Abstract
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.
Highlights
The myofascial trigger point (MTrP) defines an irritable area within a skeletal muscle associated with a hyperalgesic nodule located in a tight band of muscle fibers, and can be prone to painful mechanical deformations [1,2]
Our study aimed to investigate the effects of different exercise modalities on postneedling soreness (PNS) and Pressure Pain Threshold (PPT) of latent myofascial trigger points (MTrP), apart from studying pain and the amount of local twitch responses (LTRs) during dry needling (DN), and sex as potential modifiers of their course
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
Summary
The myofascial trigger point (MTrP) defines an irritable area within a skeletal muscle associated with a hyperalgesic nodule located in a tight band of muscle fibers, and can be prone to painful mechanical deformations (i.e., contraction, stretching, compression) [1,2]. Depending on its clinical form, MTrP may cause referred symptomatic patterns of pain, motor dysfunction, and autonomic phenomena. Active MTrP can cause major disorders in combination with spontaneous referred pain [1]. DN consists of inserting a needle through the skin, without injecting or extracting any substance, in order to trigger a mechanical stimulus and the associated responses from the peripheral and central nervous systems [6]. This action can produce mild to moderate side effects, the most notable of which is postneedling soreness (PNS)
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