Deep Dry Needling Research Articles

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

IntroductionInfraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined. Designrandomized controlled clinical trial, single-blind study. MethodSixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups. InterventionsIn 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy. Main outcome measure(s)Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured. ResultsThe findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups. ConclusionPain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.

Letter to the Editor regarding: A case with iatrogenic pneumothorax due to deep dry needling.

Letter to the Editor regarding: A case with iatrogenic pneumothorax due to deep dry needling.

Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review

ObjectiveTo summarise the available evidence about the effectiveness of deep dry needling (DN) on spasticity, pain-related outcomes, and range-of-movement (ROM) in adults after stroke. DesignA computer search of Web of Science, Scopus, Medline, Cochrane Library, Cinahl, and Physiotherapy Evidence Database (PEDro) was conducted. A hand search of the reference lists of the selected studies and other relevant publications was also undertaken. Studies were assessed by two independent reviewers and included if they complied with the following criteria: (1) participants were adults after a stroke, (2) use of DN alone or within a multimodal approach, compared to no intervention or other treatments; (3) assessment of spasticity, pain, or joint ROM as a primary or secondary outcome. We included randomised controlled trials (RCTs), case series, and case reports. Data were extracted using a standardised protocol. The methodological quality of the studies was assessed with the Checklist for Measuring quality. ResultsA total of sixteen studies, 7 of which were RCTs, were selected. All studies generally reported an improvement of spasticity level, pain intensity, and ROM after the use of DN, alone or combined with other interventions, in stroke survivors. ConclusionThe management of adults after stroke with DN may impact positively on spasticity, pain, and ROM. However, there was significant heterogeneity across trials in terms of sample size, control groups, treated muscles, and outcome measures, and a meta-analysis was not feasible. Further research should include proper blinding, sham placebo DN as control intervention, and investigate long-term effects.

The Effect of Dry Needling on Lower Limb Dysfunction in Poststroke Survivors

Background: Spasticity is one of the main complications in poststroke survivors leading to difficulties in walking and standing resulting in high levels of disability. Objective: The aim of the study was to investigate the effects of deep dry needling on lower limb dysfunction in poststroke spastic patients. Methods: A randomized clinical trial conducted in poststroke survivors who were assigned to one of 2 groups: Deep dry needling (intervention group) and sham dry needling (control group). The primary outcome measures were Modified Modified Ashworth Scale (MMAS) and functional tests (timed up and go test, 10-meter walk test). Secondary outcome measures were active ankle dorsiflexion range of motion (AROM), passive ankle dorsiflexion range of motion (PROM), single leg stance test, and Barthel index. All measurements were assessed at baseline (T0), immediately after the third session 1 week later (T1), and 1 month after the end of the intervention (T2). Results: We recruited 24 patients (71% male; mean age 57 ± 10 years; 26.4 ± 1.8 kg•m−2; time since event: 25.2 ± 12.5 months). There were significant improvements in MMAS, timed up and go test, 10-meter walk test, Barthel scale, and PROM (P < .05) in the intervention group compared to controls across the time-points. There were no significant improvements in AROM assessments (P > .05). Conclusions: Deep dry needling decreases muscle spasticity and improves lower limb function and gait speed in poststroke survivors.

Dry needling versus ultrasonic in treating cervical myofascial pain syndrome

Abstract Background Myofascial pain syndrome (MPS) is a complex pain syndrome characterized by myofascial trigger points (MTrPs) in skeletal muscles. Ultrasound (US) therapy is one of the main devices used in physical therapy, for the treatment of MTrPs in MPS. Dry needling is skilled technique also used in the treatment of MTrPs in MPS. Purpose This study aimed to compare the effect of dry needling with the effect of ultrasonic waves in the treatment of cervical myofascial pain. Subjects a sample of 30 patients with myofascial trigger points in trapezius muscle was randomly chosen and divided into 2 groups each contains 15 patients. Methods the first group was treated by ultrasonic waves in a pulsed mode (1MHz, 1W/cm², 1:1 ratio) 5 min to each trigger point and the second group was treated with deep dry needling (peppering technique) to each trigger point with a rate of 3 times per week for 3 weeks. Results All patients shows significant improvement (P &amp;gt; 0.001) immediately after treatment period with disappearance of trigger points, increasing in cervical ROM and decreasing in VAS ; but 3 weeks later trigger points reappeared, ROM decreased and VAS increased again. Conclusion both modalities of treatment were considered effective in treating myofascial pain syndrome.

Short-term effects of two deep dry needling techniques on pressure pain thresholds and electromyographic amplitude of the lumbosacral multifidus in patients with low back pain - a randomized clinical trial

ABSTRACT Objectives: The purpose of this study was to compare the effects of deep dry needling (DN) with and without needle manipulation on pressure pain thresholds (PPTs) and electromyographic (EMG) amplitude of the lumbosacral multifidus (LM) in adults with low back pain (LBP). Methods: Participants were randomized into two treatment groups: with needle manipulation (n = 21) and without needle manipulation (n = 21). All participants received a single session of the assigned DN intervention. PPTs and EMG amplitude of the LM muscle were collected three times: before DN, immediately after DN, and one week after DN. Results: The needle manipulation group had a significantly greater increase in PPT immediately after the intervention and at the one-week follow-up as compared to the no needle manipulation group. The increase of PPT in the needle manipulation group was significant immediately after the intervention, and the increase remained significant at the one-week follow-up. However, there was no significant difference in EMG amplitude of the LM muscle between groups across the three time points. Discussion: Deep DN with needle manipulation appeared to reduce mechanical pressure sensitivity more than DN without manipulation for patients with LBP. Although a single session of DN could reduce pressure pain sensitivity, it may not be sufficient to improve LM muscle function. Level of Evidence: 1b. Trial registration numbers: NCT03970486.

Analgesia mediated by stress: Possible antalgic mechanism of the dry needling technique

Abstract Introduction and Aim One of the possible mechanisms of action of dry needling is stress-induced analgesia, produced by the activation of the sympathetic nervous system (SNS). Cortisol is a steroid hormone, which is considered to be the most representative indicator of physiological states that are altered after a stressful stimulus. Although studies of other invasive techniques exist which measure the cortisol levels, no studies on dry needling have been found which gather this stress indicator. Thus, the aim of this study was to determine the changes produced in the levels of cortisol concentration in saliva after the application of the dry needling technique. Material and Methods Sixty-two healthy volunteer subjects participated in this randomized controlled single blinded trial performed at the University of Alcalá. Participants were randomly distributed into two intervention groups: deep dry needling (n = 33) and placebo needling (control) (n = 32). The saliva samples were gathered prior to the intervention and 3 minutes after finalization of the same. The level of cortisol in saliva was determined in a laboratory by performing a solid phase enzyme immunoassay using the ELISA® kit. Statistical significance was set at p &lt; 0.05. The differences between both groups were compared based on the percentage of change between the initial level and at three minutes via the Student's t-test for independent samples, estimating the effect size via the Cohen's d test. Results An increase of the levels of cortisol in saliva of 11.27% ± 4.76 was observed after the deep dry needling; in the group of placebo needling, an increase of 1.51% ± 3.08 was observed. However, when comparing both groups, no statistically significant differences were obtained (p = 0.920), with an effect size of d = 0.42. Conclusions The dry needling technique leads to an increase in the release of cortisol, one of the hormones involved in the sympathetic-excitatory relationship. This could be related to one of the possible effects of this invasive procedure with mechanisms of stress-induced analgesia. However, further studies are required to deepen our knowledge on the plausible physiological effects which support the application of the dry needling technique.

Effectiveness of dry needling in equinovarus foot deformity in patients with cerebrovascular accident

Abstract Introduction Spasticity secondary to cerebrovascular accident is one of the main causes of disability in adults. Equinovarus foot is a common condition in patients with cerebrovascular accident, with an estimated prevalence of 18% (Verdié C. 2004). This deformity is mainly caused by spasticity of the tibialis posterior muscle, together with weakness of the tibialis anterior. Aims To determine the effects of deep dry needling together with neurorehabilitation treatment (based on the Bobath concept) on spasticity and motor function after a cerebrovascular accident. Material and Methods A single-blinded randomized experimental study, which comprised ten (n = 10) patients who had suffered a cerebrovascular accident, who were randomly assigned to a control group (CG) who received neurorehabilitation treatment (n = 5) and another experimental group (EG) who received ultrasound-guided dry needling in the tibialis posterior and tibialis anterior muscles plus neurorehabilitation treatment (n = 5). Measurements were made at baseline and ten minutes after treatment by a blinded evaluator who measured spasticity (Ashworth scale) and motor function (timed up and go test). Results The subjects who received dry needling showed a decrease in spasticity after treatment of the tibialis posterior (P &lt; 0.001) and the tibialis anterior muscles (P &lt; 0.003) compared to those who did not receive treatment. The descriptive analysis of the timed up and go test, (CG pre:22.7720/post:21.8060 and EG pre:23.8960/post:17.9780*) revealed a decrease in times for both groups, which was more significant in the group of neurorehabilitation treatment plus dry needling. Conclusion The inclusion of deep dry needling in a session of neurorehabilitation treatment (following the Bobath concept) appears to be effective for the normalization of tone and for the improvement of balance during the gait cycle in patients who have suffered a cerebrovascular accident.

Assessment of needle penetration depth and relationship with its analgesic effect

Abstract Background and Aims The field of invasive physical therapy offers a wide spectrum of effective methods for the treatment of myofascial pain. All these methods share the fact that they begin with the insertion of a solid needle. Thereafter, they diverge either because of the variable use of repeated insertions or because of the application of an electric current with different intensity and duration parameters. The so-called “needle effect” is described as an anesthetic effect which is achieved by probing with the needle the point where pain pressure sensitivity is found, using an appropriate orientation and depth in order to elicit this effect. At present, there continues to be controversy regarding whether the needle effect is a true clinical effect or placebo. Material and Methods This study is a controlled clinical trial with double blinding formed by three randomized groups: sham needling, needling at the level of the subcutaneous tissue (superficial) and needling at the level of the muscle tissue (deep). The intervention consisted in the insertion of the needle at the specified depth according to each group and maintained during 60 seconds. Each group comprised of 17 volunteer inline hockey players of both sexes from the Club Reus Deportiu sports club in the junior and senior categories (between 18 and 36 years of age). Algometry and joint range of motion were determined for the dominant lower limb before and after the intervention. A Student's t-test was performed for paired comparisons and an ANOVA for multiple comparisons. Results The same degree of algometry and joint range variation was obtained before and after the intervention in the three groups under study. No significant differences regarding algometry or joint range were obtained between the group of superficial needle insertion compared to the deep dry needling group, nor for any of these groups compared to the sham group. Conclusion No improvement was found in the pain pressure sensitivity in a latent Myofascial Trigger Point (MTrP) of the gastrocnemius muscle nor were there improvements in dorsal and plantar ankle flexion immediately after treatment for any of the needle depths studied. The mere insertion of an acupuncture needle in a MTrP in young athletes does not provide any therapeutic benefit within the study parameters. Therefore, it seems reasonable that repeated insertions or specific techniques should be used to achieve a beneficial effect.

Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial.

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.

Effectiveness of Deep Dry Needling vs Ischemic Compression in the Latent Myofascial Trigger Points of the Shortened Triceps Surae from Triathletes on Ankle Dorsiflexion, Dynamic, and Static Plantar Pressure Distribution: A Clinical Trial.

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. A randomized simple blind clinical trial (NCT03273985). An outpatient clinic. Thirty-four triathletes with a latent MTrP in the shortened gastrocnemius. 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. 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. 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.

Effectiveness of dry needling on the local pressure pain threshold in patients with masticatory myofascial pain. Systematic review and preliminary clinical trial

ABSTRACT Objective: To systematically review the literature to identify controlled clinical trials evaluating the effectiveness of deep dry needling (DDN) in the treatment of patients with chronic masticatory myofascial pain (MMP). Methods: The sample size for a clinical trial was calculated and involved five patients who consecutively presented for treatment of MMP. The percentage of change in the means of three consecutive measurements of the pressure pain threshold (PPT) of myofascial trigger points (MTPs) was calculated and the statistical significance of this difference evaluated using the Wilcoxon test. Results: Twenty-five studies were considered for inclusion based on title and abstract. Only 2 studies met the inclusion criteria and were used to calculate the sample size. DDN significantly increased (p = 0.04) the PPT in MTP (44.6%) compared with sham procedure (−5.5%). Conclusion: Patients with chronic MMP treated with DDN of MTPs showed an increase in PPT measurements on the experimental side. Abbreviations: CGRP: calcitonin gene-related peptide; DC/TMD: diagnostic criteria for temporomandibular disorders; DDN: deep dry needling; DN: dry needling; LILACS: Latin American and Caribbean Health Sciences; MMP: masticatory myofascial pain; MTP: myofascial trigger point; MTPs: myofascial trigger points; PPT: pressure pain threshold; RCTs: randomized clinical trials; SciELO: Scientific Electronic Library Online; SP: Substance P; TMD: temporomandibular disorders

The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis

ABSTRACTObjective: The purpose of this systematic review was to evaluate the effects of deep versus superficial dry needling or acupuncture on pain and disability for spine-related painful conditions. A secondary purpose was to account for the differences of needling location in relation to the painful area.Methods: This PROSPERO (#CRD42018106237) registered review found 691 titles through a multi-database search. Following a comprehensive search, 12 manuscripts were included in the systematic review and 10 in the meta-analysis. Standardized mean differences (SMD) with 95% confidence intervals were calculated for pain and disability.Results: The included studies demonstrated an unclear to high risk of bias recommending a cautious interpretation of the results. A consistent effect supporting deep needling over superficial with an SMD of 0.585 [0.335, 0.835], p < 0.001 from 10 articles for pain but a non-significant effect of 0.197 [−0.066, 0.461], p = 0.14 from 2 studies for disability. A temporal examination was similar for effects on pain with an SMD of 0.450 [0.104, 0.796] immediately, 0.711 [0.375, 1.048] short-term (1 to 11 weeks), and 0.470 [0.135, 0.805] for time-points ≥12 weeks. Regionally, there was a greater effect needling the area of pain locally (SMD = 0.754) compared to remotely (SMD = 0.501).Discussion: Statistically significant between-group differences were observed favoring deep needling over superficial. Both superficial and deep needling resulted in clinically meaningful changes in pain scores over time. However, differences between groups may not be clinically meaningful. More high-quality trials are needed to better estimate the effect size of deep versus superficial needling while controlling for location and depth of the lesion.Level of evidence: 1a

Scanning electron microscopy examination of needle tips after different procedures of deep dry needling in humans

The aim of this study was to evaluate the tips and the surface conditions of two types of needles with different quality and their possible alterations after performing different needling on human beings. A total of 160 needles from AguPunt brand were examined. Surface conditions (lumps and scratches) and tip of the needles after needling procedures in humans were tested using a JEOL JSM-6360LV microscopy device. Additionally, a group of physiotherapists assessed the use of both types of needles in clinical practice using a self-reported questionnaire. Both types of needles, after performing different needling on human beings, kept the needle tips well preserved although the dry needle (Type B) suffered very little deformation even touching the bone of the scapula 10 times versus acupuncture needle (Type A), which were deformed slightly. The surface conditions revealed irregularities and scratches in both types of needles but the tips of Type A suffered more damage after different procedures (Odds ratio = 0.04,95% CI:0.01–0.13, p < 0.001). The cellular tissue adhered to the surface was similar in both types of needles and the questionnaire about clinical practice of both types of needles showed that Type B seemed easier than Type A when the physical therapist penetrated the skin and when the needle went out the skin.

Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial

BackgroundChronic non-specific neck pain is related to limited cervical mobility, impaired function, neck muscles myofascial pain syndrome, and stress at work. The aforementioned factors are strongly related and may lead to a negative impact on health-related quality of life. There are some effective conservative Physical therapy interventions for treating chronic non-specific neck pain. Currently, Deep Dry Needling is emerging as an alternative for improving symptoms and consequently, the quality of life in patients with chronic non-specific neck pain. The purpose of the study was to examine the effectiveness of Deep Dry Needling of myofascial trigger points on health-related quality of life improvement, as a secondary analysis, in people with chronic non-specific neck pain.MethodsA randomized parallel-group blinded controlled clinical trial was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2011 to September 2014. One hundred thirty subjects with chronic non-specific neck pain and active myofascial trigger points in neck muscles were randomly allocated into two groups. Subjects in the intervention group (n = 65) were treated with Deep Dry Needling in active myofascial trigger points plus stretching in neck muscles; Control group (n = 65) received only stretching. Both interventions lasted 2 weeks, 2 sessions per week. Health-related quality of life was measured with Short Form-36 (SF-36), in 5 assessments: at baseline, after intervention period; and at 1, 3 and 6 months after intervention.ResultsFor both groups, SF-36 mean values increased in all dimensions in every assessment. Significant differences (p < 0.05) were found in favor of the intervention group for all dimensions at the last assessment. For some dimensions (physical function, physical role, social function and vitality), the evidence was more consistent from the beginning.ConclusionsDeep Dry Needling plus stretching is more effective than stretching alone for Health-related quality of life improvement, especially for physical function, physical role, social function and vitality dimensions, in people with non-specific neck pain.Trial registrationCurrent Controlled Trials ISRCTN22726482. Registered 9 October 2011.

Efficacy of dry needling in patients with myofascial temporomandibular disorders related to the masseter muscle

ABSTRACT Objective This randomized, single-center clinical trial aimed to compare the efficacy of superficial dry needling (SDN) and deep dry needling (DDN) in patients with myofascial temporomandibular disorder (MTMD) related to the masseter muscle.Methods: Forty patients showing MTMD with trigger points in the masseter muscle were randomly assigned to groups. Dry needling of the masseter muscle was performed once per week for three weeks. Pressure pain threshold (PPT) measurements, visual analog scale scores, and maximal jaw opening were assessed.Results: Both patient groups showed significant pain reduction, but the SDN group showed significantly better pain reduction. The PPT measurements obtained in the follow-up examinations at three and six weeks were significantly better than the values in SDN and DDN groups.Discussion: SDN showed better pain-reduction efficacy in patients with MTMD. Further research with a larger size sample and a longer follow-up period will help elucidate the benefits of SDN.

Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial

ObjectiveTo determine the effects of inclusion of deep dry needling into a treatment session following the Bobath concept on spasticity, motor function and postural control after a stroke.Methods26 patients who...

Postneedling Soreness and Tenderness After Different Dosages of Dry Needling of an Active Myofascial Trigger Point in Patients With Neck Pain: A Randomized Controlled Trial

BackgroundPrevious studies in asymptomatic subjects have demonstrated that myofascial trigger point (MTrP) dry needling frequently is associated with postneedling soreness. However, to the authors’ 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. ObjectiveTo (1) 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 Design1-week follow-up, double-blind randomized controlled trial. SettingUniversity community. ParticipantsPatients (n = 120: 34 male; 86 female) aged 18-53 years (median ± interquartile range, 21.0 ± 7.0 years) with active MTrPs in the upper trapezius. InterventionAll 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 measuresPostneedling soreness and pressure pain threshold were assessed before treatment, during DDN procedure, and every 24 hours during 1 week. ResultsPostneedling 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). Pressure pain threshold 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. ConclusionsPostneedling 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. Clinical trial registration numberNCT02190890 Level of EvidenceI

Post-needling soreness after myofascial trigger point dry needling: Current status and future research

Post-dry needling soreness is a common complication of myofascial trigger point (MTrP) dry needling treatment. The prevention, management and relevance of this complication remain uncertain. This paper examines the current state of knowledge and suggests directions for further studies in this area. MTrPs are hypersensitive nodules in skeletal muscles' taut bands, present in several pain conditions. Dry needling has been recommended for relieving MTrP pain. MTrP dry needling procedures have shown to be associated with post-needling soreness, which is thought to be a consequence of the neuromuscular damage, and hemorrhagic and inflammatory reaction generated by the needle. Postneedling soreness is a very frequent effect after deep dry needling, usually lasting less than 72 h. It may not be especially distressing for most patients. However, patients presenting with higher levels of post-needling soreness, not perceiving dry needling effectiveness in the first session, or not having high myofascial pain intensity before treatment, could be the most likely to find post-needling soreness more distressing, functionally limiting and to abandon treatment. Future research should assess the clinical relevance of post-needling soreness. Post-needling soreness should be considered when investigating dry needling effectiveness since it could overlie the original myofascial pain and influence the patients’ pain ratings.

Effects of Superficial and Deep Dry Needling on Pain and Muscle Thickness in Subject with Upper Trapezius Muscle Myofascial Pain Syndrome

Background: Dry needling is one of the main therapeutic approaches in patients with Myofascial pain syndrome. Few studies have been compared the superficial and deep dry needling methods in these patients. Objective: To evaluate the effects of superficial and deep dry needling on pain and muscle thickness in subjects with upper trapezius myofascial pain syndrome. Design: A randomized quasi-experimental double-blinded trial. Methods: 50 subjects with upper trapezius myofascial pain syndrome (age=26/08 ± 4/62, weight=63/88 ± 8/71 kg, height=167/7 ± 4/82 cm, pain duration=9/75 ± 7/05 m) randomly assigned to the superficial (n=25) and deep (n=25) dry needling groups. The pain and maximum thickness of upper trapezius muscle in rest, fair and normal contractions were measured by visual analogue scale (VAS) and an ultrasound device respectively before and after the intervention as well as 7 and 15 days follow-up. Results: The mixed-model ANOVAs revealed a significant group-by-time interaction (F=44.03, p<0.001) for pain and muscle thickness in rest (F=67.00, p<0.001), fair (F=108.73, p<0.001) and normal contraction (F=17.73, p<0.001). The main effects of group and time were statistically significant for pain, rest, fair and normal muscle thickness (p<0.001). There were not any significant differences in rest, fair and normal muscle thickness after intervention as well as 7 and 15 days follow-up. Conclusion: Both superficial and deep dry needling techniques induced significant short-term changes in the VAS. Muscle thickness in rest, fair and normal contractions did not show any significant changes between the groups.