Article

Postneedling soreness after deep dry needling of a latent myofascial trigger point in the upper trapezius muscle: Characteristics, sex differences and associated factors

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Abstract

Background: Postneedling soreness is considered the most frequent secondary effect associated to dry needling. A detailed description of postneedling soreness characteristics has not been previously reported. Objective: (1) to assess the intensity and duration of postneedling soreness and tenderness after deep dry needling of a trapezius latent myofascial trigger point (MTrP), (2) to evaluate the possible differences in postneedling soreness between sexes and (3) to analyze the influence on postneedling soreness of factors involved in the dry needling process. Methods: Sixty healthy subjects (30 men, 30 women) with latent MTrPs in the upper trapezius muscle received a dry needling intervention in the MTrP. Pain and pressure pain threshold (PPT) were assessed during a 72 hours follow-up period. Results: Repeated measures analysis of covariance showed a significant effect for time in pain and in PPT. An interaction between sex and time in pain was obtained: women exhibited higher intensity in postneedling pain than men. The pain during needling and the number of needle insertions significantly correlated with postneedling soreness. Conclusions: Soreness and hyperalgesia are present in all subjects after dry needling of a latent MTrP in the upper trapezius muscle. Women exhibited higher intensity of postneedling soreness than men.

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... Regarding potential modifiers of PNS, we found that pain during DN and the number of LTRs influenced PNS progression, which was consistent with Martín-Pintado et al., who showed that pain during DN correlated significantly with PNS, and that higher doses in LTRs during DN correlated with higher VAS scores for PNS 24 h and 48 h after intervention, when compared with lower doses [10,11]. ...
... In contrast, sex did not show much influence on PNS, which was still discussed in the literature [10,17]. Nevertheless, when the groups were sorted by sex and based on our data (we estimated the marginal means adjusting for nVAS and the amount of LTRs), PNS course seemed very similar, except for the eccentric exercise group in males. ...
... Finally, regardless of the intervention used, all groups experienced a significant improvement in pVAS, which decreased between 6-12 h after the intervention and completely at 48-72 h after the intervention, in line with previous studies [10,[15][16][17]. ...
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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.
... The intensity of postneedling soreness seems to be associated with the number of insertions of the needle into the MTrP [21]. DDN therapies could be applied in different dosages in terms of the number of local twitch responses (LTRs) elicited. ...
... Patients who received DDN with multiple needle insertions to elicit LTRs presented with greater postneedling soreness prevalence and intensity than those in the control group, who received one unique needle insertion out of the MTrP. In line with previous preliminary research in healthy subjects [21], the number of needle insertions was associated with the intensity of postneedling 4 Postneedling Soreness and Tenderness After DDN 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 580 581 582 583 584 585 586 587 588 589 590 591 592 593 594 soreness. However, no differences were observed regarding postneedling soreness prevalence and pain intensity in between groups in which LTRs were elicited. ...
... In the present study, 94.2% of patients presented postneedling soreness, whereas other studies observed proportions of 55% [40,41], 88% [42], or 91.4% [13]. These proportions of subjects with postneedling 641 642 643 644 645 646 647 648 649 650 651 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675 676 677 678 679 680 681 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 701 702 703 704 705 706 707 708 709 710 711 712 713 714 715 716 717 718 719 720 721 722 723 724 725 726 727 728 729 730 731 732 733 734 735 736 737 738 739 740 741 742 743 744 745 746 747 748 749 750 751 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 soreness seem to be lower compared with other studies in healthy subjects [19][20][21]. Asymptomatic subjects may have a greater capacity to describe postneedling soreness in detail because it does not overlap with any myofascial pain. ...
Article
Background: Previous studies in asymptomatic subjects have demonstrated that myofascial trigger point (MTrP) dry needling is frequently associated with postneedling soreness. However, to the author's knowledge, there is not any study that performs a detailed description of postneedling soreness characteristics in patients with myofascial pain. This information could help clinicians to make evidence-informed decisions considering the benefits and negative effects of different dry needling dosages. Objective: (1) to compare the prevalence, intensity and duration of postneedling soreness and tenderness after different dosages of deep dry needling (DDN) and (2) analyze the influence on postneedling soreness of psychological factors and other factors involved in the DDN process DESIGN: A 1-week follow-up, double-blind randomized controlled trial. Setting: University community. Participants: Patients (n=120: 34 males; 86 females) aged 18 to 53 years (median±IR, 21.0±7.0y) with active MTrPs in the upper trapezius. Intervention: All patients received DDN in an active MTrP. They were randomly divided into 4 groups: no local twitch responses (LTRs) elicited (Control group), 4 LTRs elicited, 6 LTRs elicited and DDN until no more LTRs were elicited. Main outcome measures: post-needling soreness and pressure pain threshold (PPT) were assessed before treatment, during DDN procedure and every 24 hours during one week. Results: Postneedling soreness showed a significant effect for time (F2,006=173.603;P<.001,ηp2=0.659) and a significant interaction between group and time (F6,017=3.763;P=.001;ηp2=0.111). PPT showed a significant effect for time (F2,377=16.833;P<.001;ηp2=0.127) and a significant interaction between group and time (F7,130=2.100;P=.04;ηp2=0.052). Psychological factors did not show relevant correlations with the intensity of postneedling soreness. Conclusions: Postneedling soreness is present in most of subjects after DDN of active MTrPs. The groups in which DDN was performed eliciting LTRs exhibited greater post-needling soreness. The number of needle insertions was associated with postneedling soreness but psychological factors did not seem to play a relevant role on its perception.
... The insertion of a needle into a skeletal muscle can also provoke a micro trauma 42 followed by a local haemorrhage and damage to the intra-muscular nerve. 43 According to Martin-Pintado-Zugasti and colleagues, 42 post-needling soreness is observed in 50% to 100% of patients when an LTR is elicited, and the number of LTRs at one insertion site seems to be positively correlated with levels of post-needling soreness. We know that if there is too much damage, there can be an increase of SP levels, tumour necrosis factor, and cyclooxygenase. ...
... A previous study have reported that the post-needling soreness usually resolved within 72 hours and typically lasted no more than five days. 42 Future research could measure the tone and stiffness of a TP post DN on consecutive days (4)(5) to see if the tone and stiffness lessens after the soreness disappears and to see the duration of the positive effect of the DN on TPs. ...
Article
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.
... Pressure pain sensitivity directly influences muscle properties and pain due to mechanical hyperalgesia caused by DN treatment (Martín-Pintado-Zugasti et al., 2016). In the present study, we found a tendency to increased pain sensitivity at 24 h and a decrease at 72 h after the intervention probably due to the mechanical hyperalgesia caused by needling. ...
... In the present study, we found a tendency to increased pain sensitivity at 24 h and a decrease at 72 h after the intervention probably due to the mechanical hyperalgesia caused by needling. Our results are similar to those shown by other studies, which conclude that there is an effect of mechanical hyperalgesia related to post-needling soreness (Martín-Pintado-Zugasti et al., 2016) that can last up to 3 days, and that the improvement in sensitivity to pressure pain in LTrPs appears at 72 h (Martín-Pintado-Zugasti et al., 2016;Walsh et al., 2019). ...
Article
Background Latent trigger point (LTrP) can cause motor dysfunction and disturb normal patterns of motor recruitment. Objective To analyze the effects of DN in the upper trapezius (UT) LTrP on pain and the mechanical and contractile properties of the muscle. Design A randomized, double-blinded, parallel-group-trial. Methods Fifty healthy volunteers with LTrPs in the UT were randomly divided into a DN-group (n = 26) and a Sham-DN-group (n = 24) and received one session of DN or placebo treatment. Mechanical and contractile properties of the muscle and pressure pain perception (PPP) were evaluated before treatment and in a 30min, 24 h and 72 h follow-up after treatment. Results In the mechanical properties, the DN-group showed lower values than the Sham-DN-group for dynamic stiffness at 72 h (p = 0.04). The DN-group showed lower values for dynamic stiffness at 72 h from baseline (278.74 ± 38.40 to 261.54 ± 33.64 N/m; p = 0.01) and for tone at 72 h from 30min (16.62 ± 1.27 to 15.88 ± 1.31 Hz; p = 0.01). In the contractile properties, the DN-group showed higher values for maximal radial displacement (Dm) of the muscle belly at 72 h from baseline (5.38 ± 1.67 to 6.13 ± 1.70 mm; p = 0.04), higher values for contraction time at 30min (28.53 ± 8.80 s; p = 0.03) and lower ones at 72 h (24.74 ± 4.36 s; p = 0.04) from baseline (26.97 ± 6.63 s). The DN-group showed a decrease of PPP from baseline to 72 h after treatment (5.16 ± 1.33 to 4.02 ± 0.97 mm; p < 0.01). Conclusion The application of DN in healthy volunteers over LTrPs in the UT decreased dynamic stiffness, tone and contraction time and increased Dm at 72 h after treatment. Additionally, the PPP showed a decrease at 72 h after needling. ClinicalTrials.gov NCT04466813
... Pressure pain sensitivity directly influences muscle properties and pain due to mechanical hyperalgesia caused by DN treatment (Martín-Pintado-Zugasti et al., 2016). In the present study, we found a tendency to increased pain sensitivity at 24 h and a decrease at 72 h after the intervention probably due to the mechanical hyperalgesia caused by needling. ...
... In the present study, we found a tendency to increased pain sensitivity at 24 h and a decrease at 72 h after the intervention probably due to the mechanical hyperalgesia caused by needling. Our results are similar to those shown by other studies, which conclude that there is an effect of mechanical hyperalgesia related to post-needling soreness (Martín-Pintado-Zugasti et al., 2016) that can last up to 3 days, and that the improvement in sensitivity to pressure pain in LTrPs appears at 72 h (Martín-Pintado-Zugasti et al., 2016;Walsh et al., 2019). ...
Article
The aim of this study was to analyze the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on muscle stiffness. A total of 51 recreational physically active subjects with LTrPs in the upper trapezius volunteered to participate and were randomly divided into a DN-group (n=27) and a sham-DN group (n=24). Volunteers received 1-session of DN or placebo treatment. Muscle stiffness, measured with strain and shear-wave elastography, pressure pain threshold (PPT), post-needling soreness, and muscle thickness were evaluated before treatment, and at 30-min, 24-hours, and 72-hours follow-up after treatment. The DN-group showed lower values from baseline for muscle stiffness measured with shear-wave elastrography at 24-hours (from 44.44±15.97 to 35.78±11.65 kpa; p<0.01) and at 72-hours (35.04±12.61 kpa; p<0.01) and with strain elastography at 72-hours (from 1.75±0.50 to 1.36±0.40 AU; p<0.01). The DN-group showed higher values of PPT than the sham-DN group at 72-hours (4.23±0.75 vs. 5.19±1.16 kg/cm²; p<0.05). There was a progressive decrease in post-needling soreness compared to pain during needling of 33.13±21.31% at 30-min, 80.92±10.06% at 24-hours, and a total decrease in post-needling soreness in all participants at 72-hours. DN therapy is effective in reducing short-term muscle stiffness and increasing the PPT in volunteers with LTrPs in the upper trapezius after a treatment session. Perspective This study found that one session of DN intervention in latent trigger points of the upper trapezius muscle reduced muscle stiffness and the pressure pain threshold for the dry needling group compared to the sham dry needling group. Clinicaltrials.gov NCT04394741.
... We do not perform dryneedling therapy on unconscious and mentally ill patients, due to lack of feedback from the patient. Contraindications have to be considered as a potential ban to the therapy, we always should look at the potential goals that could be achieved risking the possibility of risk factor [14,15]. ...
... Severe complications after the procedure are rare. Dry needling is usually accompanied by painfulness upon piercing of the skin and during manipulations [14]. The procedure is quite often followed by bruising and blood outflow upon removal of the needle; pain after the procedure is also quite common, especially if the trapezius muscle is treated. ...
Article
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Dry needling is one of the methods used to treat myofascial pain syndrome. The treatment involves the use of disposable acupuncture needles but dry needling and acupuncture are not the same. In most cases, the treatment includes myofascial trigger point puncturing. The desired effect to be achieved during the procedure is eliciting a local muscle contraction. The most common response after treatment is pain in the needled area.
... However, in our study, the results show that immediately after treatment the intensity of pain worsened, being greater in the DN group, improving after 48 h, and the improvement is maintained and even increased one week after treatment. These results justify and support studies that have shown that pain and hyperalgesia are present in all subjects after DN treatment of latent MTrPs, usually lasting less than 72 h [77,78]. ...
Article
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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.
... Post-needling soreness directly influences PPT due to mechanical hyperalgesia caused by the DN intervention [24]. The PPT results of the present study are in consonance with previous articles using volunteers with LTrPs [11,12,25]. ...
Article
Objective To analyse the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on pressure pain threshold (PPT) and surface electromyography (sEMG). Design Randomized, double-blind, placebo controlled clinical trial. Settings Sports Rehabilitation Laboratory, University of Castilla-La Mancha. Participants Forty-six participants (18-35 years old) with LTrP in the upper trapezius were divided into two groups: DN-group and Sham-DN-group. Interventions In the DN-group, the needle was inserted 10-times through the skin, and it was manipulated up and down using a "fast in and out" technique. In the Sham-DN-group, non-penetrating needles were used. Main outcome measures PPT, sEMG at rest, and sEMG in isometric contraction of the LTrP of the upper trapezius muscle were evaluated at baseline, 30 min after treatment, and after 24 hours, and 72 hours of follow-up. Results The mean change in sEMG at rest between baseline and 30 min was -0.38 (0.38) %refRMS for the DN group and -0.05 (0.31) %refRMS for the Sham-DN group (mean difference -0.34, 95% confidence interval (CI) of the difference: -0.54 to -0.13), and between baseline and 24 hours was -0.35 (0.35) %refRMS for the DN group and -0.06 (0.58) %refRMS for the Sham-DN group (mean difference -0.29, 95% CI: -0.57 to -0.01). In addition, the DN-group showed higher values of PPT than the Sham-DN group at 72 hours (5.22 (1.23) to 4.65 (1.03) kg/cm²; p<0.05). Conclusions A single session of DN intervention was effective in reducing the electromyographic activity, muscle fatigue and pain of the upper trapezius muscle in LTrP.
... Two meta-analyses comparing the effects of dry needling with wet needling using lidocaine concluded that short-term results are similar [23][24][25][26]. In 2016, the Canadian Agency for Drugs and Technologies in Health accepted the use of DDN in the public health system for the treatment of different musculoskeletal pain syndromes [27][28][29][30]. A recent meta-analysis study on the use of DDN in temporomandibular disorders concluded that the technique in question considerably reduces pain intensity compared with sham therapy [31,32]. ...
Article
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Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points.
... In a corresponding study in 2016, Martin-Pintado et al. reported that 48 hours after a dry needling session in patients with latent trigger points of the upper trapezius muscle, the PPT was lower than before treatment [32]. The discrepancy between the present study and the Martín-Pintad study was probably due to differences in the nature of the trigger point and the number of treatment sessions in the two studies. ...
Article
Background and Objectives: The purpose of the present study was to examine the effectiveness of dry needling as local treatment of upper trapezius trigger points related to chronic neck pain on pain and pain pressure threshold in women with chronic nonspecific neck pain. Methods: Thirty females with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the intervention for three weeks. The outcomes were pain intensity and pain pressure threshold. Every outcome was recorded at baseline and 2 days after the fifth session. Results: Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. The results of the independent t-test showed a significant difference in measurements between the dry needling and passive stretch groups (P
... Regarding ankle mobility, we did not find any significant improvement, which was in contrast with previous investigations. MTPs may adversely affect clinical effects on restricted ROM [41]. According to Hong-You et al., restricted joint ROM is commonly observed in health people when latent MTPs [16] are present because they can produce a series of neuromuscular disorders, such as inefficient muscle contraction [42]. ...
Article
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Abstract: (1) Background: Myofascial pain syndrome (MPS) is a clinical condition characterized by localized non-inflammatory musculoskeletal pain caused by myofascial trigger points. Diathermy or Tecar therapy (TT) is a form of noninvasive electro-thermal therapy classified as deep thermotherapy based on the application of electric currents. This technique is characterized by immediate effects, and its being used by high performance athletes. (2) Methods: A total of thirty-two participants were included in the study who were professional basketball players. There was a 15-person Control Group and a 17-person Intervention Group. TT was applied in the Intervention Group, while TT with the device switched off (SHAM) was applied in the Control Group. The effects were evaluated through the Lunge test, infrared thermography, and pressure threshold algometry at baseline, 15, and 30 min after the intervention. (3) Results: the Intervention Group exhibited a greater increase in absolute temperature (F[1,62] = 4.60, p = 0.040, η2p = 0.13) compared to the Control Group. There were no differences between the groups in the Lunge Test (F[1.68,53.64] = 2.91, p = 0.072, η2p = 0.08) or in pressure algometry (visual analog scale, VAS) (F[3.90] = 0.73, p = 0.539, η2p = 0.02). No significant short-term significant differences were found in the rest of the variables. (4) Conclusions: Diathermy can induce changes in the absolute temperature of the medial gastrocnemius muscle.
... However, these results contradict those previously found in other conducted studies, in which mechanical hyperalgesia occurs immediately after the DN is applied to healthy subjects, lasting up to 48 h [57][58][59]. It is possible that different pain processing mechanisms are activated in patients when DN is applied to active MTrPs, as shown by immediate increases found in previous studies. ...
Article
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Abstract Background: Dry needling (DN) is often used for the treatment of muscle pain among physiotherapists. However, little is known about the mechanisms of action by which its effects are generated. The aim of this randomized controlled trial was to determine if the use of DN in healthy subjects activates the sympathetic nervous system, thus resulting in a decrease in pain caused by stress. Methods: Sixty-five healthy volunteer subjects were recruited from the University of Alcala, Madrid, Spain, with an age of 27.78 (SD = 8.41) years. The participants were randomly assigned to participate in a group with deep DN in the adductor pollicis muscle or a placebo needling group. The autonomic nervous system was evaluated, in addition to local and remote mechanical hyperalgesia. Results: In a comparison of the moment at which the needling intervention was carried out with the baseline, the heart rate of the dry needling group significantly increased by 20.60% (SE = 2.88), whereas that of the placebo group increased by 5.33% (SE = 2.32) (p = 0.001, d = 1.02). The pressure pain threshold showed significant differences between both groups, being significantly higher in the needling group (adductor muscle p = 0.001; d = 0.85; anterior tibialis muscle p = 0.022, d = 0.58). Conclusions: This work appears to indicate that dry needling produces an immediate activation in the sympathetic nervous system, improving local and distant mechanical hyperalgesia. View Full-Text Keywords: dry needling; autonomic nervous system; physiological effects; cortisol; pain physiology
... The absence of side effects in this study was due to the fact that the operators who carried out DN actions were properly trained and competent in their field. 23 This proves that DN is a minimally invasive procedure that is easy to perform and has minimal side effects. ...
Article
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BACKGROUND Myalgia is a common complaint in the general population, but it is underappreciated and often undertreated. Myofascial pain syndrome is a form of myalgia that is characterized by local regions of muscle hardness. The main components of this syndrome are the trigger points that are composed of taut bands. Various invasive and non-invasive procedures are available to inactivate myofascial trigger points. Dry needling involves inserting a filiform needle directly into a trigger point without injection of material. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn, and carries a low risk for reducing pain. OBJECTIVE The aim of this study was to test the hypothesis that dry needling could reduce pain in subjects with myofascial pain syndrome in the upper trapezius muscle on Sanglah Hospital’s workers. METHOD Twenty-six subjects with myofascial pain syndrome in the upper trapezius muscle were randomly divided into two groups: 13 subjects in the control group received acetaminophen, and 13 subjects in the dry needling group received dry needling and acetaminophen. The numeric rating scale was assessed before, 1 hour, 24 hours, and 7 days after the treatment. Side effects of dry needling were evaluated every day for 7 days follow-up. The total amount of acetaminophen was assessed at last day follow up. RESULTS At baseline, the numeric rating scale was same in control versus dry needling group. Reduction in all numeric rating scale at 1 hour, 24 hours, and 7 days after dry needling was significant (p<0.05). CONCLUSION Dry needling could reduce pain and oral analgesic consumption in subjects with myofascial pain syndrome in the upper trapezius muscle. There were no side effects of dry needling reported on this study.
... The effectiveness of DDN compared to ICT in the upper trapezius was carried out in 2016 in a comparative study. The results at 48 hours were better for DDN compared to ICT in terms of pain intensity reduction and increase in PPT [72][73][74][75][76]. Indeed, PPT were considerably greater after 48 hours in those subjects treated with DDN than in those subjects who received ICT [43]. ...
Article
Full-text available
Background: Deep dry needling (DDN) and ischemic compression technic (ICT) may be considered as interventions used for the treatment of Myofascial Pain Syndrome (MPS) in latent myofascial trigger points (MTrPs). The immediate effectiveness of both DDN and ICT on pressure pain threshold (PPT) and skin temperature of the latent MTrPs of the triceps surae has not yet been determined, especially in athletes due to their treatment requirements during training and competition. Objective: To compare the immediate efficacy between DDN and ICT in the latent MTrPs of triathletes considering PPT and thermography measurements. Method: A total sample of 34 triathletes was divided into two groups: DDN and ICT. The triathletes only received a treatment session of DDN (n = 17) or ICT (n = 17). PPT and skin temperature of the selected latent MTrPs were assessed before and after treatment. Results: Statistically significant differences between both groups were shown after treatment, showing a PPT reduction (p < 0.05) in the DDN group, while PPT values were maintained in the ICT group. There were not statistically significant differences (p > 0.05) for thermographic values before and treatment for both interventions. Conclusions: Findings of this study suggested that ICT could be more advisable than DDN regarding latent MTrPs local mechanosensitivity immediately after treatment due to the requirements of training and competition in athletes' population. Nevertheless, further studies comparing both interventions in the long term should be carried out in this specific population due to the possible influence of delayed onset muscle soreness and muscle damage on PPT and thermography values secondary to the high level of training and competition.
... Soreness after needling is reported as a common side effect. Researchers have previously suggested that this soreness results from neuromuscular tissue damage, possible bleeding of blood vessels, and an initial inflammatory response (Martin-Pintado-Zugasti, Mayoral Del Moral, Gerwin, and Fernandez-Carnero, 2018;Martin-Pintado-Zugasti, Rodriguez-Fernandez, and Fernandez-Carnero, 2016). There appears to be an association between the number of needle insertions in the tissues and the amount of post-needling soreness (Fernandez-Carnero et al., 2017;Martin-Pintado-Zugasti, Mayoral Del Moral, Gerwin, and Fernandez-Carnero, 2018). ...
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Study design: Pilot study. Background: Dry needling has been an emerging treatment option for physical therapists over the last decade. Despite the fact that studies have demonstrated the overall benefit of dry needling, there is no clear understanding how long needles should be left in place (situ). This pilot study investigated the effects of needles remaining in situ based on autonomic responses over time. Methods: A convenience sample of 21 subjects were recruited for this study. Automated pupillometry was utilized to obtain a direct measure of autonomic nervous system activity. Directly following a baseline measurement, 8 type J Seirin Acupuncture needles were inserted paravertebral at the C7-T3 segments. A total of 8 post-needling 60 seconds pupil measurements were taken at 3 minutes intervals for 24 minutes post needling. Outcomes: A statistical significant difference in mean pupil diameter was found following the needle intervention (p < .01), which implies an increased sympathetic activity. This subject sample had a statistically significantly larger mean pupil diameter immediately after the needling, which lasted until measure point 7, at 18 minutes (P < .05). At measure point 8 there was no longer a statistical significant difference compared to the premeasurement measure. Discussion: The results of this study provide evidence that dry needling results in a significant increased activity of the sympathetic nervous system for up to 18 minutes. Between 18 and 21 minutes autonomic activity returned to a non-significant difference compared to baseline. The results of this study could assist clinicians in clinical decision making to determine needle placement time.
... Potential side effects of myoActivation include: sweating, light-headedness/ presyncope, pain from needle insertion, hematoma, muscle spasm, nausea, vomiting, syncope, post-treatment muscle pain [146], pneumothorax, infection, and failure to respond. ...
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Chronic pain is a significant burden in all societies. The myofascial origins of chronic pain are often unrecognized but play a major role in chronic pain generation. Myofascial release has been shown to be effective and can augment the limited number of therapeutic tools available to manage chronic pain However, there is no standardized approach that allows for comparative analysis of this technique. myoActivation is a unique therapeutic system which targets active myofascial trigger points, fascia in tension and scars in patients with chronic pain. Targets for intervention are determined through obtaining a history of lifetime trauma and a structured, reproducible posture and movement assessment. Catenated cycles of movement tests, palpation and needling are used to achieve the goal of pain resolution through restoration of soft tissue integrity. This chapter describes the distinctive features of myoActivation from the important key elements of the patient’s clinical history, through to the aftercare instructions. Relevant evidence for each component will be presented. Case studies will be used to illustrate some important concepts and the effectiveness of myoActivation. This chapter is relevant to all clinicians that manage people living with chronic pain.
... Postneedling soreness is thought to be result of neuromuscular injury, and hemorrhage and inflammatory reaction caused by the needle. The needle insertions, pain perceived during treatment (Martin-Pintado-Zugasti et al., 2018;Martin-Pintado-Zugasti et al., 2016) and psychosocial factors (Martin-Pintado-Zugasti et al., 2017) have been shown to correlate with postneedling soreness. Postneedling soreness is usually resolved within 72 hours and commonly within clinical practice patients receiving DN do not consider this soreness relevant. ...
Article
This edition of the overview of current myofascial pain literature features several interesting and important publications. From Australia, Braithwaite and colleagues completed an outstanding systematic review of blinding procedures used in dry needling (DN)studies. Other papers tackled the interrater reliability of the identification of trigger points (TrP), the presence of muscle hardness related to latent TrPs, pelvic floor examination techniques, and the links between TrPs, headaches and shoulder pain. Israeli researchers developed a theoretical model challenging the contributions of the Cinderella Hypothesis to the development of TrPs. As in almost all issues, we included many DN, injection and acupuncture studies, which continue to be the focus of researchers all over the world.
... Moreover, although patients with LBP treated with DN who experienced LTR, compared to no LTR, had temporary improvements in sensorimotor function of multifidus, no between-group difference was reported with pain, sensitivity, or disability levels [90]. Exhausting the LTR has been associated with higher levels of inflammation [91] and subsequently more post-treatment soreness [33,81,92,93]. It is unknown if or how many patients experienced a LTR in our sample since this variable was not collected nor is it always observable in the lumbar spine [94]. ...
Article
Objective: The purpose of this study was to examine the within and between-group effects of segmental and distal dry needling (DN) without needle manipulation to a semi-standardized non-thrust manipulation (NTM) targeting the symptomatic spinal level for patients with non-specific low back pain (NSLBP). Methods: Sixty-five patients with NSLBP were randomized to receive either DN (n = 30) or NTM (n = 35) for six sessions over 3 weeks. Outcomes collected included the oswestry disability index (ODI), patient specific functional scale (PSFS), numeric pain rating scale (NPRS), and pain pressure thresholds (PPT). At discharge, patients perceived recovery was assessed. Results: A two-way mixed model ANOVA demonstrated that there was no group*time interaction for PSFS (p = 0.26), ODI (p = 0.57), NPRS (p = 0.69), and PPT (p = 0.51). There was significant within group effects for PSFS (3.1 [2.4, 3.8], p = 0.018), ODI (14.5% [10.0%, 19.0%], p = 0.015), NPRS (2.2 [1.5, 2.8], p = 0.009), but not for PPT (3.3 [0.5, 6.0], p = 0.20). Discussion: The between-group effects were neither clinically nor statistically significant. The within group effects were both significant and exceeded the reported minimum clinically important differences for the outcomes tools except the PPT. DN and NTM produced comparable outcomes in this sample of patients with NSLBP. Level of evidence: 1b
... The PPT increased significantly in the ISP group while it showed no significant change in the UT group after the interventions. This finding can be attributed to post-needling soreness, which has been reported to remain from one to five days after DN 32 . The post-needling soreness may be more of an issue in the UT than ISP due to the higher limbic system activity in patients with UT myofascial pain syndrome 33 . ...
Article
Context: Chronic musculoskeletal disorders in shoulder joint are often associated with myofascial trigger points (MTrP), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe post-needle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard. Objective: To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. We hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP. Design: Single-blind randomized clinical trial. Setting: Sports medicine physical therapy clinic. Participants: 40 overhead athletes (age 36±16 yo; 20 females, 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n=21) and ISP DN (n=19) groups. Intervention: An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in three sessions (2-day interval between sessions) for each group. Main outcome measures: Pain intensity (visual analog scale), pain pressure threshold (PPT) and disability in the arm, hand and shoulder (DASH) were assessed before and after the interventions. Results: Pain and disability decreased significantly in both groups (P<0.001) and PPT increased significantly only in the ISP group (p=0.020). However, none of the outcome measures showed a significant inter-group difference after treatments (P>0.05). Conclusions: Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.
... Therefore, the results suggest a delay effect after the dry needling technique with twitch response. There is also a relationship between the patient's gender and pain relief as well as the frequency needed to receive LTR until the end of the treatment so that there is no more LTR [33]. The study results are consistent with our study, especially in the group of dry needling without LTR. ...
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Abstract: (3038 Views) Purpose: Dry needling has been introduced as an effective method to treat the upper trapezius myofascial pain. Muscle damage after receiving the local twitch response can increase the risk of tissue fibrosis in some cases. This study aimed to investigate how the clinical parameters change after dry needling without local twitch response. Methods: This is a quasi-experimental study, with pretest and posttest. A total of 26 patients suffering from neck pain with an active trigger point in their upper trapezius muscles were recurited via the convenience sampling methods. In all patients, the needle was moved 15 times in the trigger point of the trapezius muscle and then remained in place for 5 minutes. Participants were assigned in the dry needling with local twitch response (experimental group) when a local twitch response was evoked from muscle and without receiving local twitch response or deqi (control group) when a local twitch response was not seen. Then, they were treated with one session of dry needling. Before the intervention and 24 hours after the treatment, pain, pain pressure threshold, and neck disability index were evaluated. The obtained data were analyzed by multivariate ANCOVA using SPSS version 20. Results: After the treatment, no significant changes were seen in the experimental group compared to the control group (P>0.05) regarding the pain, the pain pressure threshold, and neck disability index. Conclusion: Dry needling along with receiving local twitch response does not have a superiority over the dry needling without receiving the local twitch response while the treatment aimed to receive the immediate effects. Keywords: Myofascial trigger point syndrome, Dry needling, Local twitch response
... Post-treatment soreness is a common phenomenon ensuing during the treatment of MTrPs. It is one of the main adverse effects associated with MTrP procedures, frequently occurring after deep dry needling (Leon-Hernandez et al., 2016;Martin-Pintado-Zugasti et al., 2015;Martin-Pintado-Zugasti et al., 2016, 2014. Several studies have ascertained possible ways of reducing posttreatment soreness, i.e. electrical nerve stimulation (Leon-Hernandez et al., 2016), spray and stretch (Martin-Pintado Zugasti et al., 2014) and ischemic compression (Martin-Pintado- Zugasti et al., 2015). ...
Article
Background Kinesio taping is a possible therapeutic modality for myofascial pain, nevertheless, very scarce research has been performed on this subject. Objective To evaluate the immediate and short-term effect of kinesio taping application on myofascial trigger points (MTrPs) and pressure pain thresholds (PPTs) in the upper trapezius and gastrocnemius muscles. Methods Two randomized, single-blinded, controlled trials were simultaneously executed on the upper trapezius and gastrocnemius muscles. Different participants in each study were randomly assigned to an active intervention (N = 15) or control (N = 15) group. Kinesio taping was applied on the gastrocnemius or upper trapezius muscles by positioning three “I” strips in a star shape (tension on base) directly above the MTrPs in the active intervention group and a few centimeters away from the MTrPs in the controls. Results The second evaluation on both sides showed lower PPT values than the first evaluation in the control group, denoting that the spots were more sensitive. The third evaluation showed even lower values. The active intervention group showed a contralateral side pattern similar to the controls. However, on the side of the kinesio taping application, the PPT values of the second evaluation were higher (the spots were less sensitive) and after 24 h returned to the original values. The difference between the PPT measurements on the MTrPs’ side of the active intervention group vs. the controls (time-group interaction) was significant (F (2,56) = 3.24, p = 0.047). Conclusions We demonstrated that a kinesio taping application positioned directly above the MTrPs may prevent an increase in sensitivity (decrease in PPT) immediately after application and prevent further sensitization up to 24 h later. The fact that two different muscles were similarly affected by the kinesio taping application, confirmed that the results were not in error. Further studies are needed to directly test the effect of a kinesio taping application on post-treatment soreness.
Article
Background Cervicogenic headache (CGH) is a common condition with a neuroanatomical basis involving the trigeminal nerve. Dry needling (DN) is a safe and effective treatment for CGH but most studies involve deep DN to cervical musculature. Objective The aim of this study was to investigate immediate effects of superficial DN of the trigeminal nerve innervation field on numeric pain rating scale (NPRS), flexion-rotation test (FRT), cervical range of motion (AROM), and pain-pressure threshold (PPT) of right (R) and left (L) supraorbital (SO), and right (R) and left (L) greater occipital (GO) nerves in participants with CGH. Methods A parallel controlled randomized design involving 30 participants with CGH received either superficial DN (N = 17) or sham DN (N = 13). Participants and outcome assessors were blind to group assignment. Wilcoxon signed rank analyzed within-group effects and Mann–Whitney U analyzed between-group. Results Statistically significant between-group differences were observed for NPRS (P < .001) and AROM (P < .006) favoring DN and were clinically meaningful. Right and left Flexion rotation tests (FRT) outcomes were non-significant (P = .137) but clinically meaningful. No differences were observed for PPT over: R SO (P = .187); L SO (P = .052); R GO (P = .187); or L GO (P = .052). Between-group effect sizes across variables were moderate to large (0.53–1.4) but confidence intervals were wide. Conclusion Superficial DN targeting the innervation field of the trigeminal nerve improves clinical outcomes in patients with CGH. Only the immediate effects were analyzed and the sample size was small. Larger, longer-term assessments are needed comparing superficial DN of the trigeminal innervation field and other conservative interventions for CGH.
Article
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.
Article
Acupuncture and dry needling are both minimally invasive procedures that use thin, filiform needles without injectate for the management of a variety of neuromusculoskeletal pain conditions. While the theoretical constructs underlying the use of acupuncture and dry needling are unique, both appear to have the ability to elicit biochemical, biomechanical, endocrinological and neurovascular changes associated with reductions in pain and disability. However, optimal treatment dosage has yet to be determined, and there is a lack of consistency in the literature on the number of needles that should be inserted and the needle retention time. Therefore, the purpose of this narrative review is to further explore the importance of these two variables. While trigger point dry needling advocates single needle insertions via repetitive, quick in-and-out pistoning, most acupuncture and dry needling clinical trials have incorporated multiple needles for five to 40 minutes. Notably and to date, using a single needle to repeatedly prick trigger points one at a time with fast-in and fast-out pistoning maneuvers has not yet been shown to produce significant and clinically meaningful long term improvements in pain and disability in many musculoskeletal conditions. Insertion of multiple needles for typically 20-30 minute durations has been shown to produce larger treatment effect sizes and longer-lasting outcomes than brief, single-needle strategies. Moreover, the number of needles and needle retention time are two variables associated with treatment dosage and must be carefully matched with specific musculoskeletal conditions and the patient’s goals.
Article
Objective: To determine the immediate efficacy of a single session of deep dry needling (DDN) vs ischemic compression (ICT) in a latent myofascial trigger point (MTrP) of the shortened triceps surae from triathletes for ankle dorsiflexion and redistribution of plantar pressures and stability. Design: A randomized simple blind clinical trial (NCT03273985). Setting: An outpatient clinic. Subjects: Thirty-four triathletes with a latent MTrP in the shortened gastrocnemius. Methods: Triathletes were randomized to receive a single session of DDN (N = 17) or ICT (N = 17) in a latent MTrP of the shortened triceps surae. The primary outcome was ankle dorsiflexion range of motion (ROM) by a universal goniometer. Secondary objectives were distribution of dynamic and static plantar pressures by T-Plate platform pressure, with measurements both before and after five, 10, 15, 20, and 25 minutes of treatment. Results: There were no statistically significant differences (P > 0.05) for ankle dorsiflexion ROM or dynamic and static plantar pressures between the experimental group treated with DDN and the control group treated with ICT before and after treatment. Conclusions: DDN vs ICT carried out in latent MTrPs of the shortened gastrocnemius of triathletes did not present differences in terms of dorsiflexion ROM of the tibiofibular-talar joint or in static and dynamic plantar pressure changes before and immediately after treatment.
Article
Background Application of dry needling is usually associated to post-needling induced-pain. Development of post-needling intervention targeting to reduce this adverse event is needed. Objective To determine the effectiveness of low-load exercise on reducing post-needling induced-pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. Design A 72h follow-up, single-blind randomized controlled trial. Setting Urban hospitals. Participants Individuals with subacromial pain syndrome (n=90, 52% female, mean age: 35±13 years) with active TrPs in the infraspinatus muscle. Interventions All individuals received dry needling into infraspinatus active TrP. Then, they were randomly divided into experimental group, which received a single bout of low-load exercise of shoulder muscles; placebo group, which received inactive ultrasound for 10min; and control group, which did not receive any intervention. Outcome Measures Numerical pain rate scale (NPRS, 0-10 point) at post-needling, immediate post-intervention (2min), and 24h, 48h, and 72h after needling. Shoulder pain (NPRS, 0-10) and disability (DASH: Disabilities of the Arm, Shoulder and Hand; SPADI: Shoulder Pain and Disability Index) were assessed before and 72h after needling. Results The 5x3 ANCOVA showed that the exercise group demonstrated a larger decrease in post-needling induced-pain immediately after (P=.001), 24h (P=.001) and 48h after (P=.006) than placebo or control groups. No differences were found at 72h (P=.03). Similar improvement in shoulder pain (P<.001) and related-disability (DASH: P<.001; SPADI: P<.001) was observed 72h after needling irrespective of the treatment group. Conclusions Low-load exercise was effective for reducing post-needling induced-pain on active TrPs in the infraspinatus muscle 24h and 48h after needling. The application of post-needling intervention did not influence short-term pain and disability changes.
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Background: Myofascial trigger point (MTrP) injection and trigger point dry needling (TrPDN) are widely accepted therapies for myofascial pain syndrome (MPS). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. Objective: This is the first review exploring the available literature, regardless of study design, on the neurophysiological effects and clinical significance of the LTR as it relates to reductions in pain and disability secondary to MTrP needling. Methods: PubMed, MEDLINE, Science Direct and Google Scholar were searched up until October 2016 using terms related to trigger point needling and the LTR. Results: and Discussion: Several studies show that eliciting a LTR does not correlate with changes in pain and disability, and multiple systematic reviews have failed to conclude whether the LTR is relevant to the outcome of TrPDN. Post needling soreness is consistently reported in studies using repeated in and out needling to elicit LTRs and increases in proportion to the number of needle insertions. In contrast, needle winding without LTRs to MTrPs and connective tissue is well supported in the literature, as it is linked to anti-nociception and factors related to tissue repair and remodeling. Additionally, the positive biochemical changes in the MTrP after needling may simply be a wash out effect related to local vasodilation. While the LTR during TrPDN appears unnecessary for managing myofascial pain and unrelated to many of the positive effects of TrPDN, further investigation is required.
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Trigger point dry needling is a treatment technique used by physical therapists around the world. In the United States, trigger point dry needling has been approved as within the scope of physical therapy practice in a growing number of states. There are several dry needling techniques, based on different models, including the radiculopathy model and the trigger point model, which are discussed here in detail. Special attention is paid to the clinical evidence for trigger point dry needling and the underlying mechanisms. Comparisons with injection therapy and acupuncture are reviewed. Trigger point dry needling is a relatively new technique used in combination with other physical therapy interventions.
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Objectives: Trigger point dry needling (TrP-DN) is commonly used to treat persons with myofascial pain, but no studies currently exist investigating its safety. The aim of this study was to determine the incidence of Adverse Events (AEs) associated with the use of TrP-DN by a sample of physiotherapists in Ireland. Methods: A prospective survey was undertaken consisting of two forms recording mild and significant AEs. Physiotherapists who had completed TrP-DN training with the David G Simons Academy (DGSA) were eligible to take part in the study. Data were collected over a ten-month period. Results: In the study, 39 physiotherapists participated and 1463 (19.18%) mild AEs were reported in 7629 treatments with TrP-DN. No significant AEs were reported giving an estimated upper risk rate for significant AEs of less than or equal to (≤) 0.04%. Common AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19%). Uncommon AEs were aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13%). Rare AEs were fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%. Discussion: While mild AEs were very commonly reported in this study of TrP-DN, no significant AEs occurred. For the physiotherapists surveyed, TrP-DN appeared to be a safe treatment.
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During the past decades, worldwide clinical and scientific interest in dry needling (DN) therapy has grown exponentially. Various clinical effects have been credited to dry needling, but rigorous evidence about its potential physiological mechanisms of actions and effects is still lacking. Research identifying these exact mechanisms of dry needling action is sparse and studies performed in an acupuncture setting do not necessarily apply to DN. The studies of potential effects of DN are reviewed in reference to the different aspects involved in the pathophysiology of myofascial triggerpoints: the taut band, local ischemia and hypoxia, peripheral and central sensitization. This article aims to provide the physiotherapist with a greater understanding of the contemporary data available: what effects could be attributed to dry needling and what are their potential underlying mechanisms of action, and also indicate some directions at which future research could be aimed to fill current voids.
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Study design: Systematic review and meta-analysis. Background: Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points. When palpated, active myofascial trigger points cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a myofascial trigger point, with the goal of reducing pain and restoring range of motion. Objective: To explore the evidence regarding the effectiveness of dry needling to reduce pain in patients with MPS of the upper quarter. Methods: An electronic literature search was performed using the key word dry needling. Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trial (RCT), dry needling intervention group, and MPS involving the upper quarter. The RCTs that met these criteria were assessed and scored for internal validity using the MacDermid Quality Checklist. Four separate meta-analyses were performed: (1) dry needling compared to sham or control immediately after treatment, (2) dry needling compared to sham or control at 4 weeks, (3) dry needling compared to other treatments immediately after treatment, and (4) dry needling compared to other treatments at 4 weeks. Results: The initial search yielded 246 articles. Twelve RCTs were ultimately selected. The methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range, 0-48; best possible score, 48). The findings of 3 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling. The findings of 2 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can decrease pain after 4 weeks in patients with upper-quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. Conclusion: Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS. Due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation. Level of evidence: Therapy, level 1a-.
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Clinical measurement. To evaluate the intrarater, interrater, and test-retest reliability of an accessible digital algometer, and to determine the minimum detectable change in normal healthy individuals and a clinical population with neck pain. Pressure pain threshold testing may be a valuable assessment and prognostic indicator for people with neck pain. To date, most of this research has been completed using algometers that are too resource intensive for routine clinical use. Novice raters (physiotherapy students or clinical physiotherapists) were trained to perform algometry testing over 2 clinically relevant sites: the angle of the upper trapezius and the belly of the tibialis anterior. A convenience sample of normal healthy individuals and a clinical sample of people with neck pain were tested by 2 different raters (all participants) and on 2 different days (healthy participants only). Intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change were calculated. A total of 60 healthy volunteers and 40 people with neck pain were recruited. Intrarater reliability was almost perfect (ICC = 0.94-0.97), interrater reliability was substantial to near perfect (ICC = 0.79-0.90), and test-retest reliability was substantial (ICC = 0.76-0.79). Smaller change was detectable in the trapezius compared to the tibialis anterior. This study provides evidence that novice raters can perform digital algometry with adequate reliability for research and clinical use in people with and without neck pain.
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Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables. MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTrPs). Active MTrPs were most prevalent in the infraspinatus (77%) and the upper trapezius muscles (58%), whereas latent MTrPs were most prevalent in the teres major (49%) and anterior deltoid muscles (38%). The number of muscles with active MTrPs was only moderately correlated with the DASH score. The prevalence of muscles containing active and latent MTrPs in a sample of patients with chronic non-traumatic shoulder pain was high.
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To investigate the effects of dry needling over active trigger points (TrPs) in the masseter muscle in patients with temporomandibular disorders (TMD). Twelve females, aged 20 to 41 years old (mean = 25, standard deviation +/- 6 years) diagnosed with myofascial TMD were recruited. Each patient attended two treatment sessions on two separate days and received one intervention assigned in a random fashion, at each visit: deep dry needling (experimental) or sham dry needling (placebo) at the most painful point on the masseter muscle TrP. Pressure pain threshold (PPT) over the masseter muscle TrP and the mandibular condyle and pain-free active jaw opening were assessed pre- and 5 minutes postintervention by an examiner blinded to the treatment allocation of the subject. A two-way repeated-measures analysis of variance (ANOVA) with intervention as the between-subjects variable and time as the within-subjects variable was used to examine the effects of the intervention. The ANOVA detected a significant interaction between intervention and time for PPT levels in the masseter muscle (F = 62.5; P < .001) and condyle (F = 50.4; P < .001), and pain-free active mouth opening (F = 34.9; P < .001). Subjects showed greater improvements in all the outcomes when receiving the deep dry needling compared to the sham dry needling (P < .001). The application of dry needling into active TrPs in the masseter muscle induced significant increases in PPT levels and maximal jaw opening when compared to the sham dry needling in patients with myofascial TMD.
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G*Power is a free power analysis program for a variety of statistical tests. We present extensions and improvements of the version introduced by Faul, Erdfelder, Lang, and Buchner (2007) in the domain of correlation and regression analyses. In the new version, we have added procedures to analyze the power of tests based on (1) single-sample tetrachoric correlations, (2) comparisons of dependent correlations, (3) bivariate linear regression, (4) multiple linear regression based on the random predictor model, (5) logistic regression, and (6) Poisson regression. We describe these new features and provide a brief introduction to their scope and handling.
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Unlabelled: Sex-related influences on pain and analgesia have become a topic of tremendous scientific and clinical interest, especially in the last 10 to 15 years. Members of our research group published reviews of this literature more than a decade ago, and the intervening time period has witnessed robust growth in research regarding sex, gender, and pain. Therefore, it seems timely to revisit this literature. Abundant evidence from recent epidemiologic studies clearly demonstrates that women are at substantially greater risk for many clinical pain conditions, and there is some suggestion that postoperative and procedural pain may be more severe among women than men. Consistent with our previous reviews, current human findings regarding sex differences in experimental pain indicate greater pain sensitivity among females compared with males for most pain modalities, including more recently implemented clinically relevant pain models such as temporal summation of pain and intramuscular injection of algesic substances. The evidence regarding sex differences in laboratory measures of endogenous pain modulation is mixed, as are findings from studies using functional brain imaging to ascertain sex differences in pain-related cerebral activation. Also inconsistent are findings regarding sex differences in responses to pharmacologic and non-pharmacologic pain treatments. The article concludes with a discussion of potential biopsychosocial mechanisms that may underlie sex differences in pain, and considerations for future research are discussed. Perspective: This article reviews the recent literature regarding sex, gender, and pain. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men.
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To compare the efficacies of an intramuscular stimulation technique and 0.5% lidocaine injection to trigger points in myofascial pain syndrome. Forty-three people with myofascial pain syndrome of the upper trapezius muscle. Twenty-two subjects were treated with intramuscular stimulation and another 21 with 0.5% lidocaine injection at all the trigger points on days 0, 7 and 14. Intramuscular stimulation resulted in a significant reduction in Wong-Baker FACES pain scale scores at all visits and was more effective than trigger point injection. Intramuscular stimulation also resulted in significant improvement on the Geriatric Depression Scale - Short Form. Local twitch responses occurred in 97.7% (42/43) of patients. All the passive cervical ranges of motion were significantly increased. Post-treatment soreness was noted in 54.6% of patients in the intramuscular stimulation group and 38.1% in the trigger point injection group, respectively, and gross subcutaneous haemorrhage (> 4 cm2) was seen in only one patient in the trigger point injection group. In managing myofascial pain syndrome, after one month intramuscular stimulation resulted in more significant improvements in pain intensity, cervical range of motion and depression scales than did 0.5% lidocaine injection of trigger points. Intramuscular stimulation is therefore recommended for myofascial pain syndrome.
Article
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To compare the efficacies of dry needling of trigger points (TrPs) with and without paraspinal needling in myofascial pain syndrome of elderly patients. Single-blinded, randomized controlled trial. Forty (40) subjects, between the ages of 63 and 90 with myofascial pain syndrome of the upper trapezius muscle. Eighteen (18) subjects were treated with dry needling of all the TrPs only and another 22 with additional paraspinal needling on days 0, 7, and 14. At 4-week follow-up the results were as follows: (1) TrP and paraspinal dry needling resulted in more continuous subjective pain reduction than TrP dry needling only; (2) TrP and paraspinal dry needling resulted in significant improvements on the geriatric depression scale but TrP dry needling only did not; (3) TrP and paraspinal dry needling resulted in improvements of all the cervical range of motions but TrP dry needling only did not in extensional cervical range of motion; and (4) no cases of gross hemorrhage were noted. TrP and paraspinal dry needling is suggested to be a better method than TrP dry needling only for treating myofascial pain syndrome in elderly patients.
Article
To investigate the effect of ischemic compression (IC) versus placebo and control on (1) reducing postneedling soreness of one latent myofascial trigger point (MTrP) and on (2) improving cervical range of motion (CROM) in asymptomatic subjects. A 72-hour follow-up, randomized, double-blind, placebo-controlled trial. University community. Asymptomatic volunteers (N=90:40 men, 50 women) aged 18 to 39 years (mean±SD, 22±3y). All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into three groups: a treatment group, who received IC over the needled trapezius muscle, a placebo group who received sham IC and a control group who did not receive any treatment after needling. Visual analog scale (VAS; during needling, at post-treatment, 6, 12, 24, 48 and 72 hours) and CROM (at pre-needling, postneedling, 24 and 72 hours). Subjects in the IC group showed significantly lower postneedling soreness than the placebo and the control groups subjects immediately after treatment (Mean±SD; IC: 20.1±4.8; Placebo: 36.7±4.8; Control: 34.8±3.6) and at 48 hours (Mean±SD; IC: 0.6±1; Placebo: 4.8±1; control: 3.8±0.7). In addition, subjects in the dry needling+IC group showed significantly lower postneedling soreness duration (P=.026). All subjects significantly improved the cervical range of motion in contralateral lateroflexion and both homolateral and contralateral rotations, but only the improvements found in the IC group reached the minimal detectable change. IC can potentially be added immediately after dry needling of MTrPs in the upper trapezius muscle because it has the effect of reducing postneedling soreness intensity and duration. The combination of dry needling and IC seems to improve CROM in homolateral and contralateral cervical rotation movements. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Article
Objective To investigate (1) the effect of spray and stretch (SS) versus control on reducing post-needling soreness of one latent myofascial trigger point (MTrP) and (2) if higher levels of psychological distress are associated with increased post-needling pain intensity. Design A 72-hour follow-up, single-blind randomized controlled trial. Setting University community. Participants Healthy volunteers (N=70:40 men,30 women) aged 18 to 36 years (mean±SD, 21±4y) with latent MTrP in one upper trapezius muscle. Intervention All subjects received a dry needling application over the upper trapezius muscle. Then, participants were randomly divided into two groups: an intervention group, which received SS over the needled trapezius muscle, and a control group that did not receive any intervention. Main outcome measures Visual analog scale (VAS; at post-needling, post-treatment, 6, 12, 24, 48 and 72 hours), pressure pain threshold (PPT; at pre-needling, post-needling, 24 and 48 hours). Psychological distress was evaluated by the Symptom Checklist-90-Revised. Results Repeated measures analysis of variance (ANOVA) demonstrated a significant interaction between group and time (F3,204.8=3.19, P<.05, ηp2=0.04) for changes in post-needling soreness. Between-group differences were only significant immediately after intervention (P=.002) and there were no differences found between groups after 6 hours of the intervention (P>.05). Repeated measures of covariance (ANCOVA) showed that none of the psychological covariates affected these results. Somatization, anxiety, interpersonal sensitivity and hostility were significantly correlated (P<.05) with post-needling pain intensity. Repeated measures ANOVA did not show a significant effect of SS on mechanical hiperalgesia (F2.6,175=1.9, P=.131, ηp2=0.02). Conclusions The SS had a short-term (less than 6 hours) effect reducing post-needling soreness of a latent MTrP. PPT did not significantly change after SS. Psychological factors are related to post-needling pain.
Article
Kibler (Medicine and Science in Sports and Exercise 30 (1998) 79) suggests that when there is dysfunction in a proximal body segment, distal segments have to change workloads in order to preserve movement outcomes at the most distal body segment. One aspect of function is the timing of muscle activation. As the presence of pain could affect the muscle activation pattern (MAP), the effects of pain-free latent myofascial trigger points (LTrPs) in the scapular rotator muscle group were investigated. Surface electromyography was used to identify the MAP of the upper and lower trapezius, serratus anterior, infraspinatus and middle deltoid during scapular plane elevation. Repeated measures ANOVA was used to compare the control group (n=14) and the LTrP group (n=28). The LTrP group was then randomly assigned to either placebo intervention or true treatment to investigate the effect of removing the LTrPs. The data established that LTrPs in the scapular rotator muscles changes the MAP of this muscle group and of muscles further distal in the shoulder girdle kinetic chain. Treatment to remove LTrPs normalised the MAP.
Article
Evidence suggests that there are important differences between men and women with respect to the perception and experience of pain. The objective of this review is to provide a general overview of this area and to explore potential mechanisms for such differences. It will focus on a range of different types of evidence including experimental studies, epidemiology, as well as more clinically orientated treatment investigations. Some of the biological, psychological and social factors thought to help understand why such variation between men and women occurs will be considered. While there are still many unanswered questions, what is clear is that it is no longer acceptable to simply ignore such potentially important differences between the sexes in their experience of pain.
Article
Recent years have witnessed substantially increased research regarding sex differences in pain. The expansive body of literature in this area clearly suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women. Also, differences in responsivity to pharmacological and non-pharmacological pain interventions have been observed; however, these effects are not always consistent and appear dependent on treatment type and characteristics of both the pain and the provider. Although the specific aetiological basis underlying these sex differences is unknown, it seems inevitable that multiple biological and psychosocial processes are contributing factors. For instance, emerging evidence suggests that genotype and endogenous opioid functioning play a causal role in these disparities, and considerable literature implicates sex hormones as factors influencing pain sensitivity. However, the specific modulatory effect of sex hormones on pain among men and women requires further exploration. Psychosocial processes such as pain coping and early-life exposure to stress may also explain sex differences in pain, in addition to stereotypical gender roles that may contribute to differences in pain expression. Therefore, this review will provide a brief overview of the extant literature examining sex-related differences in clinical and experimental pain, and highlights several biopsychosocial mechanisms implicated in these male-female differences. The future directions of this field of research are discussed with an emphasis aimed towards further elucidation of mechanisms which may inform future efforts to develop sex-specific treatments.
Article
Objectives: To determine the prevalence of myofascial trigger points (MTrPs) in the gluteus medius (GMe) and quadratus lumborum (QL) for subjects with patellofemoral pain (PFP), and to examine the relationship between MTrPs and force production of the GMe after treatment. Design: Randomized controlled trial. Setting: A physical therapy clinic. Participants: Subjects (N=52; mean age ± SD, 30±12y; mean height ± SD, 172±10cm; mean mass ± SD, 69±14kg) volunteered and were divided into 2 groups: a PFP group (n=26) consisting of subjects with PFP, and a control group (n=26) with no history of PFP. Interventions: Patients with PFP received trigger point pressure release therapy (TPPRT). Main outcome measures: Hip abduction isometric strength and the presence of MTrPs. Results: Prevalence of bilateral GMe and QL MTrPs for the PFP group was significantly higher compared with controls (P=.001). Subjects in the PFP group displayed significantly less hip abduction strength compared with the control group (P=.007). However, TPPRT did not result in increased force production. Conclusions: Subjects with PFP have a higher prevalence of MTrPs in bilateral GMe and QL muscles. They demonstrate less hip abduction strength compared with controls, but the TPPRT did not result in an increase in hip abduction strength.
Article
Many clinical pain conditions, including migraine, fibromyalgia, and temporomandibular disorders, occur more frequently among females than males. Greater pain sensitivity among females has been considered as one possible explanation for these differences. Despite considerable clinical and experimental research on the topic, no consensus has emerged on the existence or nature of gender differences in response to noxious stimuli. In this Focus article the authors take the position that females exhibit greater sensitivity to noxious stimuli than males. In support of this position, they review the experimental literature on gender and pain responses. Then, they present and discuss a schematic model of several systems involved in the transmission and modulation of nociceptive information, which may contribute to gender-associated differences in pain sensitivity. Finally, the authors highlight several issues to be addressed by future research in this area.
Article
Gender role refers to the culturally and socially constructed meanings that describe how women and men should behave in certain situations according to feminine and masculine roles learned throughout life. The aim of this meta-analysis was to evaluate the relationship between gender role and experimental pain responses in healthy human participants. We searched computerized databases for studies published between January 1950 and May 2011 that had measured gender role in healthy human adults and pain response to noxious stimuli. Studies were entered into a meta-analysis if they calculated a correlation coefficient (r) for gender role and experimental pain. Searches yielded 4465 'hits' and 13 studies were eligible for review. Sample sizes were 67-235 participants and the proportion of female participants was 45-67%. Eight types of gender role instrument were used. Meta-analysis of six studies (406 men and 539 women) found a significant positive correlation between masculine and feminine personality traits and pain threshold and tolerance, with a small effect size (r = 0.17, p = 0.01). Meta-analysis of four studies (263 men and 297 women) found a significant negative correlation between gender stereotypes specific to pain and pain threshold and tolerance, with a moderate effect size (r = -0.41, p < 0.001). In conclusion, individuals who considered themselves more masculine and less sensitive to pain than the typical man showed higher pain thresholds and tolerances. Gender stereotypes specific to pain scales showed stronger associations with sex differences in pain sensitivity response than masculine and feminine personality trait scales.
Article
The purpose of this systematic review was to summarize and critically appraise the results of 10 years of human laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian and conducted in multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The first set of results (122 articles), which is presented in this paper, examined sex difference in the perception of laboratory-induced thermal, pressure, ischemic, muscle, electrical, chemical, and visceral pain in healthy subjects. This review suggests that females (F) and males (M) have comparable thresholds for cold and ischemic pain, while pressure pain thresholds are lower in F than M. There is strong evidence that F tolerate less thermal (heat, cold) and pressure pain than M but it is not the case for tolerance to ischemic pain, which is comparable in both sexes. The majority of the studies that measured pain intensity and unpleasantness showed no sex difference in many pain modalities. In summary, 10 years of laboratory research have not been successful in producing a clear and consistent pattern of sex differences in human pain sensitivity, even with the use of deep, tonic, long-lasting stimuli, which are known to better mimic clinical pain. Whether laboratory studies in healthy subjects are the best paradigm to investigate sex differences in pain perception is open to question and should be discussed with a view to enhancing the clinical relevance of these experiments and developing new research avenues.
Article
The aim of this study was to describe the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius,sternocleidomastoid, levator scapulae and suboccipital muscles between patients presenting with mechanical neck pain and control healthy subjects. Twenty subjects with mechanical neck pain and 20 matched healthy controls participated in this study. TrPs were identified, by an assessor blinded to the subjects' condition, when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band, and reproduction of the referred pain typical of each TrP. The mean number of TrPs present on each neck pain patient was 4.3 (SD: 0.9), of which 2.5 (SD: 1.3) were latent and 1.8 (SD: 0.8) were active TrPs. Control subjects also exhibited TrPs (mean: 2; SD: 0.8). All were latent TrPs. Differences in the number of TrPs between both study groups were significant for active TrPs (P < 0.001), but not for latent TrPs (P > 0.5). Moreover, differences in the distribution of TrPs within the analysed cervical muscles were also significant (P < 0.01) for all muscles except for both levators capulae. All the examined muscles evoked referred pain patterns contributing to patients' symptoms. Active TrPs were more frequent in patients presenting with mechanical neck pain than in healthy subjects.
Article
SUMMARY: Our aim was to analyze the differences in the referred pain patterns and size of the areas of those myofascial trigger points (TrPs) involved in chronic tension type headache (CTTH) including a number of muscles not investigated in previous studies. Thirteen right handed women with CTTH (mean age: 38 ± 6 years) were included. TrPs were bilaterally searched in upper trapezius, sternocleidomastoid, splenius capitis, masseter, levator scapulae, superior oblique (extra-ocular), and suboccipital muscles. TrPs were considered active when both local and referred pain evoked by manual palpation reproduced total or partial pattern similar to a headache attack. The size of the referred pain area of TrPs of each muscle was calculated. The mean number of active TrPs within each CTTH patient was 7 (95% CI 6.2-8.0). A greater number (T = 2.79; p = 0.016) of active TrPs was found at the right side (4.2 ± 1.5) when compared to the left side (2.9 ± 1.0). TrPs in the suboccipital muscles were most prevalent (n = 12; 92%), followed by the superior oblique muscle (n =11/n = 9 right/left side), the upper trapezius muscle (n = 11/n = 6) and the masseter muscle (n = 9/n=7). The ANOVA showed significant differences in the size of the referred pain area between muscles (F = 4.7, p = 0.001), but not between sides (F = 1.1; p = 0.3): as determined by a Bonferroni post hoc analysis the referred pain area elicited by levator scapulae TrPs was significantly greater than the area from the sternocleidomastoid (p = 0.02), masseter (p = 0.003) and superior oblique (p = 0.001) muscles. Multiple active TrPs exist in head, neck and shoulder muscles in women with CTTH. The referred pain areas of TrPs located in neck muscles were larger than the referred pain areas of head muscles. Spatial summation of nociceptive inputs from multiple active TrPs may contribute to clinical manifestations of CTTH.
Article
This study was designed to investigate the effects of injection with a local anesthetic agent or dry needling into a myofascial trigger point (TrP) of the upper trapezius muscle in 58 patients. Trigger point injections with 0.5% lidocaine were given to 26 patients (Group I), and dry needling was performed on TrPs in 15 patients (Group II). Local twitch responses (LTRs) were elicited during multiple needle insertions in both Groups I and II. In another 17 patients, no LTR was elicited during TrP injection with lidocaine (9 patients, group Ia) or dry needling (8 patients, group IIa). Improvement was assessed by measuring the subjective pain intensity, the pain threshold of the TrP and the range of motion of the cervical spine. Significant improvement occurred immediately after injection into the patients in both group I and group II. In Groups Ia and Ib, there was little change in pain, tenderness or tightness after injection. Within 2-8 h after injection or dry needling, soreness (different from patients' original myofascial pain) developed in 42% of the patients in group I and in 100% of the patients in group II. Patients treated with dry needling had postinjection soreness of significantly greater intensity and longer duration than those treated with lidocaine injection. The author concludes that it is essential to elicit LTRs during injection to obtain an immediately desirable effect. TrP injection with 0.5% lidocaine is recommended, because it reduces the intensity and duration of postinjection soreness compared with that produced by dry needling.
Article
The myofascial trigger point (MTrP) is the hallmark physical finding of the myofascial pain syndrome (MPS). The MTrP itself is characterized by distinctive physical features that include a tender point in a taut band of muscle, a local twitch response (LTR) to mechanical stimulation, a pain referral pattern characteristic of trigger points of specific areas in each muscle, and the reproduction of the patient's usual pain. No prior study has demonstrated that these physical features are reproducible among different examiners, thereby establishing the reliability of the physical examination in the diagnosis of the MPS. This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed, and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies, the LTR being the most difficult, and that the interrater reliability of the identification of MTrP features among different muscles also varies.
Article
Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department (ED). The reliability of visual analog scale (VAS) scores has not been demonstrated in the acute setting where pain fluctuation might be greater than for chronic pain. The objective of the study was to assess the reliability of the VAS for measurement of acute pain. This was a prospective convenience sample of adults with acute pain presenting to two EDs. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) and a Bland-Altman analysis were used to assess reliability of paired VAS measurements obtained 1 minute apart every 30 minutes over two hours. The summary ICC for all paired VAS scores was 0.97 [95% CI = 0.96 to 0.98]. The Bland-Altman analysis showed that 50% of the paired measurements were within 2 mm of one another, 90% were within 9 mm, and 95% were within 16 mm. The paired measurements were more reproducible at the extremes of pain intensity than at moderate levels of pain. Reliability of the VAS for acute pain measurement as assessed by the ICC appears to be high. Ninety percent of the pain ratings were reproducible within 9 mm. These data suggest that the VAS is sufficiently reliable to be used to assess acute pain.
Article
To evaluate immediate effects of two different modes of acupuncture on motion-related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure. Thirty-six patients with chronic neck pain and limited cervical spine mobility participated in a prospective, randomized, double-blind, sham-controlled crossover trial. Every patient was treated once with needle acupuncture at distant points, dry needling (DN) of local myofascial trigger points and sham laser acupuncture (Sham). Outcome measures were motion-related pain intensity (visual analogue scale, 0-100 mm) and range of motion (ROM). In addition, patients scored changes of general complaints using an 11-point verbal rating scale. Patients were assessed immediately before and after each treatment by an independent (blinded) investigator. Multivariate analysis was used to assess the effects of true acupuncture and needle site independently. For motion-related pain, use of acupuncture at non-local points reduced pain scores by about a third (11.2 mm; 95% CI 5.7, 16.7; P = 0.00006) compared to DN and sham. DN led to an estimated reduction in pain of 1.0 mm (95% CI -4.5, 6.5; P = 0.7). Use of DN slightly improved ROM by 1.7 degrees (95% CI 0.2, 3.2; P = 0.032) with use of non-local points improving ROM by an additional 1.9 degrees (95% CI 0.3, 3.4; P = 0.016). For patient assessment of change, non-local acupuncture was significantly superior both to Sham (1.7 points; 95% CI 1.0, 2.5; P = 0.0001) and DN (1.5 points; 95% CI 0.4, 2.6; P = 0.008) but there was no difference between DN and Sham (0.1 point; 95% CI -1.0, 1.2; P = 0.8). Acupuncture is superior to Sham in improving motion-related pain and ROM following a single session of treatment in chronic neck pain patients. Acupuncture at distant points improves ROM more than DN; DN was ineffective for motion-related pain.
Article
Little is known about sex differences in the temporal pattern of descending inhibitory mechanisms, such as descending noxious inhibitory control (DNIC). Sex differences in temporal characteristics of DNIC were investigated by measuring pressure pain thresholds (PPTs) over time in the trapezius muscles (local pain areas) and the posterolateral neck muscles (referred pain areas) following repeated bilateral injection of hypertonic versus isotonic saline into both trapezius muscles. Ten females and 11 males received two consecutive bilateral injections, with 15 min interval, of either 5.8% hypertonic saline (0.5 ml in each side for each bilateral injection) or isotonic saline as a control in a randomized manner. Following hypertonic saline injection, the maximal pain intensities of the first and second bilateral injections were significantly higher in females than in males. The PPTs in the trapezius muscles were significantly lower in females than in males. Significantly higher PPTs (hypoalgesia) in men than in women were shown 15 min after the first bilateral injection, and 7.5 and 15 min after the second bilateral injection in the referred pain areas. Importantly, the second bilateral injection failed to further increase the PPTs for both sexes. These results showed that there were sex differences in temporal characteristics of descending inhibition with long-lasting hypoalgesia in men than in women. Repeated noxious muscular stimuli may inhibit further build-up of DNIC, which may reflect a mechanism of plasticity of the descending inhibitory systems following recurrent nociceptive barrage for both sexes.
Article
Gender differences in pain habituation, temporal summation, and pressure hyperalgesia evoked by repeated injections of glutamate into the dominant trapezius muscle were investigated. The glutamate-evoked muscle pain intensity and pressure pain threshold (PPT) were assessed. The PPTs were measured bilaterally in the trapezius muscles (local pain area) and posterolateral neck muscles (referred pain area) after glutamate injection in healthy and age-matched males and females (each n=14). Two glutamate injections (0.4 ml, 2M each) were injected with an interval of 5 min. One injection of glutamate (0.4 ml, 2M) served as a control. Males, but not females, rated the second injection (maximal pain intensity) significantly less painful than the first injection. The area under the visual analogue scale pain curve of the second injection was significantly larger than the first injection in females. Repeated glutamate injections, but not one-glutamate injection, significantly decreased PPTs in the local pain area, with no significant gender differences. No PPTs changes were observed either in the contralateral trapezius muscle or bilaterally in the referred pain areas in either sex. These results suggest that a less efficient pain habituation and a greater susceptibility to the development of temporal summation of muscle pain in females, but not in males, might be one of the contributing factors to the higher incidence of neck shoulder pain in females. In addition, the reduction of PPTs in the local pain area evoked by intramuscular glutamate injection may represent an early process of peripheral pressure hyperalgesia, which is most likely gender independent.
Article
A growing body of literature suggests that the experience of clinical pain differs across ethnocultural groups. Additionally, some evidence indicates greater sensitivity to experimentally induced pain among African Americans; however, most studies have included only one pain modality. This study examined ethnic differences in responses to multiple experimental pain stimuli, including heat pain, cold pressor pain, and ischemic pain. Heat pain threshold and tolerance, ratings of repetitive suprathreshold heat, and ischemic and cold pressor pain threshold and tolerance were assessed in 120 (62 African American, 58 white) healthy young adults. Also, several psychological instruments were administered. No ethnic group differences emerged for threshold measures, but African Americans had lower tolerances for heat pain, cold pressor pain and ischemic pain compared to whites. Ratings of intensity and unpleasantness for suprathreshold heat stimuli were significantly higher among African Americans. African Americans reported greater use of passive pain coping strategies and higher levels of hypervigilance. Controlling for passive pain coping did not account for group differences in pain responses, while controlling for hypervigilance rendered group differences in heat pain tolerance and ischemic pain tolerance non-significant. These findings demonstrate differences in laboratory pain responses between African Americans and whites across multiple stimulus modalities, and effect sizes for these differences in pain tolerance were moderate to large for suprathreshold measures. Hypervigilance partly accounted for group differences. Additional research to determine the mechanisms underlying these effects is warranted.
Article
The purpose of this study was to investigate gender-specific motor control strategies during eccentric exercise and delayed onset muscle soreness (DOMS) in the shoulder region. Twelve healthy males and females participated in the study. Eccentric shoulder exercises were conducted on the dominant shoulder while the other side served as control. The exerted force, range of shoulder elevation, rating of perceived exertion, pain intensity, and surface electromyography (EMG) from the trapezius muscles were recorded and analyzed. A significant decrease in exerted force during exercise was only found in males despite similar rating of perceived exertion among genders. During eccentric exercise: males showed increasing root mean square (RMS) of the EMG while a decrease occurred for females, no difference between genders in mean power frequency of the EMG were seen. During static and dynamic contractions: no differences between genders in pain intensity or RMS were observed; RMS of the exercised side were lower than that of the control side (P<0.05) at 24 h after exercise. The results indicated a more prominent muscle fatigue resistance in females compared with males and mobilization of different muscle activation strategies during eccentric exercise. A protective adaptation to DOMS, i.e. decrease in RMS values was found with no gender differences.
Article
Referred pain and pain characteristics evoked from the extensor carpi radialis brevis, extensor carpi radialis longus, extensor digitorum communis, and brachioradialis muscles was investigated in 20 patients with lateral epicondylalgia (LE) and 20-matched controls. Both groups were examined for the presence of myofascial trigger points (TrPs) in a blinded fashion. The quality and location of the evoked referred pain, and the pressure pain threshold (PPT) at the lateral epicondyle on the right upper extremity (symptomatic side in patients, and dominant-side on controls) were recorded. Several lateral elbow pain parameters were also evaluated. Within the patient group, the elicited referred pain by manual exploration of 13 out of 20 (65%) extensor carpi radialis brevis muscles, 12/20 (70%) extensor carpi radialis longus muscles, 10/20 (50%) brachioradialis muscles, and 5/20 (25%) extensor digitorum communis muscles, shares similar pain patterns as their habitual lateral elbow and forearm pain. The mean number of muscles with TrPs for each patient was 2.9 [95% confidence interval (CI) 1,4] of which 2 (95% CI 1,3) were active, and 0.9 (95% CI 0,2) were latent TrPs. Control participants only had latent TrPs (mean: 0.4; 95% CI 0,2). TrP occurrence between the 2 groups was significantly different for active TrPs (P<0.001), but not for latent TrPs (P>0.05). The referred pain pattern was larger in patients than in controls, with pain referral to the lateral epicondyle (proximally) and to the dorso-lateral aspect of the forearm in the patients, and confined to the dorso-lateral aspect of the forearm in the controls. Patients with LE showed a significant (P<0.001) lower PPT (mean: 2.1 kg/cm; 95% CI 0.8, 4 kg/cm) as compared with controls (mean: 4.5 kg/cm; 95% CI 3, 7 kg/cm). Within the patient group, PPT at the lateral epicondyle was negatively correlated with both the total number of TrPs (rs=-0.63; P=0.003) and the number of active TrPs (rs=-0.5; P=0.02): the greater the number of active TrPs, the lower the PPT at the lateral epicondyle. Our results suggest that in patients with LE, the evoked referred pain and its sensory characteristics shared similar patterns as their habitual elbow and forearm pain, consistent with active TrPs. Lower PPT and larger referred pain patterns suggest that peripheral and central sensitization exists in LE.
Article
To investigate the changes in pressure pain threshold of the secondary (satellite) myofascial trigger points (MTrPs) after dry needling of a primary (key) active MTrP. Single blinded within-subject design, with the same subjects serving as their own controls (randomized). Fourteen patients with bilateral shoulder pain and active MTrPs in bilateral infraspinatus muscles were involved. An MTrP in the infraspinatus muscle on a randomly selected side was dry needled, and the MTrP on the contralateral side was not (control). Shoulder pain intensity, range of motion (ROM) of shoulder internal rotation, and pressure pain threshold of the MTrPs in the infraspinatus, anterior deltoid, and extensor carpi radialis longus muscles were measured in both sides before and immediately after dry needling. Both active and passive ROM of shoulder internal rotation, and the pressure pain threshold of MTrPs on the treated side, were significantly increased (P < 0.01), and the pain intensity of the treated shoulder was significantly reduced (P < 0.001) after dry needling. However, there were no significant changes in all parameters in the control (untreated) side. Percent changes in the data after needling were also analyzed. For every parameter, the percent change was significantly higher in the treated side than in the control side. This study provides evidence that dry needle-evoked inactivation of a primary (key) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral. This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon.
Article
This study examined gender differences in the effect of experimental muscle pain on changes in the relative activation of regions of the upper trapezius muscle during a sustained contraction. Surface electromyographic (EMG) signals were recorded from multiple locations over the upper trapezius muscle with a 10 x 5 grid of electrodes from nine women and nine men during 90 degrees shoulder abduction sustained for 60s. Measurements were performed before and after the injection of 0.4 ml hypertonic (painful) and isotonic (control) saline into the cranial region of the upper trapezius muscle. The EMG root mean square (RMS) was computed for each location of the grid to form a map of the EMG amplitude distribution. The peak pain intensity following the injection of hypertonic saline was greater for women (numerical rating scale 0-10: women 6.0+/-2.1, men 4.2+/-0.9; P<0.01). For both genders, upper trapezius RMS averaged across the grid decreased following the injection of hypertonic saline (P<0.0001). Moreover, there was a relatively larger pain-induced decrease in RMS in the cranial region compared to the caudal region of the muscle for both genders. During the non-painful sustained contractions, the EMG RMS progressively increased more in the cranial than the caudal region, for both men and women, due to fatigue. This mechanism was maintained in men but not in women during the painful condition. The results demonstrate that muscle pain alters the normal adaptation of upper trapezius muscle activity to fatigue in women but not in men.
The Gunn Approach to the Treatment of Chronic 431
  • C Gunn
Gunn C. The Gunn Approach to the Treatment of Chronic 431
Ischemic Com-491 pression After Dry Needling of a Latent Myofascial Trigger 492
  • T Gallego-Izquierdo
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Gallego-Izquierdo T, Fernandez-Carnero J. Ischemic Com-491 pression After Dry Needling of a Latent Myofascial Trigger 492
Sex, gender, and pain: A review of re-505 File: bmr-1-bmr630.tex; BOKCTP/wyn p
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