A comparative study of sonographic and clinical parameters in patient with upper trapezius muscle trigger point following dry needling and intramuscular electrical stimulation: a randomized control trial

BACKGROUND

The most common cause of muscle pain is myofascial pain syndrome. Myofascial pain syndrome caused by sensitive areas called trigger points (TrP). Some physiotherapy modalities have acceptable effects for this disorder, but it is necessary to check the effects of placebo, appropriate dose, and long-term effects for each intervention. The aim of this study is to investigate the effect of intramuscular electrical stimulation (IMES) compared to dry needling (DN) on sonographic and clinical parameters in upper trapezius muscle TrP.

METHODS

This is a randomized, single-blind control trial. The study period was from December 2, 2020, to April 10, 2021. Thirty volunteer patients with active upper trapezius TrP were randomly allocated into two groups: (1) IMES, (2) DN. Participants received interventions in three sessions. Primary outcome measurements were neck range of motion (ROM) and TrP circumference. Secondary outcome measurements were pain by visual analog scale (VAS), pain pressure threshold (PPT), disability, TrP longitudinal and transverse diameter, TrP stiffness, and muscle blood flow by vascular resistance index (RI). All outcome measurements were evaluated before, after, and one month after the intervention. If the data were normal, the repeated measure ANOVA test was used; if data were not normal, the Friedman test and the Kruskal-Wallis test was used. A significance level of 0.05 has considered.

RESULTS

ROM increment was significantly more in the IMES group. TrP circumference decrement was significantly more in the IMES group. VAS changes did not show significant difference between two groups. The PPT improvement was significantly more in the IMES group. Disability changes were not significant. Longitudinal diameter changes were significantly more in the IMES group. TrP stiffness changes were not significant. The vascular RI decreased significantly in IMES group.

CONCLUSION

It seems that both IMES and DN have promising effects for improving upper trapezius TrPs. However, IMES is more effective in some clinical and ultrasound parameters. In order to investigate the effects of this intervention more precisely more studies are necessary.

TRIAL REGISTRATION

This study was prospectively registered at Iranian registry of clinical trials (IRCT: IRCT20170616034567N2).

Neurophysiological effects of latent trigger point dry needling on spinal reflexes

Deep dry needling (DDN) is a method to treat muscle trigger points (TrPs) often found in persons with neuromuscular pain and spasticity. Currently, its neurophysiological actions are not well established. Thus, to understand how DDN affects spinal cord physiology, we investigated the effects of TrP DDN on spinal reflexes. In 17 adults with latent TrPs in the medial gastrocnemius (MG) without known neurological or orthopedic injuries, the H reflex, M wave, and reciprocal inhibition in the soleus, MG, and lateral gastrocnemius (LG) and passive ankle range of motion (ROM) were measured before and immediately, 90 min, and 72 h after a single bout of DDN at the MG TrPs. The MG maximum M wave (Mmax) amplitude was decreased immediately and 90 min post DDN (by -14% and -18%) and returned to pre-DDN level at 72 h post. LG and soleus Mmax did not change. The maximum H reflex (Hmax) amplitude did not change in any of the triceps surae. Soleus inhibition was increased significantly immediately (+30%) and 72 h (+36%) post DDN. ROM was increased by ≈4° immediately and ≈3° at 72 h post DDN. Temporary reduction of MG (but not soleus or LG) Mmax amplitude after DDN and its recovery at 72 h post indicate temporary and specific effects of DDN in the treated muscle. The immediate and 72 h post increases in the ROM and soleus inhibition with no changes in Hmax suggest complex effects of DDN at the spinal level.NEW & NOTEWORTHY In this study, we examined the effects of deep dry needling (DDN) on spinal reflexes in the triceps surae. We found that the H reflex (an excitatory reflex) did not change after DDN but soleus inhibition was increased immediately and 72 h after DDN, corresponding to increases in ankle range of motion. Differential effects of DDN on excitatory and inhibitory reflexes over the first 72 h may reflect its complex neurophysiological effects at the spinal level.

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.

Resting muscle tension and trigger points in elite junior short-track athletes and healthy non-athletes: a cross-sectional examination

Introduction

Short-track speed skating (short track) is an Olympic sport characterized by a specific body position and counterclockwise movement on the track. Based on previous studies, we hypothesized that athlete body positions employed in this sport could lead to asymmetric overuse disorders of the left lower limb muscles. An increased number of latent trigger points (LTrPs) was confirmed in individual muscles of the overloaded left limb of short-track athletes. This study aimed to compare the number of LTrPs and the level of resting muscle tone between elite junior short-track athletes and healthy non-athletes.

Methods

The experimental (EXP) group comprised 15 elite short-track junior athletes from the Polish national team and the control (CON) group comprised 15 healthy young volunteers. In both groups, the left leg was tested for (i) the presence of LTrPs and (ii) resting muscle tone (RMT), assessed using surface electromyography in six muscles.

Results

The EXP group showed a higher number of LTrPs in the left lower limb, compared with the CON group. The muscle that was most significantly affected in the athletes was the vastus lateralis obliquus [χ 2 (1, N = 30), p < 0.001, V Cramer = 0.71]. This muscle also differed significantly between the groups in terms of the RMT (p = 0.033, Cohen's d = 0.87).

Conclusions

Elite short-track junior athletes presented with increased RMT and an increased number of LTrPs in the vastus lateralis oblique muscle, compared with healthy non-athletes.

Dry Needling in Overhead Athletes with Myofascial Shoulder Pain: A Systematic Review

The treatment of myofascial pain in athletes requires a set of rehabilitation techniques that aim to be effective quickly. In this context, dry needling (DNY) has shown interesting results due to its ability to reduce pain in the short term. Thus, the aim of this study was to investigate the role of DNY in managing myofascial shoulder pain in overhead athletes. PubMed, Scopus and Web of Science were screened up to March 2024, to identify studies that met the following inclusion criteria: overhead athletes with shoulder pain with a DNY approach for myofascial trigger points (MTrPs), RCT, case-control study, feasibility study as the study design. Exclusion criteria were studies that did not include athletes, studies that did not focus on the treatment of MTrPs with DNY, other reviews, no full-text availability and papers written in a language other than English. Out of 399 articles, 165 were excluded as duplicates. Of the 234 articles screened, only 6 articles met the inclusion criteria. A total of 6 studies were included in the systematic review. Initial results showed that DNY improved pain rapidly and in the short term; however, there is still no consensus on the minimum number and the interval between treatments. Major findings reported a rapid potential decrease in perceived pain, shoulder disability and an increase in muscle strength; in this scenario, DNY might be a valid solution in a sports rehabilitation setting.

Immediate Effect of Ultrasound-Guided Dry Needling on Soleus Muscle Spasticity in Stroke Survivors

BACKGROUND

Dry needling (DN) is commonly used to treat various neuromuscular syndromes. It is effective in reducing spasticity in stroke and other neurological conditions. The current study explores the immediate effect of ultrasound-guided dry needling on soleus muscle spasticity and thickness in individuals with stroke.

METHODS

Approval was obtained from the Institutional Sub-ethics Committee of Dr. D. Y. Patil College of Physiotherapy, Pune. The trial was registered with the Clinical Trials Registry of India. Thirty stroke survivors having soleus muscle spasticity ranging from grade 1 to 4 on the Modified Modified Ashworth Scale (MMAS) were selected. Spasticity was also assessed using the Modified Tardeau Scale (MTS) and H-reflex. Soleus muscle architecture was assessed by using ultrasonography (USG). Participants received a single session of DN for the spastic soleus muscle. Pre and immediate post-DN outcome measures were assessed.

RESULTS

Based on USG findings, the thickness of the soleus muscle significantly increased by 2.67 mm (p<0.001) after dry needling treatment. The MMAS showed decreased spasticity by 1.47 (p<0.001) for ankle plantar flexors. A significant reduction of H-reflex values by 1.4 mV (p<0.001) was noted. The MTS also showed a significant increase in the range of ankle motion by 2.7 (p<0.001). All these indicate an immediate reduction of spasticity following DN.

CONCLUSION

Based on the findings of the current study, we can conclude that a single session of USG-guided DN has an immediate beneficial effect on reducing soleus muscle spasticity and increased muscle thickness in individuals with stroke.

No Evidence of Short-term Changes in Muscle Activity Elicited by Dry Needling in Chronic Unilateral Shoulder Pain Patients

OBJECTIVE

The aim of the study was to assess short-term changes in shoulder muscle activity elicited by dry needling in chronic unilateral shoulder pain (USP) patients.

METHODS

A randomized, double-blind, placebo-controlled clinical trial was conducted, in which 30 volunteers with USP were recruited and randomly assigned to either real or sham dry needling conditions. Pain intensity scores, pressure pain threshold, glenohumeral internal rotation angles, and electromyographic activity during isotonic shoulder tasks (shoulder flexion and extension) were assessed before, immediately, and 72 hours after the intervention in the infraspinatus and deltoid muscles.

RESULTS

A single application of real dry needling resulted in lower pain intensity scores and a larger range in glenohumeral internal rotation 72 hours after the intervention in comparison with sham dry needling. No differences in pressure pain threshold or muscle activity were observed due to the intervention.

DISCUSSION

A single application of real dry needling resulted in clinically significant changes in the short term. No differences were detected in muscle activation in the infraspinatus or deltoid muscles. Complementary interventions and longer follow-up times may be required to observe changes in muscle activity.

Qualitative ultrasonography scale of the intensity of local twitch response during dry needling and its association with modified joint range of motion: a cross-sectional study

BACKGROUND

The relevance of local twitch response (LTR) during dry needling technique (DNT) is controversial, and it is questioned whether LTR is necessary for successful outcomes. Furthermore, because the LTR during the deep DNT may be evoked with different intensities, it is unknown whether the magnitude of LTR intensity is associated with optimal clinical results, especially concerning to the effects of joint maximal range of motion (ROM). This study aimed to (i) determine whether visual inspections can quantify the LTR intensity during the DNT through a qualitative ultrasonography scale of LTR intensity (US-LTR scale), and (ii) assess the differences of US-LTR scale associated with changes in the maximal joint ROM.

METHODS

Using a cross-sectional design, seven asymptomatic individuals were treated with DNT in the latent myofascial trigger point in both medial gastrocnemius muscles. During DNT, three consecutive LTRs were collected. The US-LTR scale was used to classify the LTRs into strong, medium, and weak intensities. The categories of US-LTR were differentiated by the velocity of LTRs using the optical flow algorithm. ROM changes in ankle dorsiflexion and knee extension were assessed before and immediately after DNT.

RESULTS

The US-LTR scale showed the third LTR was significantly smaller than the first one (p < 0.05). A significant difference in velocity was observed between US-LTR categories (p < 0.001). A significant difference in the ROM was observed between the strong and weak-medium intensity (p < 0.05).

CONCLUSIONS

The present findings suggest that the LTR intensity can be assessed using a qualitative US-LTR scale, and the effects of DNT on joint maximal ROM is maximized with higher LTR intensity. This study reports a novel qualitative method for LTR analysis with potential applications in research and clinical settings. However, further research is needed to achieve a broader application.

Effects of Dry Needling of Latent Trigger Points on Viscoelastic and Muscular Contractile Properties: Preliminary Results of a Randomized Within-Participant Clinical Trial

This study aimed to evaluate changes in neuromuscular function and pain perception in latent trigger points (TrPs) in the gastrocnemius muscle after a single session of dry needling. A randomized within-participant clinical trial was conducted. Fifty volunteers with latent TrPs in the gastrocnemius muscles were explored. Each extremity was randomly assigned to a control or experimental (dry needling) group. Viscoelastic parameters and contractile properties were analyzed by tensiomyography. Ankle dorsiflexion range of motion was assessed with the lunge test. Pressure pain thresholds (PPT) and pain perceived were also analyzed. The results observed that three viscoelastic proprieties (myotonometry) showed significant differences in favor of the experimental extremity in the lateral gastrocnemius: stiffness (p = 0.02), relaxation (p = 0.045), and creep (p = 0.03), but not in the medial gastrocnemius. No changes in tensiomyography outcomes were found. The control extremity showed a higher increase in PPTs (i.e., decrease in pressure pain sensitivity) than the experimental extremity (p = 0.03). No significant effects for range of motion or strength were observed. In general, gender did not influence the effects of dry needling over latent TrPs in the gastrocnemius muscle. In conclusion, a single session of dry needling was able to change some parameters of neuromuscular function, such as muscle tone, relaxation, pressure pain sensitivity, and creep in the lateral (but not medial) gastrocnemius but did not improve strength or range of motion.

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).

Electromyographic Assessment of the Efficacy of Deep Dry Needling versus the Ischemic Compression Technique in Gastrocnemius of Medium-Distance Triathletes

Several studies have shown that gastrocnemius is frequently injured in triathletes. The causes of these injuries are similar to those that cause the appearance of the myofascial pain syndrome (MPS). The ischemic compression technique (ICT) and deep dry needling (DDN) are considered two of the main MPS treatment methods in latent myofascial trigger points (MTrPs). In this study superficial electromyographic (EMG) activity in lateral and medial gastrocnemius of triathletes with latent MTrPs was measured before and immediately after either DDN or ICT treatment. Taking into account superficial EMG activity of lateral and medial gastrocnemius, the immediate effectiveness in latent MTrPs of both DDN and ICT was compared. A total of 34 triathletes was randomly divided in two groups. The first and second groups (n = 17 in each group) underwent only one session of DDN and ICT, respectively. EMG measurement of gastrocnemius was assessed before and immediately after treatment. Statistically significant differences (p = 0.037) were shown for a reduction of superficial EMG measurements differences (%) of the experimental group (DDN) with respect to the intervention group (ICT) at a speed of 1 m/s immediately after both interventions, although not at speeds of 1.5 m/s or 2.5 m/s. A statistically significant linear regression prediction model was shown for EMG outcome measurement differences at V1 (speed of 1 m/s) which was only predicted for the treatment group (R² = 0.129; β = 8.054; F = 4.734; p = 0.037) showing a reduction of this difference under DDN treatment. DDN administration requires experience and excellent anatomical knowledge. According to our findings immediately after treatment of latent MTrPs, DDN could be advisable for triathletes who train at a speed lower than 1 m/s, while ICT could be a more advisable technique than DDN for training or competitions at speeds greater than 1.5 m/s.