for surgery. Other secondary variables included changes in electromyography and ultrasound; intensity of pain; Boston Carpal Tunnel Syndrome Questionnaire (BCTQ); hand dynamometries; and possible adverse effects.

RESULTS

The wrists treated by DN had a reduced risk of needing surgery at 12 weeks by 62% compared to the control group (RR = 0.38, 95% CI[0.2-0.72]), with this value being significant (p-value = 0.003). This group also obtained a significant improvement in the intensity of pain (p-value = 0.006), and in the BCTQ-severity of syntoms scale and BCTQ-functional situation scale (p-value = 0.039 and p-value = 0.019 respectively). Statistical significance was not reached in the dynamometries performed, nor in the results of the electromyography and ultrasound studies. Adverse effects were infrequent or unimportant.

CONCLUSIONS

Application of DN to wrists with mild or moderate CTS reduces the need for surgery, and improves the clinical symptoms and functionality of the hand.

Dry Needling in Sports and Sport Recovery: A Systematic Review with an Evidence Gap Map

BACKGROUND

Dry needling is an increasingly popular technique used in sports and regenerative medicine contexts. However, there is no comprehensive overview of investigations of dry needling in sports and sport recovery.

OBJECTIVES

The objectives were to perform a systematic review of dry needling in sports athletes with an evidence gap map, to identify current gaps in the literature, and to provide stakeholders with direction for future research.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines were followed. Studies on healthy and injured athletes receiving dry needling were included. Three databases (PubMed, Scopus, and Web of Science) were searched, data were synthesized narratively, key data were summarized quantitatively, and an evidence gap map was created.

RESULTS

The authors incorporated 24 studies into the current study, encompassing 580 athletes, predominantly involving talent/developmental and highly trained/national-level athletes across 13 sports. Most studies used passive or placebo controls, with 37.5% incorporating active controls. Interventions focused mainly on the lower limbs (58.3%). Around 69% of studies reported pain perception outcomes, while six examined muscular strength, activity, and range of motion. While results varied, dry needling generally showed a more positive effect on pain than on athletic performance.

CONCLUSIONS

Dry needling studies seem to describe general effectiveness and safety for reducing pain and muscle stiffness in a wide variety of body regions. However, further research is needed on underrepresented populations such as elite, world-class, and Paralympic athletes, as well as expanding investigations into long-term effects and a broader range of muscle groups, particularly the hamstrings. The results may be valuable for medical professionals, sports medicine specialists, and researchers.

REGISTRATION

OSF project no.: osf.io osf.io/h3yeq.

Dry needling in multiple sclerosis: a scoping review

OBJECTIVE

Dry needling (DN) has recently been investigated as an alternative strategy to reduce muscle spasticity and improve mobility in people with multiple sclerosis (pwMS). The aim of the present review was to identify any available literature on the potential benefits of DN in pwMS.

METHODS

A systematic literature search was conducted in the PubMed, Scopus, ScienceDirect, Embase/Ovid, CINAHL, CENTRAL, Web of Science and PEDro databases and at ClinicalTrials.gov. The search results were limited to studies published between 2000 and 2023 without language restrictions. All articles reporting on the application of DN (defined as the use of a needle to target myofascial trigger point(s) without injection) in pwMS were included. Studies related to traditional medicine were excluded. Two reviewers independently investigated the quality of reporting based on Joanna Briggs Institute critical appraisal tools. Data on the effects of DN on muscle spasticity, pain intensity, mobility and other reported outcomes in pwMS were extracted and analyzed.

RESULTS

Four original articles (two case reports and two case series) and one conference paper reporting the findings of a randomized controlled trial randomized controlled trial (RCT) were included. The RCT was small (n = 16 participants) and sham-controlled with no significant differences between groups. In all four case reports/series, reduced spasticity was observed following DN treatment in pwMS. Findings with respect to other outcomes (including pain intensity, mobility, quality of life, manual dexterity and disability reduction) were mixed.

CONCLUSION

Although no firm conclusions can be drawn from these uncontrolled case reports/series, DN for pwMS appears feasible and (based on limited clinical observation) may have potential as an adjunct therapeutic method to address spasticity in pwMS. However, the quantity and quality of available data are extremely limited. There is a need for high-quality studies of DN (ideally adequately sized RCTs with a low risk of bias) to further explore its effectiveness in the MS population.

Prediction Model for Sciatic Nerve Procedures: A Cross-Sectional Study

Objectives: We aimed to create a predictive model to estimate sciatic nerve depth using anthropometric and demographic data to enhance safety and precession in needle-based interventions. Setting: The study was conducted at Universidad Europea de Madrid, Spain. Methods: A Cross-sectional observational study was carried out between January and April 2024. The study included fifty volunteers aged 18-45 years, without any muscle tone affections, lower limb asymmetries, or history of lower limb surgeries. Demographic and anthropometric data were collected, including sex, age, height, weight, BMI, and leg length measure and thigh circumference at specific points. The sciatic nerve depth was measured using ultrasound imaging under the gluteal fold and in the posterior middle third of the thigh. Results: Correlation analysis revealed significant associations between thigh circumference at the proximal and middle third and sciatic nerve depth. A multiple linear regression model identified that the proximal thigh circumference was a significant predictor of sciatic nerve depth, explaining 44.5% of the variance. The variance increased to 49.7% when gender was added. The depth of the sciatic nerve in the middle third explained 38.2% of the variance. And the inclusion of gender in the model explained 40.8% of the variance for the middle third. Conclusions: This study identify significant predictors such as the thigh girth at the proximal and mid-third levels, gender, and the BMI. These findings suggest that clinicians can use these anthropometric measurements to estimate sciatic nerve depth more accurately, reducing the risk of accidental nerve injury and improve the precision and safety of needling procedures during invasive procedures.

A Novel Therapeutic Approach Targeting Spinal Accessory and Dorsal Scapular Nerves for the Relief of Posterior Neck, Trapezius, and Interscapular Pain

Background/Objectives: Posterior neck, trapezius, and interscapular pain, exacerbated by poor posture such as forward head and rounded shoulders, is common. In this study, we aimed to assess the clinical outcomes of isotonic saline injections at nerve entrapment points (NEPs) within the sternocleidomastoid (SCM) and scalenus medius (SM) muscles for alleviating spinal accessory nerve (SAN) and dorsal scapular nerve (DSN) compression in patients suffering from posterior neck, trapezius, and interscapular pain. Methods: In this retrospective study, 68 patients were included, with 34 receiving isotonic saline injections and 34 undergoing Extracorporeal Shock Wave Therapy (ESWT) as a control. The clinical outcomes were evaluated using the Visual Analog Scale (VAS) and Percent Pain Intensity Difference (PPID) before and after therapy. The effectiveness of isotonic saline injections targeting NEPs in the SCM and SM muscles in relieving pain associated with SAN and DSN entrapment was assessed. Results: Both treatments significantly reduced VAS and PPID scores, with injection therapy showing a larger treatment effect size (Cohen's d: 3.521 for VAS and 3.521 for PPID) compared to ESWT (Cohen's d: 1.379 for VAS and 1.710 for PPID). The mean clinically important difference observed for VAS was 4.2, exceeding the expected value of 2.6, indicating a substantial improvement in pain and patient quality of life. Conclusions: Isotonic saline injections at the NEPs of SAN and DSN within the SCM and SM muscles might potentially reduce posterior neck, trapezius, and interscapular pain associated with possible nerve entrapment, without causing complications. Further research is needed to validate these findings in larger, controlled trials.

Effectiveness of deep dry needling combined with stretching for the treatment of pain in patients with myofascial trigger points: A systematic review and meta-analysis

OBJECTIVE

The combination of dry needling and stretching has been proposed for the treatment of myofascial trigger points (MTPs), but it is not currently known whether the combination of both interventions would be of greater interest than the application of stretching alone. Thus, this systematic review aimed to compare the effectiveness of deep dry needling with stretching versus stretching alone on pain among patients with MTPs.

METHODS

The PubMed, Web of Science, Cochrane Library, and Scopus databases were searched to identify studies analysing the effect of deep dry needling in combination with stretching versus stretching alone for the treatment of pain. The Cochrane risk of bias 2 tool (RoB2) was used to assess the risk of bias, and the DerSimonian‒Laird method was applied to estimate the pooled standard effect sizes (ESs) and their 95% confidence intervals (95% CIs).

RESULTS

Five randomized controlled trials were included in this systematic review, and their pooled ES for pain was -1.73 (95% CI: -3.06; -0.40). The RoB2 tool revealed that four studies had an unclear risk of bias, and one study had a high risk of bias.

CONCLUSIONS

Adding deep dry needling to stretching for the treatment of MTP may be an effective approach for the treatment of pain in patients with MTPs. Further research is needed to clarify the ideal number of local twitch responses to perform during deep dry needling.

A surge in queries: Analyzing the increased public interest in dry needling using Google trends - A cross-sectional observational study

BACKGROUND

To monitor public interest (PI) in information related to Dry needling (DN) therapy and examine potential temporal, seasonal, and income-related trends that may impact PI by using the relative search volume (RSV) from the Google Trends tool for the keyword "Dry Needling."

METHODS

For this cross-sectional observational study, a dataset was created using the Google Trends tool from 2004 to the present in the United States (US). To examine potential income-related disparities in PI in DN across the US, RSV values were recorded in the five states with the highest and the lowest median income (Maryland, New Hampshire, New Jersey, Utah, and Washington and Mississippi, West Virginia, Arkansas, New Mexico, Kentucky, respectively).

RESULTS

A linear regression model showed that the PI in DN increased significantly (R2 = 0,902, p < 0.001). There were no significant differences between the RSV values between the month of the year and the season of the year (p = 1.000 and p = 0.997, respectively). RSV values of the five highest-income and low-income states showed significant increases (R2 = 0,624, p < 0.001, and R2 = 0,477, p < 0.001, respectively). More rapid growth in interest in DN in states with high income compared to those with low income (p < 0.001).

CONCLUSIONS

PI in DN treatment is increasing in both high and low-income states. States with higher incomes are more interested. DN treatment is expected to become more popular, which will lead to a rising demand for comprehensive education in medical schools and clinician training programs. In addition, there will also be a need for easily accessible, high-quality information resources.

Acute effects of self-myofascial release compared to dry needling on myofascial pain syndrome related outcomes: Range of motion, muscle soreness and performance. A randomized controlled trial

OBJECTIVES

myofascial pain syndrome (MPS) is associated with reductions in range of movement (ROM), decrease in physical function and performance and increase in pain in different populations. Elucidating the best prevention and treatment strategies for MPS has been one of the main goals in the last decade. The objective of the present study was to compare the acute effects of self-myofascial foam rolling release (SFR) and dry-needling (DN) techniques on ankle dorsiflexion ROM, soreness post-needling and performance through countermovement jump (CMJ) height.

METHODS

a prospective crossover design composed by 12 active adults, aged 23.41 ± 1.68 years (weight: 78.33 ± 9.02 Kg; height: 1.79 ± 0.088 m) with active ankle dorsiflexion restriction was performed. Participants were randomized into the SFR and DN techniques to analyze its effects on ankle dorsiflexion ROM, muscle soreness and jump height at pre, post and 24 h post-intervention.

RESULTS

significant improvements were found by DN on ankle dorsiflexion at 24 h post intervention and muscle soreness by SFR at the same time point. No significant differences were found between conditions.

CONCLUSIONS

Both SFR and DN are effective in improving ankle dorsiflexion and performance in young adults without producing an acute effect in muscle soreness.

The Effects of Dry-Needling Therapy on the Quality of Life in Athletes with Myofascial Pain Syndrome: Repeated Measures Design Study

Background: This study aims to investigate the effects of dry-needling treatment on the quality of life in athletes with myofascial pain syndrome (MPS). Methods: The participants included in the study were 50 athletes (38 males and 12 females) diagnosed with MPS. The treatments were carried out in four sessions, 5/7 days apart on 55 muscles in total. A 36-item health survey (SF-36) was implemented to determine the participants' quality of life. The chi-square test was used to determine the differences between measurements. Results: Dry-needling treatment has a positive influence on self-perspective of physical functioning (p = 0.011, on average), physical problems (p = 0.001, on average), emotional problems (p = 0.004, on average), social functioning (p = 0.001, on average), pain (p = 0.001, on average), and mental health and vitality (p = 0.001, on average) in athletes with MPS. The only quality-of-life dimension not influenced by the dry-needling treatment is the general health perception (p = 0.340, on average). Conclusions: Dry-needling therapy has positive effects on the perception of quality of life in athletes with MPS.

The utilization of dry needling and an upper extremity exercise program for individuals with cervicogenic headaches: A pilot study

OBJECTIVE

To investigate whether a combination of dry-needling treatments and upper extremity neuromuscular reeducation exercises can significantly improve neck pain and/or headache-related disability, joint position error, cervical range of motion, and pain pressure threshold in individuals suffering from cervicogenic headache (CGH).

METHODS

This study is a quasi-experimental design. Seven participants met the inclusion criteria and received dry needling to three muscles that reproduced the participant's headache symptoms and completed the Neck Disability Index (NDI), Headache Disability Inventory (HDI), Visual Analog Scale (VAS), and Numeric Pain Rating Scale (NPRS). Participants performed an exercise regimen designed to address strength and mobility of cervical and scapulothoracic musculature.

RESULTS

There were significant improvements seen in cervical range of motion and neck pain-related disability (NDI) during the 4-week treatment period.

CONCLUSION

Dry needling and neuromuscular re-education (NMR) exercises could be effective components of treatment for individuals suffering from CGH to reduce disability and pain.

Effects of Myofascial Release Techniques on Joint Range of Motion of Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Although myofascial release techniques (MRTs) are commonly used to improve athletes' range of motion (ROM), the effectiveness of MRTs may vary depending on the specific method performed. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on the ROM performance of athletes. (2) Methods: The electronic databases of Cochrane Library, PubMed, Scopus, and Web of Science were searched to identify relevant articles published up to June 2023. This study utilized the PRISMA guidelines, and four databases were searched. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was reported using the GRADE scale. The overall effect size was calculated using the robust variance estimator, and subgroup analyses were conducted using the Hotelling Zhang test. (3) Ten studies met the inclusion criteria. The overall effect size results indicated that the myofascial release intervention had a moderate effect on ROM performance in athletes when compared to the active or passive control groups. (4) Conclusions: Alternative MRTs, such as myofascial trigger point therapy, can further improve the ROM performance of athletes. Gender, duration of intervention, and joint type may have a moderating effect on the effectiveness of MRTs.

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

PURPOSE

To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain.

MATERIAL AND METHODS

A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression.

RESULTS

No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030).

CONCLUSION

The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial

PURPOSE

Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles.

METHODS

Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor.

RESULTS

The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01).

CONCLUSIONS

Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.

Electrical dry needling versus a non-invasive multicomponent intervention in the treatment of myofascial trigger points in patients with chronic low back pain: A randomised clinical trial

OBJECTIVE

To compare the effects of electrical dry needling with a non-invasive multi-component intervention in patients with chronic low back pain.

DESIGN

A randomised single-blind clinical trial.

SETTING

Outpatient Physiotherapy Clinic; home.

PARTICIPANTS

Sixty-four patients with chronic low back pain aged 30-65 years.

INTERVENTIONS

Six-week electrical dry needling on myofascial trigger points, and a non-invasive multicomponent intervention (home exercise programme, stretching and ischemic compression).

MAIN MEASURES

Pain (Visual Analogue Scale), disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), kinesiophobia (Tampa Scale of Kinesiophobia), quality of life and sleep (Short Form 36-item Health Survey and Pittsburgh Sleep Quality Index), isometric endurance of trunk flexor muscles (McQuade test), lumbar mobility in flexion (finger-to-floor distance), and pressure pain threshold (algometer) were assessed at baseline, after 6 weeks, and after 2 months.

RESULTS

ANOVA showed statistically significant differences in group-by-time interaction for most pain pressure thresholds of myofascial trigger points (P < 0.05), for disability (Roland-Morris Disability Questionnaire: F = 6.14, P = 0.016; and Oswestry Disability Index: F = 7.36, P = 0.009), for trunk anteflexion (F = 10.03, P = 0.002) and for habitual sleep efficacy (F = 6.65, P = 0.012), use of hypnotics (F = 4.77, P = 0.033) and total score of quality of sleep (F = 8.23, P = 0.006).

CONCLUSIONS

In comparison to a non-invasive multicomponent intervention, electrical dry needling has more positive effects on disability, pain intensity, kinesiophobia, and reducing patients' sensitivity to myofascial trigger points pressure, at post-treatment and at 2 months.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04804228. Registered on May 28th, 2021. Available at https://clinicaltrials.gov/ct2/show/NCT04804228.

Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial

INTRODUCTION

Piriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS.

METHODS

Thirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor.

RESULT

After DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7-0.08), p < 0.05, d = 0.56 (0.1-1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (-6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to -0.02)] compared to the control group.

CONCLUSION

The findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

Effectiveness of ultrasound guided interfascial hydrodissection with the use of saline anesthetic solution for myofascial pain syndrome of the upper trapezius: a single blind randomized controlled trial

Background

Myofascial pain syndrome (MPS) is described as pain that arise from myofascial trigger points (MTrPs) which is a hyperirritable spot within a taut band of skeletal muscle. A newer needling technique called the interfascial hydrodissection (IH), wherein anesthetic saline solution (ASS) is injected between the fascia of the muscles using ultrasound as guide. It is theorized that this technique blocks the nerve branches and improve gliding in between the muscle and fascia.

Objective

To determine the short and long-term effects of interfascial hydrodissection using 2% Lidocaine and saline solution compared to dry needling with MPS of the upper trapezius on pain and quality of life using.

Methods

This study is a single-blind randomized controlled trial where ultrasound guided IH with ASS was compared to dry needling (DN) of the MTrPs. Both groups were taught self-stretch exercises (SSE) to be done everyday after the procedure. Outcome measures were pain using the visual analogue scale (VAS) and quality of life assessment with EQ-5D-5l questionnaire. All participants were assessed by a blinded assessor before the intervention, immediately after, 10 and 30 min, one week, two weeks, four weeks, three months, and six months after the procedure. Data Analysis: Two-way mixed ANOVA and follow-up independent T-test were conducted for the outcome measures across several time points between the 2 groups.

Results

A total of 46 participants with two dropouts were all included during the final analysis. Both groups demonstrated significant differences in VAS scores between baseline and the different time points, the IH + SSE group demonstrated the more significant effect size at as compared to the DN + SSE group. For EQ-5D-5l, no statistical differences were seen in all dimensions but there was a larger effect size for usual activities, pain/discomfort and anxiety/depression.

Conclusion

Interfascial hydrodissection is a technique that can manage both short and long term symptoms of MPS. This could be utilized as an alternative management for those with chronic MPS of the upper trapezius.

Philippine Health Research Registry ID

PHRR221003-005034.

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain

BACKGROUND

 Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling.

OBJECTIVE

 The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain.

METHODS

 A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023.

RESULTS

 A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability.

CONCLUSION

 Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

Effects of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with chronic ankle instability: A systematic review and meta-analysis

OBJECTIVE

Acupuncture or similar needling therapy has long been used to improve well-being, but its effectiveness in management of chronic ankle instability (CAI) is unclear. To investigate the efficacy of acupuncture or similar needling therapy on pain, proprioception, balance, and self-reported function in individuals with CAI.

METHODS

Nine databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, CNKI, WanFang, and CQVIP) were systematically searched from inception to April 2023. This study included randomized controlled trials involving acupuncture or similar needling therapy as an intervention for individuals with CAI. Data were extracted independently by two assessors using a standardized form. Literature quality and risk bias were assessed by using the PEDro scale.

RESULTS

Twelve trials (n = 571) were found, of which the final meta-analysis was conducted with eight. Different studies employ varying treatments, including specific needle types, techniques, and therapeutic frameworks. Compared to control without acupuncture or similar needling therapy, acupuncture or similar needling intervention resulted in improved pain (WMD 1.33, 95 % CI 0.14-2.52, I²=90 %, p = 0.03), proprioception (active joint position sense, WMD 1.71, 95 % CI 0.95-2.48, I²=0 %, p < 0.0001), balance (SMD 0.54, 95 % CI 0.03-1.04, I²=46 %, p = 0.04), and self-reported function (Cumberland Ankle Instability Tool (WMD 2.92, 95 % CI 0.94-4.90, I²=78 %, p = 0.004); American Orthopedic Foot and Ankle Society (WMD 9.36, 95 % CI 6.57-12.15, I²=0 %, p < 0.001); Foot and Ankle Ability Measure: activities of daily living (WMD 5.09, 95 % CI 1.74-8.44, I²=0 %, p = 0.003)) for individuals with CAI.

CONCLUSIONS

The available evidence suggests that acupuncture or similar needling therapy may improve pain, proprioception, balance, and self-reported function in individuals with CAI, but more trials are needed to verify these findings. Furthermore, various needles and techniques using in different studies have resulted in methodologic limitations that should be addressed in the future.

Effectiveness of Dry Needling and Ischaemic Trigger Point Compression of the Levator Scapulae in Patients with Chronic Neck Pain: A Short-Term Randomized Clinical Trial

BACKGROUND

Chronic neck pain (CNP) may be associated with latent myofascial trigger points (MTrPs) in the levator scapulae (LS), which can be treated with ischemic compression (IC) and dry needling (DN). Variables and elastography changes are evaluated to compare the short-term efficacy of two treatments with DN.

METHODS

A randomized clinical trial is conducted with 80 participants in two groups: the DN group (n = 40) and IC group (n = 40). The duration is 12 weeks, and mechanical heterogeneity index, pressure pain threshold (PPT), and pain intensity are measured at baseline, immediately after, 48 h after, and one week after treatment.

RESULTS

Statistically significant changes were immediately observed between the two groups: PPT decreased in the DN group (p = 0.05), while it increased in the IC group. At 48 h and one week after treatment, these values increased in the DN group and remained higher than in the IC group. The heterogeneity index improved in both groups but more significantly in the DN group than in the IC group.

CONCLUSIONS

In subjects with CNP who had latent plus hyperalgesic MTrPs in the LS muscle, DN outperformed IC in PPT, pain intensity, and mechanical heterogeneity index at 48 h and one week after initiating therapy.

Evaluation of the Efficacy of Ultrasound-Guided Dry Needling Therapy and Exercise in Piriformis Muscle Syndrome

BACKGROUND

 Piriformis muscle syndrome (PMS) is characterized by symptoms of buttock pain and numbness radiating to the back of the thigh due to irritation of the sciatic nerve. This study aimed to evaluate the efficacy of dry needling (DN) therapy and exercise programs on pain, neuropathic pain, physical function, and disability in patients with PMS.

METHODS

 Forty-four patients with PMS were included in the study. Patients were divided into two groups, those who were treated with DN three times once per week under ultrasound guidance and those who had an exercise program for three weeks. To identify the outcomes of the treatment modalities, pre-treatment and post-treatment first-month and third-month visual analog scale (VAS), Oswestry Disability Index (ODI) questionnaire, Lower Extremity Functional Scale (LEFS), and Douleur Neuropathique 4 (DN4) questionnaire scores were used.

RESULTS

 There was no statistically significant difference between the groups in baseline scores of VAS (p = 0.548), DN4 (p = 0.446), and LEFS (p = 0.880), but in the DN group, baseline ODI scores were significantly higher than in the exercise group (p = 0.001). The group comparisons showed no statistically significant differences in decreasing pain, reducing disability, and increasing functional status scores among the groups at post-treatment first-month and third-month assessments (p > 0.05).

CONCLUSION

Both treatment modalities are beneficial in reducing pain and disability, and increasing the functional status of the patients with PMS in three months of follow-up. In patients who cannot adapt to exercise programs, DN treatment under ultrasound guidance should be kept in mind as a minimally invasive treatment modality with no adverse effects.

The Impact of Dry Needling With Electrical Stimulation on Pain and Disability in Patients With Musculoskeletal Shoulder Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Musculoskeletal shoulder pain (MSP) is a common orthopedic condition frequently treated by orthopedic surgeons and physical therapists in an interdisciplinary manner. Dry needling with electrical stimulation (DNES) is an increasingly popular intervention used for the conservative treatment of MSP during physical therapy. To date, no systematic review and meta-analysis have examined the impact of DNES on outcomes in patients with MSP. This study aims to explore the effectiveness and safety of DNES in patients with MSP to improve patient outcomes. A systematic review and meta-analysis were conducted using PubMed, MEDLINE, CINAHL, and Web of Science from database inception to March 10, 2023. Inclusion criteria were studies with DNES as an intervention, recorded patient outcomes, and randomized controlled trials (RCTs) only. DNES with or without conventional physical therapy (CPT) was compared to CPT alone, which included interventions such as exercise, manual therapy, dry needling without electrical stimulation, and/or interferential current. A total of five RCTs were analyzed from 144 articles retrieved on the initial search. Included patients (n=342) had an average age of 48.75 ± 5.92 years, an average follow-up time of 3.40 ± 1.42 months, and 184 patients receiving DNES with or without CPT. Patients treated with DNES with or without CPT (n=163) had a frequency-weighted mean decrease in pain of 4.8 ± 1.4 points, whereas patients treated with CPT alone (n=158) had a frequency-weighted mean decrease in pain of 3.3 ± 2.2 points. For meta-analysis of pain outcomes (n=321 total patients), DNES with or without CPT improved pain by 1.40/10 points as compared to CPT alone with no significant difference between groups (p=0.203; Cohen's d effect size (ES): 4.352; 95% CI: -2.343, 11.048). Patients treated with DNES with or without CPT (n=118) had a frequency-weighted mean decrease in disability of 34.7 ± 9.1 points. In contrast, patients treated with CPT alone (n=115) had a frequency-weighted decrease in disability of 20.1 ± 5.0 points. For meta-analysis of disability outcomes (n=233 total patients), DNES with or without CPT did not have a significant improvement in disability as compared to CPT alone (p=0.282; Cohen's d ES: 0.543; 95% CI: -0.446, 1.532). No serious adverse effects were reported for patients treated with DNES with or without CPT or CPT alone. DNES with or without CPT may significantly improve pain and disability in patients with MSP. However, DNES with or without CPT does not provide statistically significant improvements in pain or disability compared to CPT alone. Furthermore, DNES appears to be a safe intervention for MSP.

Ultrasound-guided pulsed radiofrequency versus dry needling for pain management in chronic neck and shoulder myofascial pain syndrome patients at a tertiary hospital in China: a randomised controlled trial protocol

INTRODUCTION

Myofascial pain syndrome (MPS), especially in the neck and shoulder region, is one of the most common chronic pain disorders worldwide. Dry needling (DN) and pulsed radiofrequency (PRF) are the two effective methods for treating MPS. We aimed to compare the effects of DN and PRF in chronic neck and shoulder MPS patients.

METHODS AND ANALYSIS

This is a prospective, single-centre, randomised, controlled trial in a tertiary hospital. We plan to recruit 108 patients aged 18-70 years who are diagnosed with chronic MPS in the neck, shoulder and upper back regions and randomly allocate them to either the DN or PRF group at a 1:1 ratio. The DN group will receive ultrasound-guided intramuscular and interfascial DN 8-10 times per pain point or until local twitch responses are no longer elicited and 30 min of indwelling. The PRF group will receive ultrasound-guided intramuscular (0.9% saline 2 mL, 42℃, 2 Hz, 2 min) and interfascial (0.9% saline 5 mL, 42℃, 2 Hz, 2 min) PRF. Follow-up will be performed by the research assistant at 0, 1, 3 and 6 months postoperatively. The primary outcome is the postoperative 6-month pain visual analogue score (0-100 mm). Secondary outcomes include pressure pain threshold measured by an algometer, Neck Disability Index, depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), sleep status (Likert scale) and overall quality of life (36-Item Short Form Survey). Between-group comparisons will be analysed using either a non-parametric test or a mixed effects linear model.

ETHICS AND DISSEMINATION

This study was approved by the medical ethics committee of Peking Union Medical College Hospital (JS-3399). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals.

TRIAL REGISTRATION NUMBER

NCT05637047, Pre-results.

Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review

The number of systematic reviews (SR) summarizing the literature regarding the clinical effects of Dry Needling (DN) has increased rapidly. Yet, rigorous evidence about the clinical effectiveness of this technique is still lacking. The aim of this umbrella review is to summarize the evidence about the clinical effects of trigger point DN on musculoskeletal disorders across all body regions. PubMed, Web of Science and Embase were searched to identify SRs examining the effect of DN (as a stand-alone intervention or combined with another treatment modality) compared to sham/no intervention or a physical therapy (PT) intervention with at least one clinical outcome in the domain of pain or physical functioning. Risk of bias (RoB) was assessed with the AMSTAR-2 tool. Quantification of the overlap in primary studies was calculated using the corrected covered area (CCA). The electronic search yielded 2286 results, of which 36 SRs were included in this review. Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region. Some SRs favored wet needling (WN) over DN for short-term pain reductions. Results on physical functioning outcomes were contradictory across body regions. Limited data is available for mid- and long-term effects. DN has a short-term analgesic effect in all body regions and may be of additional value to the interventions that are used to date in clinical practice. Several studies have shown an additional treatment effect when combining DN to physiotherapeutic interventions compared to these interventions in isolation. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence.

Effectiveness of Manual Trigger Point Therapy in Patients with Myofascial Trigger Points in the Orofacial Region-A Systematic Review

The objective was to compile, synthetize, and evaluate the quality of the evidence from randomized controlled trials (RCTs) regarding the effectiveness of manual trigger point therapy in the orofacial area in patients with or without orofacial pain. This project was registered in PROSPERO and follows the PRISMA guidelines. Searches (20 April 2021) were conducted in six databases for RCTs involving adults with active or latent myofascial trigger points (mTrPs) in the orofacial area. The data were extracted by two independent assessors. Four studies were included. According to the GRADE approach, the overall quality/certainty of the evidence was very low due to the high risk of bias of the studies included. Manual trigger point therapy showed no clear advantage over other conservative treatments. However, it was found to be an equally effective and safe therapy for individuals with myofascial trigger points in the orofacial region and better than control groups. This systematic review revealed a limited number of RCTs conducted with patients with mTrPs in the orofacial area and the methodological limitations of those RCTs. Rigorous, well-designed RCTs are still needed in this field.

Dry needling in the management of tendinopathy: A systematic review of randomized control trials

INTRODUCTION

The objective of the study is to evaluate the best available evidence on the effectiveness of DN in the management of tendinopathy.

METHODS

Seven randomized control trials were selected following an electronic search in PubMed, Web of Science, Scopus, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants, which investigated the effect of the DN technique on the management of tendinopathies. Only studies in the English language published in peer-reviewed journals between 1999 and 2020 were included. The methodological quality of the studies was assessed using the PEDro scale.

RESULTS

The PEDro score of the studies ranged from 5 to 9 with a mean score of 6.7 ± 1.2 (mean ± SD). A total of 357 participants were enrolled in the seven included studies, which were on greater trochanteric pain syndrome, lateral epicondylitis, supraspinatus tendinopathy and Achilles tendinopathy. DN was compared with various interventions, including platelet-rich plasma injection, autologous blood injection and non-steroidal anti-inflammatory medication. All the selected studies reported a significant positive effect of DN on pain intensity and other outcome measures, such as patient-specific functional score, disability index, range of motion and health-related quality of life.

CONCLUSION

The results indicate that DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months. DN can be considered among the many options available for the management of tendinopathy.

Dry needling for the treatment of acute myofascial pain syndrome in general practitioners' clinics: a cohort study

BACKGROUND

Musculoskeletal pain is one of the leading complaints in the ambulatory setting. There are many ways to treat it, including pharmacologic and non-pharmacologic approaches. Dry needling (DN) is an option that is easy to learn, cheap and has a good safety profile. The aim of this study was to assess the association between DN performed by GPs for acute myofascial pain syndrome (MPS) and pain relief and to evaluate factors associated with treatment success.

METHODS

In this prospective cohort study, two GPs performed DN in their clinics. Patients were asked to rank their pain using the Short-Form McGill Pain Questionnaire (SF-MPQ) before, 10-min and 1-week after the procedure. The SF-MPQ index consists of 3 parts; visual analog scale (VAS), pain rating index (PRI) and present pain intensity (PPI). Logistic regressions were performed to assess the variables associated with short- and medium- term success.

RESULTS

Fifty two patients were recruited from September 2019 until August 2020. VAS was 6.0 ± 2.3 (before), 4.1 ± 2.5 (10-min after) and 2.6 ± 2.71 (1-week after), P < 0.05. PRI was 17 ± 9.1 (before), 10.8 ± 8.5 (10-min after) and 5.1 ± 6.5 (1-week after), P < 0.05. PPI was 2.6 ± 1.0 (before), 1.7 ± 1.0 (10-min after) and 1.1 ± 1.2 (1-week after), P < 0.05. Short-term success was associated with the physician who performed the procedure (OR 10.08, 95% CI 1.15,88.4) and with the use of a single needle (vs. multiple needles inserted) (OR 4.55, 95% CI 1.03,20.11). Medium-term success was associated with being a native born (non-immigrant), OR 8.59, 95% CI 1.11,66.28 and with high level of initial pain, OR 11.22, 95% CI 1.82,69.27.

CONCLUSION

Our study demonstrated improvement in acute pain 10-min and 1-week after DN performed by a GP, in all parts of the SF-MPQ. Therefore, we believe DN is a good therapeutic option for GPs to aid patients suffering from MPS.

Correlation between thoracic kyphosis and dry needle length required to reach the pleural space needling the upper trapezius: A cadaveric fluoroscopic assessment

BACKGROUND

It is unknown whether greater prone thoracic kyphosis increases pneumothorax risk during upper trapezius dry needling.

OBJECTIVES

To fluoroscopically assess for a correlation between prone thoracic kyphosis and needle length required to reach the pleural space dry needling the upper trapezius in prone.

DESIGN

Cadaveric study.

METHODS

Prone thoracic kyphosis was assessed using dual bubble inclinometers. A 30 mm dry needle was inserted into the midsubstance of the upper trapezius perpendicular to the thoracic kyphosis. A single C-arm fluoroscopic image was obtained. This procedure was repeated with 40, 50, and 60 mm needles. Images were independently viewed by a radiologist to make a binary decision (yes vs. no) whether the needle had potentially broached the pleural space.

RESULTS

Fifteen cadaveric specimens with a mean age of 74.9 ± 9.7 and mean kyphosis of 21.5° ±7.7 were used. A 30 mm needle never reached the pleural space. The pleural space was potentially broached on one, four and six occasions by the 40, 50, and 60 mm needle respectively. The correlation between needle depth penetration and kyphosis was not significant (r = 0.03, p = 0.93). Longer needles (50 and 60 mm) were significantly (p = 0.0049) more likely to reach the pleural space than shorter needles (30 and 40 mm).

CONCLUSION

Thoracic kyphosis was not correlated with needle length required to reach the pleural space. Clinicians may consider selecting shorter needles (<40 mm) to mitigate potential risk while dry needling the upper trapezius in prone.

Comparison of the effectiveness between dry needling with and without needle retention in myofascial trigger points in upper trapezius muscle: A randomized comparative trial

BACKGROUND

Dry needling (DN) is commonly used to treat myofascial trigger points (MTrPs).

OBJECTIVE

To compare the effect between DN with and without needle retention in the treatment of MTrPs in the upper trapezius muscle.

METHODS

Fifty-four patients who had active MTrPs in the upper trapezius muscle were randomly allocated into the DN group or the DN with retention group. The DN group received DN only, while the DN with retention group received DN with needle retention for 30 minutes. The visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded both before and after 7 and 14 days of the treatment sessions.

RESULTS

Both groups showed a significant decrease of the VAS at 7 and 14 days (mean difference DN group -53.0, DN with retention group -57.0, p< 0.001). The PPT was also significantly improved in both groups (mean difference DN group 109.8 kPa, DN with retention group 132.3 kPa, p< 0.001). However, there were no significant differences in the VAS or PPT between the groups.

CONCLUSIONS

Both DN and DN with retention had significant improvement of pain intensity in the treatment of MTrPs in the upper trapezius muscle at 14 days. However, pain reduction was not significantly different between the interventions.

Dry Needling of the Popliteus Muscle Validation by Ultrasound Imaging: A Cross-Sectional Observational Study

Dry needling is a widely used technique for the treatment of painful syndromes in the musculature, however, its usefulness is of greater relevance in deep structures, such as the popliteus muscle, as it is more difficult to access. This muscle is heavily involved in knee pathology, being a source of pain and functional impairment, especially secondary to underlying pathologies. The method selected for the observation and study of the soft tissues, by means of imaging tests that do not use ionising radiation, is ultrasound. A cross-sectional observational study is proposed. It will be carried out in a healthy population, during the years 2021 and 2022, observing, by ultrasound, the results of the popliteal puncture technique, recorded by Mayoral del Moral et al. A popliteus muscle needle reach of 92% was achieved with this technique, in 48 of 50 patients. The results of the present cross-sectional observational study in living subjects, support that the popliteal puncture, described by Mayoral et al. is a reliable and safe approach, when performed with a 0.30 × 50 mm needle, and no adverse reactions or punctures of the vascular-nerve structures have been reported during the interventions.

Effectiveness of Dry Needling and Ischemic Trigger Point Compression in the Gluteus Medius in Patients with Non-Specific Low Back Pain: A Randomized Short-Term Clinical Trial

BACKGROUND

The presence of latent myofascial trigger points (MTrPs) in the gluteus medius is one of the possible causes of non-specific low back pain. Dry needling (DN) and ischemic compression (IC) techniques may be useful for the treatment of these MTrPs.

METHODS

For this study, 80 participants were randomly divided into two groups: the dry needling group, who received a single session of DN to the gluteus medius muscle plus hyperalgesia (n = 40), and the IC group, who received a single session of IC to the gluteus medius muscle plus hyperalgesia (n = 40). Pain intensity, the pressure pain threshold (PPT), range of motion (ROM), and quality of life were assessed at baseline, immediately after treatment, after 48 h, and one week after treatment.

RESULTS

Statistically significant differences were shown between the two groups immediately after the intervention, showing a decrease in PPT (p < 0.05) in the DN group and an increase in PPT in the IC group. These values increased more and were better maintained at 48 h and after one week of treatment in the DN group than in the IC group. Quality of life improved in both groups, with greater improvement in the DN group than in the IC group.

CONCLUSIONS

IC could be more advisable than DN with respect to UDP and pain intensity in the most hyperalgesic latent MTrPs of the gluteus medius muscle in subjects with non-specific low back pain, immediately after treatment. DN may be more effective than IC in terms of PPT, pain intensity, and quality of life in treating latent plus hyperalgesic gluteus medius muscle MTrPs in subjects with non-specific low back pain after 48 h and after one week of treatment.

Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review

This study aims to analyze the effects of Dry Needling (DN) for the release of myofascial trigger points (MTrPs) in the triceps surae muscles (TSM). A systematic review was performed up to February 2022 in PubMed, PEDro, Scopus, CENTRAL, and Web of Science. Selection criteria were studies involving subjects older than 18 years presenting MTrPs in the TSM, without any concomitant acute or chronic musculoskeletal conditions; DN interventions applied to the MTrPs of the TSM; and results on pain, range of motion (ROM), muscle strength, muscle stiffness, and functional outcomes. The PEDro scale was used to assess the methodological quality of the studies, and the Risk of Bias Tool 2.0 to assess risk of bias. A total of 12 studies were included in the systematic review, involving 426 participants. These results suggest that DN of MTrPs in TSM could have a positive impact on muscle stiffness and functional outcomes. There are inconclusive findings on musculoskeletal pain, ROM, and muscle strength. Significant results were obtained in favor of the control groups on pressure pain thresholds. Despite the benefits obtained on muscle stiffness and functional performance, the evidence for the use of DN of MTrPs in the TSM remains inconclusive.

Immediate Effects of Adding Dry Needling to Thoracic Manipulation and Exercise in Cervical Range of Motion for Adults With Neck Pain: A Randomized Clinical Trial

OBJECTIVE

The purpose of this study was to determine the immediate effects of adding dry needling (DN) to thoracic spine manipulation and neck-specific exercise in individuals with neck pain.

METHODS

Forty-two participants with neck pain were randomized to either the true (n = 21) or sham (n = 21) DN groups, receiving treatment on the initial visit and 2 to 3 days later. Outcomes were assessed on day 1, both at baseline and immediately after the initial treatment, at the second treatment 2 to 3 days later, and at the final visit 5 to 7 days after visit 2. Primary outcomes were Neck Disability Index (NDI) (0-50) and current pain via numeric pain rating scale (0-10). Secondary outcomes were cervical range of motion, pain pressure threshold, and global rating of change.

RESULTS

Repeated measures analysis of covariance with baseline value as covariate revealed no significant difference in NDI scores at either follow-up time point with adjusted mean differences (95% confidence interval) of -0.11 (-2.70 to 2.48) and 0.31 (-1.96 to 2.57). There were no between-group differences in pain at any time point via Independent-Samples Median Test (P value range of .54-1.0). Secondary outcome measures were similarly not statistically different between groups except for immediate improvements in rotation to the side opposite of pain, which favored DN, with an adjusted mean difference (95% confidence interval) of 7.85 (3.54-12.15) degrees.

CONCLUSION

The addition of DN to thoracic spinal manipulation and neck-specific exercise did not affect improvements in NDI score or numeric pain rating scale but showed an increase in cervical range of motion.

Efficacy of Dry Needling and Acupuncture in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis

Fibromyalgia (FM) is a syndrome that involves chronic pain, fatigue, sleep disturbance and impaired quality of life and daily functioning. In addition to medical and psychological therapies, other therapies including acupuncture and dry needling aim to reduce pain and disability in patients with FM. The aim of this study was to investigate the efficacy of dry needling and acupuncture in patients with FM regarding pain, function and disability in both the short and the long term. MEDLINE, PubMed, SCOPUS and Web of Science databases were systematically searched for randomized controlled trial studies evaluating efficacy data of dry needling or/and acupuncture treatments to improve pain, fatigue, sleep disturbance and impaired quality of life and/or daily function. A qualitative analysis including the methodological quality and a systematic data synthesis was performed. A total of 25 studies addressed the selection criteria. Most studies had an acceptable methodological quality. Four studies assessed the effect of dry needling, and twenty-one studies assessed the effect of acupuncture. In general, both interventions improved pain, anxiety, depression, fatigue, stiffness, quality of sleep and quality of life. However, both techniques were not compared in any study. Acupuncture and dry needling therapies seems to be effective in patients with FM, since both reduced pain pressure thresholds, anxiety, depression, fatigue, sleep disturbances and disability in the short term. It is still required to compare both techniques and their application in the long term.

Immediate Effect of Dry Needling on the Viscoelastic Properties of a Trigger Point on the Infraspinatus Muscle Measured with MyotonPRO

Purpose: This article investigates the immediate effects of a dry needling (DN) puncture on the viscoelastic properties (tone, stiffness, elasticity) of a trigger point (TP) in the infraspinatus muscle in non-traumatic chronic shoulder pain. Method: Forty-eight individuals with non-traumatic chronic shoulder pain were recruited. The presence of a TP in the infraspinatus muscle was confirmed by a standardized palpatory exam. The viscoelastic properties were measured with a MyotonPRO device at baseline (T1), immediately after DN (T2), and 30 minutes later (T3). A DN puncture was applied to the TP to obtain a local twitch response while performing the technique. Results: Analyses of variance showed significant decreases in tone (p < 0.001) and stiffness (p = 0.003) across time after the DN technique. Post hoc tests revealed a significant reduction in tone and stiffness from T1 to T2 (p ≤ 0.004) and no significant changes from T2 to T3 (p ≥ 0.10). At T3, only stiffness remained significantly lower compared to T1 (p = 0.013). Conclusions: This study brings new insights on the immediate mechanical effect of DN on tone and stiffness of TPs. Whether these effects are associated with symptom improvement and long-term effects still needs to be verified.

Effects of dry needling on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain: A randomized controlled pilot study

BACKGROUND

Myofascial trigger points (MTrPs) in neck muscles seem to be related to the main symptoms of patients with chronic neck pain.

OBJECTIVE

The objective was to investigate the effects of dry needling (DN) on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain.

METHODS

A double blind randomized controlled pilot trial was designed. Twenty-one patients with chronic neck pain were randomly allocated to the DN group (n= 7), Sham-DN group (n= 7) or Control group (n= 7). All groups received a Transcutaneous Electrical Nerve Stimulation and Therapeutic Ultrasound (TENS/US) protocol with patient education. The DN and Sham-DN groups received two sessions of DN and sham DN, respectively. The primary outcome was pain intensity. Secondary outcomes were disability, kinesiophobia, pain catastrophizing, psychological distress, self-reported improvement and success of blinding.

RESULTS

The DN group showed a greater decrease in pain intensity, disability and pain catastrophizing compared to the Sham-DN group (p< 0.05) and the Control group (p< 0.05). The DN group showed the highest self-reported improvement.

CONCLUSION

Adding two sessions of DN in active MTrPs in upper trapezius, levator scapulae and sternocleidomastoid muscles to a TENS/US protocol with patient education decreased pain intensity, disability and pain catastrophizing in patients with chronic neck pain.

Exploring the Underlying Mechanisms of Action of Dry Needling: What Is the Immediate Effect on Muscle Electrophysiology? An Experimental Randomized Controlled Trial

OBJECTIVE

Dry needling is a commonly used treatment technique for myofascial pain syndromes, such as trapezius myalgia. Despite the shown positive clinical effects on pain, the underlying mechanisms of action, such as the effect on muscle electrophysiology, remain unclear. The aim of this study was to investigate the effect of dry needling, compared with sham needling, in the upper trapezius muscle on surface electromyography activity and the relation with pain in office workers with trapezius myalgia.

DESIGN

For this experimental randomized controlled trial, 43 office workers with work-related trapezius myalgia were included. Surface electromyography activity was measured before and after a pain-provoking computer task and immediately after, 15, and 30 mins after treatment with dry or sham needling. Pain scores were evaluated at the same time points as well as 1, 2, and 7 days after treatment.

RESULTS

No significant differences in surface electromyography activity between dry needling and sham needling were found. Significant positive low to moderate Spearman correlations were found between surface electromyography activity and pain levels after dry needling treatment.

CONCLUSIONS

This study shows no immediate effects of dry needling on the electrophysiology of the upper trapezius muscle, compared with sham needling.

Efficacy of Exercise on Postneedling Soreness: A Randomized Controlled Trial

This study aimed to investigate the efficacy of concentric, eccentric, and isometric exercise protocols on the postneedling soreness (PNS) after the dry needling (DN) of latent myofascial trigger points (MTrP) in the medial gastrocnemius muscle. A randomized clinical trial was carried out. Volunteers, ≥18 years old, with a latent MTrP in the medial gastrocnemius muscle were included. Subjects with contraindications to DN, active MTrPs, and/or other treatments in MTrPs in the 3 months prior to recruitment were excluded. A total of 69 participants were randomly allocated to four groups, where post-DN intervention consisted of an eccentric, concentric, or isometric exercise, or no exercise, and they were assessed for PNS intensity (visual analog scale (pVAS)), pressure pain threshold (PPT, analog algometer), pain intensity (nVAS), and local twitch responses (LTRs) during DN, as well as demographics and anthropometrics. The mixed-model analyses of variance showed significant interaction between time and pVAS, and between time and PPT (p < 0.001). While the multivariate test confirmed that PNS and PPT improved over time within each group, specifically between 6–12 h post-intervention, the post hoc analyses did not show significant differences between groups. The mixed-model analyses of covariance showed a significant nVAS effect (p < 0.01) on PNS decrease, and some effect of the LTRs (p < 0.01) and sex (p = 0.08) on PPT changes. All groups improved PNS and PPT, but none of them showed a greater improvement above the others. The most dramatic decrease was observed between 6–12 h post-exercise, although concentric and eccentric exercise had an effect immediately after the intervention. Between all potential modifiers, pain during DN significantly influenced PNS progression, while LTRs and sex seemed to determine PPT course over time.

A mixed-methods survey of physiotherapists who practice acupuncture and dry needling in Ontario, Canada: practice characteristics, motivations, and professional outcomes

Background

Physiotherapists (PTs) across the globe are increasingly incorporating filiform needling techniques (e.g., acupuncture, dry needling) into their clinical toolkits; and, the evidence base for these complementary therapies is becoming progressively more robust. However, to date, little is known about needling PTs themselves.

Methods

Using a cross-sectional survey design, PTs authorized to perform needling therapies in Ontario, Canada were recruited for anonymous participation (n = 2061) in an online survey. The survey asked providers about their demographics and practice characteristics, rationale for and views about therapeutic needling, and their related clinical and professional outcomes. The response rate was 20.7% (n = 426), and 22.3% (n = 95) of respondents provided textual responses to an open-ended qualitative question.

Results

While study respondents’ demographic features appear similar to their broader professional population, Ontario’s needling PTs are less likely to work in public sector settings. Most completed training in medical acupuncture rather than dry needling, and typically used needling in over one-third of patient visits. Almost all endorsed needling as an effective musculoskeletal treatment, the primary factor informing their adoption of the practice. While many viewed traditional Chinese medical theories as a useful explanatory framework, most relied on biomedical epistemology to drive their needling work. A majority of respondents reported that the inclusion of needling within their clinical toolkits had improved their likelihood of achieving excellent clinical results, helped support patient recruitment and retention, and heightened their professional satisfaction. While a few reported earning a higher income as a result, most reported that their clinical use of needling in addition to other PT modalities reduced their physical fatigue after a day’s work.

Conclusions

This study represents a first scholarly investigation into the motivations, training backgrounds and practice patterns of PTs who use acupuncture or dry needling. Additional research from other jurisdictions is needed to evaluate the transferability of study findings.

Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study

BACKGROUND

Dry needling (DN) is increasingly used for treating myofascial trigger points (MTrPs) and has shown significant effects on pain and function. This study aimed to assess feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the effects of infraspinatus DN on corticospinal excitability and mechanical pain sensitivity.

METHOD

This randomized feasibility study included adults with chronic non-traumatic shoulder pain and a infraspinatus MTrP. Participants were randomized to receive real DN or sham DN in the infraspinatus MTrP. Feasibility outcomes included data pertaining to recruitment, retention of participants, completeness and safety of assessment procedures. Neurophysiological and psychophysical outcomes included corticospinal excitability and mechanical pain sensitivity measured by active motor threshold (aMT) and pressure pain threshold (PPT), respectively. They were assessed at baseline, immediately after and 24 h post-intervention.

RESULTS

Twenty-one participants were recruited over a 6-month period. Nineteen participants completed the treatment and follow-up assessment. Motor evoked potential responses were discernible in all but 1 participant. Only 1 minor adverse event related to transcranial magnetic stimulation (mild headache) affected the measurements. No DN adverse effects were recorded in both groups. An overall completeness rate of 81% was reached, with 70% completeness in the DN group and 91% in the sham group. Data analysis revealed that real DN increased corticospinal excitability (reduced aMT) 24 h post-intervention (Mdn = - 5.96% MSO, IQR = 5.17, p = 0.04) and that sham DN triggered similar responses immediately after the intervention (Mdn = - 1.93% MSO, IQR = 1.11, p = 0.03). Increased mechanical pain sensitivity (reduced PPT) was significant only in the sham group, both immediately (Mdn = - 0.44 kg/cm2, IQR = 0.49, p = 0.01) and 24 h post-intervention (Mdn = - 0.52 kg/cm2, IQR = 1.02, p = 0.02). Changes in corticospinal excitability was positively correlated with changes in mechanical pain sensitivity in the DN group, both immediately (r = 0.77, p = 0.02) and 24 h post-intervention (r = 0.75, p = 0.05).

CONCLUSION

The present study demonstrates the feasibility of quantifying the neurophysiological and psychophysical effects of DN, and provides recommendations and guidelines for future studies. Moreover, it provides preliminary evidence that DN may increase corticospinal excitability of the infraspinatus muscle in patients with chronic shoulder pain and that the relationship of neurophysiological and psychophysical effects is promising to better understand its mechanisms of action.

TRIAL REGISTRATION

NCT04316793 ; retrospectively registered November 3, 2020.

Treatment of thoracic spine pain and pseudovisceral symptoms with dry needling and manual therapy in a 78-year-old female: A case report

DESIGN

Case Report.

BACKGROUND AND PURPOSE

Thoracic spine pain and movement dysfunction is a relatively common problem in the general population but has received little attention in research. Dry needling is frequently utilized by physical therapists and has been shown to reduce pain and improve function in areas, such as the cervical and lumbar spine, shoulder, hip, and knee. However, little research has been performed on the use of dry needling in the thoracic area with only two prior case studies being published. This case report documents the use of dry needling and manual therapy to treat a patient with symptoms of thoracic spine pain with concurrent pseudovisceral symptoms of chest pain and difficulty breathing.

CASE DESCRIPTION

The patient was a 78-year-old female who was referred to physical therapy with complaints of pain focused in her mid-thoracic spine radiating anteriorly into her chest. The patient underwent medical diagnostic tests prior to her referral to physical therapy to rule out cardiac pathology, pulmonary pathology, and fracture. She was treated with dry needling and manual therapy for a total of four sessions over a two-week period.

OUTCOMES

Fifteen days after her initial evaluation, the patient reported she was pain-free with a pain score of 0/10 on the VAS. She reported she was no longer taking pain medication or NSAIDS. She was able to return to normal daily activities without restriction and normal sleep pattern. Her score on the Oswestry disability index at intake was 42% impairment and 2% impairment after 4 treatments. At follow-up 6 weeks and 12 weeks after her discharge from physical therapy, the patient reported she continued to be pain-free.

The effect of dry needling of myofascial trigger points on muscle stiffness and motoneuron excitability in healthy subjects

BACKGROUND

Myofascial trigger points (MTrPs) are hypersensitive nodules in a taut band (TB) of skeletal muscle. Dry needling (DN) is an invasive technique recommended for the treatment of MTrPs. However, to our knowledge, no studies have investigated the influence of the DN technique on modification of muscle stiffness and neurophysiological properties of MTrPs.

OBJECTIVE

The objective was to examine the effect of DN on muscle stiffness and motoneuron excitability of a latent medial MTrP (nodule and TB) of the soleus muscle in non-injured subjects.

METHODS

A double-blinded randomised controlled trial of 46 subjects with latent medial MTrPs of the soleus was conducted, in which all received one session of DN. The intervention group (n = 23) were subjected to DN into the MTrP (the nodule), while the control group (n = 23) were subjected to DN into the TB. Assessment was carried out at baseline (pre-test), after the intervention (post-test) and 1 week after the intervention (follow-up). Biomechanical variables (muscle resistive force at 10°/s and 180°/s, muscle extensibility and strength), as measured with an isokinetic dynamometer, and neurophysiological variables (H-reflex), were recorded.

RESULTS

There were no statistically significant differences in biomechanical or neurophysiological assessments between groups. Considering the intra-group analysis, subjects in the intervention group exhibited increased maximal isometric voluntary force to ankle plantarflexion (MIVF_p) at both post-intervention and follow-up assessment (p < 0.0125; 0.2 < d < 0.5), while no changes were found in the control group.

CONCLUSION

One session of DN targeting latent MTrPs did not change muscle stiffness, muscle extensibility or motoneuron excitability. Further research on subjects with muscle tone disorders should be considered to better address the impact of DN on muscle tone.

TRIAL REGISTRATION NUMBER

NCT02575586 (ClinicalTrials.gov).

Current advances and novel research on minimal invasive techniques for musculoskeletal disorders

The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.

Postrace Dry Needling Does Not Reduce Subsequent Soreness and Cramping-A Randomized Controlled Trial

OBJECTIVE

To identify whether a single session of postrace dry needling can decrease postrace soreness and quantity of postrace leg cramps in half-marathon and full-marathon runners.

DESIGN

Single-blind, prospective, randomized, controlled trial.

SETTING

Finish line of 2018 Salt Lake City Marathon & Half-Marathon.

PARTICIPANTS

Runners aged 18 years or older who completed a marathon or half-marathon.

INTERVENTIONS

True or sham dry needling of the bilateral vastus medialis and soleus muscles within 1 hour of race completion by 2 experienced practitioners.

MAIN OUTCOME MEASURES

The primary outcome measure was numeric pain rating improvements for soreness on days 1, 2, 3, and 7 compared to immediately postrace. Secondary outcome measures included number of postrace cramps and subjective improvement of soreness.

RESULTS

Sixty-two runners were included with 28 receiving true and 34 receiving sham dry needling. Objective pain scores showed an increase in pain of the soleus muscles at days 1 and 2 (P ≤ 0.003 and P ≤ 0.041, respectively) in the dry needling group. No differences were seen in postrace pain in the vastus medialis muscles (P > 0.05). No association was seen between treatment group and presence of postrace cramping at any time point (P > 0.05). Subjectively, there was a nonsignificant trend for those receiving dry needling to feel better than expected over time (P = 0.089), but no difference with cramping (P = 0.396).

CONCLUSIONS

A single postrace dry needling session does not objectively improve pain scores or cramping compared to sham therapy.

Granisetron vs. lidocaine injection to trigger points in the management of myofascial pain syndrome: a double-blind randomized clinical trial

OBJECTIVES

Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome.

METHODS

We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged ≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30 mm on a 100 mm visual analog scale. Each participant received a single dose of 1 mL lidocaine 2% or 1 mg (in 1 mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale.

RESULTS

Both interventions were successful in reducing neck pain and disability (all p-values <0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups.

CONCLUSIONS

Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1 mg (in 1 mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.

Effectiveness of Dry Needling versus Placebo on Gait Performance, Spasticity, Electromyographic Activity, Pain, Range-of-Movement and Quality of Life in Patients with Multiple Sclerosis: A Randomized Controlled Trial Protocol

Dry needling (DN) is an emerging technique commonly used in neurological and musculoskeletal pain conditions, but there have been no previous studies in patients with multiple sclerosis (pwMS). This trial aims to assess the efficacy of deep DN, compared with sham placebo DN, on gait performance, spasticity level, pain, electromyographic activity, range-of-movement (ROM) and quality of life in pwMS. Forty adults with MS were randomly assigned to one study group. The DN group will undergo 2 sessions (once per week) using DN over the rectus femoris (RF) and gastrocnemius medialis (GM) muscles at the lower extremity with higher spasticity. The placebo group will receive the same protocol using a sham placebo needle (Dong Bang needle). Outcome measures will include gait performance, using the GaitRite^® system, spasticity level with the Modified Ashworth Scale, superficial electromyographic activity of RF and GM, pain (pressure algometer), ROM (goniometer), and quality of life (Musiqol). This study is the first investigating the short-term effect of DN, compared with placebo, in pwMS, and taking into account the possible changes in the electromyographic activity of the lower limb. Therefore, the results may help to understand the suitability of using this technique in the clinical setting for this population. Trial registration: ACTRN12619000880145.

Dry Needling and Photobiomodulation Decreases Myofascial Pain in Trapezius of Women: Randomized Blind Clinical Trial

OBJECTIVE

The purpose of this study was to assess whether dry needling (DN) added to photobiomodulation (PBM) has effects on the treatment of active myofascial trigger points in the upper trapezius.

METHODS

This study was a randomized clinical trial, with 43 participants divided into 3 groups: DN and PBM (DNP), DN, and DN outside of the trigger point (DNout). Each group received 1 session of DN followed by PBM therapy with the machine turned on or off. Pain, disability, pain pressure threshold, and muscle activity were assessed before the intervention and afterward at intervals of 10 minutes, 30 minutes, 1 week, and 1 month.

RESULTS

Pain decreased after intervention in the DNP and DNout groups, with mean differences, respectively, of 1.33 cm (95% confidence interval [CI], 0.019-2.647) and 2.78 cm (95% CI, 1.170-2.973). Scores for the disability questionnaire decreased in all groups after intervention (F = 36.53, P < .0001) after the intervention, with mean differences of 3.8 points in the DNP group (95% CI, 1.082-5.518), 3.57 in the DN group (95% CI, 0.994-6.149), and 5.43 in the DNout group (95% CI, 3.101-7.756). There were no significant differences between or within groups in pain pressure threshold (F = 2.14, P = .139), with mean differences after 30 minutes of 0.139 kgf for the DNP group (95% CI, -0.343 to 0.622), 0.273 for the DN group (95% CI, -0.661 to 1.209), and -0.07 for the DNout group (95% CI, -0.465 to 0.324). Muscle activation for the DN group increased 8.49% after the intervention, where for the DNP group it decreased 11.5%, with a significant difference between groups.

CONCLUSION

DN added to PBM presented similar results compared to DNout and DN. In this sample, the effects of the application of DN outside of the trigger point had better effects on pain and disability scores than DN applied directly on the trigger point.

Comparison of the effect of two different types of dry-needling techniques on subacromial impingement syndrome

INTRODUCTION

Infraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined.

DESIGN

randomized controlled clinical trial, single-blind study.

METHOD

Sixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups.

INTERVENTIONS

In 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy.

MAIN OUTCOME MEASURE(S)

Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured.

RESULTS

The findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups.

CONCLUSION

Pain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.

A comparison of dry needling and kinesiotaping therapies in myofascial pain syndrome: A randomized clinical study

Objectives

This study aims to compare the effectiveness of dry needling (DN) and kinesiotaping (KT) therapies on pain, quality of life, depression, and physical function in the treatment of myofascial pain syndrome (MPS).

Patients and methods

The study included a total of 60 patients (4 males, 56 females; mean age 31.2±9.8 years; range, 18 to 56 years) diagnosed with MPS between January 2014 and June 2014. The patients were randomly divided into two treatment groups: the DN group (n=30) and KT group (n=30). Both groups performed stretching and postural exercises. The scales used for measurements were the Visual Analog Scale (VAS) for pain, a pressure algometer for the pressure-pain threshold, the Short Form-36 (SF-36) for the quality of life, Beck Depression Inventory (BDI) for depression, and the Neck Pain and Disability Scale (NPDS) for physical function. The patients were evaluated by a single assessor three times: pre-treatment, at the end of the treatment, and two months after the treatment.

Results

Both DN and KT provided significant improvements for all baseline measurements (VAS, pressure pain threshold, all subscales of SF-36, BDI, and NPDS scores) at the end of the treatment and two months after the treatment (p<0.05). However, there was no significant difference between the groups in all measurements (p>0.05).

Conclusion

Kinesiotaping is as an effective method as DN in the treatment of MPS. It can be served as a non-invasive alternative to patients with needle phobia.