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Murillo C, Cerezo-Téllez E, Torres-Lacomba M, Pham TQ, Lluch E, Falla D, Vo TT. Unraveling the Mechanisms Behind the Short-Term Effects of Dry Needling: New Insights From a Mediation Analysis With Repeatedly Measured Mediators and Outcomes. Arch Phys Med Rehabil 2024:S0003-9993(24)01165-1. [PMID: 39147008 DOI: 10.1016/j.apmr.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/01/2024] [Accepted: 07/18/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To explore the causal pathways underlying the short-term effects of deep dry needling (DDN) in people with chronic neck pain. DESIGN Explanatory longitudinal mediation analysis with repeatedly measured mediators and outcomes. SETTING Primary care setting. PARTICIPANTS Patients (N=128) with chronic neck pain. INTERVENTIONS Participants were randomized into 2 groups; DDN of the neck muscles combined with stretching (n=64) and stretching alone (n=64). MAIN OUTCOME MEASURES Two outcomes (pain intensity and neck pain-related disability) and 3 candidate mediators (local pressure pain thresholds [PPTs], cervical range of motion [ROM], and neck muscle strength) were included. Pain intensity was also included as a competing mediator in the mediation analysis for disability. Mediators and outcomes were measured at 3 time points: after intervention and at 2- and 4-week follow-up. Age, sex, and the baseline values of the outcome and mediators were included as pretreatment mediator-outcome confounders. RESULTS Reductions in pain intensity strongly mediated the short-term effects of DDN on disability, from after intervention to 4-week follow-up. In addition, the attenuation of local hypersensitivity (via increasing PPTs) moderately mediated reductions in pain intensity at each time point. On the other hand, gains in cervical ROM contributed to reducing neck pain-related disability. Changes in muscle strength did not lead to better outcomes. CONCLUSIONS This novel study demonstrated that DDN effect on neck pain-related disability is strongly driven by the analgesic effects of this physical therapy modality. Increasing PPTs and cervical ROM seem to be also part of the mechanisms behind DDN's effect.
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Affiliation(s)
- Carlos Murillo
- Division of General Internal Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Ester Cerezo-Téllez
- Department of Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - María Torres-Lacomba
- Department of Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain; Physiotherapy in Women's Health Research Group, Department of Physiotherapy, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Thien Quy Pham
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tat-Thang Vo
- Department of Epidemiology in Dermatology, Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), Université Paris Est Créteil (UPEC), Créteil, France
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Demeco A, de Sire A, Salerno A, Marotta N, Palermi S, Frizziero A, Costantino C. Dry Needling in Overhead Athletes with Myofascial Shoulder Pain: A Systematic Review. Sports (Basel) 2024; 12:156. [PMID: 38921850 PMCID: PMC11207993 DOI: 10.3390/sports12060156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
The treatment of myofascial pain in athletes requires a set of rehabilitation techniques that aim to be effective quickly. In this context, dry needling (DNY) has shown interesting results due to its ability to reduce pain in the short term. Thus, the aim of this study was to investigate the role of DNY in managing myofascial shoulder pain in overhead athletes. PubMed, Scopus and Web of Science were screened up to March 2024, to identify studies that met the following inclusion criteria: overhead athletes with shoulder pain with a DNY approach for myofascial trigger points (MTrPs), RCT, case-control study, feasibility study as the study design. Exclusion criteria were studies that did not include athletes, studies that did not focus on the treatment of MTrPs with DNY, other reviews, no full-text availability and papers written in a language other than English. Out of 399 articles, 165 were excluded as duplicates. Of the 234 articles screened, only 6 articles met the inclusion criteria. A total of 6 studies were included in the systematic review. Initial results showed that DNY improved pain rapidly and in the short term; however, there is still no consensus on the minimum number and the interval between treatments. Major findings reported a rapid potential decrease in perceived pain, shoulder disability and an increase in muscle strength; in this scenario, DNY might be a valid solution in a sports rehabilitation setting.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.F.); (C.C.)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.d.S.); (N.M.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.F.); (C.C.)
| | - Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (A.d.S.); (N.M.)
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | - Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.F.); (C.C.)
- ASST “Gaetano Pini” CTO, 20122 Milano, Italy
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.F.); (C.C.)
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Trybulski R, Stanula A, Żebrowska A, Podleśny M, Hall B. Acute Effects of the Dry Needling Session on Gastrocnemius Muscle Biomechanical Properties, and Perfusion with Latent Trigger Points - A Single-Blind Randomized Controlled Trial in Mixed Martial Arts Athletes. J Sports Sci Med 2024; 23:136-146. [PMID: 38455447 PMCID: PMC10915622 DOI: 10.52082/jssm.2024.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
The study aimed to evaluate the immediate effects of a dry needling (DN) therapy session on biomechanical properties, muscle power, perfusion, and pressure pain threshold of the gastrocnemius muscle with latent trigger points. Twenty mixed martial arts athletes (MMA) were randomly divided into two groups: experimental (eDN, n = 10) and sham (qDN, n = 10) to undergo one session of DN either with a real or a qazi needle. The measurements were taken at rest, 1-5 minutes after the DN (Post1-5min) and 24h after the DN (Post24h). DN significantly increased the muscle perfusion (Post1-5min and Post24h, p < 0.001), reduced its tone (Post1-5min and Post24h, p < 0.001) and stiffness (Post1-5min, p < 0.05; Post24 h, p < 0.001), and improved its elasticity (Post1-5min and Post24h, p < 0.001). DN also caused a significant increase in pressure pain threshold (Post1-5min, p < 0.001; Post24h, p < 0.05) and in muscle power (Post24h, p < 0.01). The DN session increased the blood perfusion and improved the biomechanical properties of the gastrocnemius muscle, which led to improved muscle power. The DN also had an analgesic effect. These effects were maintained at 24 h, which suggests that DN could facilitate muscle recovery in a post-exercise period of MMA athletes.
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Affiliation(s)
- Robert Trybulski
- Medical Department of the Wojciech Korfanty Upper Silesian Academy, Poland
| | - Arkadiusz Stanula
- Laboratory of Sport Performance Analysis, Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - Aleksandra Żebrowska
- Department of Physiology, School of Physiological-Medical Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | | | - Barbara Hall
- Department of Physiology, School of Physiological-Medical Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
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Trybulski R, Kużdżał A, Bichowska-Pawęska M, Vovkanych A, Kawczyński A, Biolik G, Muracki J. Immediate Effect of Cryo-Compression Therapy on Biomechanical Properties and Perfusion of Forearm Muscles in Mixed Martial Arts Fighters. J Clin Med 2024; 13:1177. [PMID: 38398489 PMCID: PMC10889478 DOI: 10.3390/jcm13041177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Mixed martial arts (MMA) fighters use their arms and hands for striking with the fists, grappling, and defensive techniques, which puts a high load on the forearms and hand muscles. New methods are needed to decrease the risk of injury and increase the effectiveness of regeneration. This study aimed to assess the effectiveness of cryo-compression (CC) therapy of different times (3 and 6 min) on forearm muscles in MMA fighters by investigating muscle pain, stiffness, tension, elasticity strength, and perfusion. Twenty professional male MMA fighters aged 26.5 ± 4.5 years, with training experience of 10.3 ± 5.0 years, were enrolled on an experimental within-group study design. The participants underwent CC therapy at a temperature of 3 °C and compression of 75 mmHg for 3 min and, in the second session, for 6 min. The investigated parameters were in the following order: (1) perfusion in non-reference units (PU), (2) muscle tone (T-[Hz]), (3) stiffness (S-[N/m]), (4) elasticity (E-[arb]), (5) pressure pain threshold (PPT-[N/cm]), and (6) maximum isometric force (Fmax [kgf]) at two time points: (1) at rest-2 min before CC therapy (pre) and (2) 2 min after CC therapy (post). There were significant differences between 3 and 6 min of CC therapy for PU and T. Meanwhile, F, E, PPT, and S were significantly different when comparing pre- to post-conditions. These results provide evidence that CC therapy is a stimulus that significantly affects parameters characterizing muscle biomechanical properties, pain threshold, strength, and tissue perfusion.
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Affiliation(s)
- Robert Trybulski
- Medical Department Wojciech Korfanty Upper Silesian Academy, 40-659 Katowice, Poland
| | - Adrian Kużdżał
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Marta Bichowska-Pawęska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Andriy Vovkanych
- Department of Physical Therapy and Ergotherapy, Ivan Boberkyj Lviv State University of Physical Culture, 79007 Lviv, Ukraine;
| | - Adam Kawczyński
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Grzegorz Biolik
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Jarosław Muracki
- Institute of Physical Culture Sciences, Department of Physical Education and Health, University of Szczecin, 70-453 Szczecin, Poland;
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McGowen JM, Hoppes CW, Forsse JS, Albin SR, Abt J, Koppenhaver SL. Myotonometry is Capable of Reliably Obtaining Trunk and Thigh Muscle Stiffness Measures in Military Cadets During Standing and Squatting Postures. Mil Med 2024; 189:e213-e219. [PMID: 37208314 DOI: 10.1093/milmed/usad179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Low back and lower extremity injuries are responsible for the highest percentage of musculoskeletal injuries in U.S. Army soldiers. Execution of common soldier tasks as well as army combat fitness test events such as the three-repetition maximum deadlift depends on healthy functioning trunk and lower extremity musculature to minimize the risk of injury. To assist with appropriate return to duty decisions following an injury, reliable and valid tests and measures must be applied by military health care providers. Myotonometry is a noninvasive method to assess muscle stiffness, which has demonstrated significant associations with physical performance and musculoskeletal injury. The aim of this study is to determine the test-retest reliability of myotonometry in lumbar spine and thigh musculature across postures (standing and squatting) that are relevant to common soldier tasks and the maximum deadlift. MATERIALS AND METHODS Repeat muscle stiffness measures were collected in 30 Baylor University Army Cadets with 1 week between each measurement. Measures were collected in the vastus lateralis (VL), biceps femoris (BF), lumbar multifidus (LM), and longissimus thoracis (LT) muscles with participants in standing and squatting positions. Intraclass correlation coefficients (ICCs3,2) were estimated, and their 95% CIs were calculated based on a mean rating, mixed-effects model. RESULTS The test-retest reliability (ICC3,2) of the stiffness measures was good to excellent in all muscles across the standing position (ICCs: VL = 0.94 [0.87-0.97], BF = 0.97 [0.93-0.98], LM = 0.96 [0.91-0.98], LT = 0.81 [0.59-0.91]) and was excellent in all muscles across the squatting position (ICCs: VL = 0.95 [0.89-0.98], BF = 0.94 [0.87-0.97], LM = 0.96 [0.92-0.98], LT = 0.93 [0.86-0.97]). CONCLUSION Myotonometry can reliably acquire stiffness measures in trunk and lower extremity muscles of healthy individuals in standing and squatting postures. These results may expand the research and clinical applications of myotonometry to identify muscular deficits and track intervention effectiveness. Myotonometry should be used in future studies to investigate muscle stiffness in these body positions in populations with musculoskeletal injuries and in research investigating the performance and rehabilitative intervention effectiveness.
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Affiliation(s)
- Jared M McGowen
- Department of Health, Human Performance, and Recreation, Baylor University, One Bear Place, Waco, TX 76798, USA
| | - Carrie W Hoppes
- Doctoral Program in Physical Therapy, Army-Baylor University, Joint Base San Antonio, Fort Sam Houston, TX 78234, USA
| | - Jeff S Forsse
- Department of Health, Human Performance, and Recreation, Baylor University, One Bear Place, Waco, TX 76798, USA
| | | | - John Abt
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX 75024, USA
| | - Shane L Koppenhaver
- Department of Health, Human Performance, and Recreation, Baylor University, One Bear Place, Waco, TX 76798, USA
- Doctoral Program in Physical Therapy, Baylor University, One Bear Place, Waco, TX 76798, USA
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McGowen JM, Albin SR, Hoppes CW, Forsse JS, Abt J, Koppenhaver SL. Physically Active Adults with Low Back Pain do not Demonstrate Altered Deadlift Mechanics: A Novel Application of Myotonometry to Estimate Inter-Muscular Load Sharing. Int J Sports Phys Ther 2024; 19:1462-1472. [PMID: 38179583 PMCID: PMC10761629 DOI: 10.26603/001c.90707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
Background Rehabilitation clinicians that work with physically active populations are challenged with how to safely return patients back to performing deadlift movements following low back injury. Application of reliable and valid tests and measures to quantify impairments related to low back pain (LBP) enhances clinical decision making and may affect outcomes. Myotonometry is a non-invasive method to assess muscle stiffness which has demonstrated significant associations with physical performance and musculoskeletal injury. Hypothesis/Purpose The purpose of this study was to compare the stiffness of trunk (lumbar multifidus [LM] and longissimus thoracis [LT]) and lower extremity (vastus lateralis [VL] and biceps femoris [BF]) muscles between individuals with and without LBP during the lying, standing, and deadlifting body positions. Study Design Cross-sectional cohort comparison. Methods Muscle stiffness measures were collected in the VL, BF, LM, and LT muscles with participants in lying (supine and prone), standing, and the trap bar deadlift position. Separate analyses of covariance were conducted to compare absolute and relative muscle stiffness between the groups for each muscle and condition. Results Sixty-eight participants (41 female, 21.3 years, 34 LBP) volunteered for the study. Within the deadlift condition there was a significantly greater increase in the percent-muscle stiffness change in the VL (p = .029, 21.9%) and BF (p = .024, 11.2%) muscles in the control group than in the LBP group. There were no differences in percent-muscle stiffness changes for the standing condition nor were there any absolute muscle stiffness differences between the two groups for the three conditions. Conclusion No differences in muscle stiffness were identified in the lying, standing, or deadlifting conditions between participants with and without LBP. Differences in percent stiffness changes were noted between groups for the deadlift position, however the differences were modest and within measurement error. Future studies should investigate the utility of myotonometry as a method to identify LBP-related impairments that contribute to chronic and/or recurrent low back injury. Level of Evidence Level 3.
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Affiliation(s)
| | | | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy Baylor University
| | | | - John Abt
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine
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7
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Kopecká B, Ravnik D, Jelen K, Bittner V. Objective Methods of Muscle Tone Diagnosis and Their Application-A Critical Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:7189. [PMID: 37631726 PMCID: PMC10458714 DOI: 10.3390/s23167189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
"Muscle tone" is a clinically important and widely used term and palpation is a crucial skill for its diagnosis. However, the term is defined rather vaguely, and palpation is not measurable objectively. Therefore, several methods have been developed to measure muscle tone objectively, in terms of biomechanical properties of the muscle. This article aims to summarize these approaches. Through database searches, we identified those studies related to objective muscle tone measurement in vivo, in situ. Based on them, we described existing methods and devices and compared their reliability. Furthermore, we presented an extensive list of the use of these methods in different fields of research. Although it is believed by some authors that palpation cannot be replaced by a mechanical device, several methods have already proved their utility in muscle biomechanical property diagnosis. There appear to be two issues preventing wider usage of these objective methods in clinical practice. Firstly, a high variability of their reliability, and secondly, a lack of valid mathematical models that would provide the observed mechanical characteristics with a clear physical significance and allow the results to be compared with each other.
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Affiliation(s)
- Barbora Kopecká
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - David Ravnik
- Faculty of Health Sciences, University of Primorska, 6310 Izola, Slovenia
| | - Karel Jelen
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Václav Bittner
- Faculty of Science, Humanities and Education, Technical University of Liberec, 461 17 Liberec, Czech Republic
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Lee S, Moon H, Ryu Y, Lee IS, Chae Y. Sensory and emotional responses to deep pressure stimulation at myofascial trigger points: a pilot study. Front Neurosci 2023; 17:1197302. [PMID: 37483352 PMCID: PMC10360180 DOI: 10.3389/fnins.2023.1197302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Objective Although manual pressure, such as that used during a massage, is often associated with pain, it can simultaneously be perceived as pleasant when applied to certain body areas. We hypothesized that stimulation of myofascial trigger points (TPs) leads to simultaneous pain and pleasure. TPs are hyperirritable points located in the taut band of the skeletal muscle. Method In this study, we measured the muscle tone, muscle stiffness, and pressure pain threshold of TPs and control points in the left brachioradialis muscle of 48 healthy participants. We also applied deep compression to the two points and collected subjective data on pain, pleasantness, unpleasantness, and relief. Result Greater muscle stiffness was observed in the TPs versus control points (t = 6.55, p < 0.001), and the pain threshold was significantly lower in the TPs (t = -6.21, p < 0.001). Unpleasantness ratings after deep compression were significantly lower in the TPs compared with control points (t = -2.68, p < 0.05). Participants experienced greater relief at the TPs compared with control points (t = 2.01, p < 0.05), although the perceived pain did not differ between the two types of points. Conclusion We compared the properties of TPs and control points, and found that deep compression at TPs was associated with higher muscle tone and stiffness, lower unpleasantness ratings, and higher relief ratings compared with the control points. These findings suggest that, at least for some TPs, pain and pleasantness are simultaneously elicited by deep pressure stimulation.
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Affiliation(s)
- Seoyoung Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Heeyoung Moon
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Yeonhee Ryu
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - In-Seon Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, Republic of Korea
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Becerra-Yañez P, Núñez-Cortés R, López R, Ortiz M, Pérez M, Cruz-Montecinos C. Treadmill exercise post dry needling improves heel rise in patients recovering from surgical ankle fracture: A randomised controlled trial. J Bodyw Mov Ther 2023; 34:60-65. [PMID: 37301559 DOI: 10.1016/j.jbmt.2023.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/10/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Little is known about the effectiveness of the dry needling technique (DNT) plus exercise on motor function in musculoskeletal diseases. OBJECTIVE To evaluate the effects of treadmill exercise immediately after DNT on pain, range of motion (ROM) and bilateral heel rise test in patients recovering from surgical ankle fracture. METHOD A randomised, parallel-group, controlled trial was conducted on patients recovering from surgical ankle fracture. Patients received the DNT intervention for the triceps surae muscle. Then, participants were randomly assigned to the experimental (DNT plus incline treadmill for 20 min) or control group (DNT plus rest for 20 min). Baseline and immediate post-intervention assessments included: visual analogue scale (VAS), maximal ankle dorsiflexion ROM and bilateral heel rise test. RESULTS A total of 20 patients recovering from surgical ankle fracture were included. Eleven patients were assigned to the experimental group (mean age 46 ± 12.6 years, 2/9 men/women) and nine to the control group (mean age 52 ± 13.4 years, 2/7 men/women). Two-way ANOVA showed a significant time × group interaction for bilateral heel rise test (F = 5.514, p = 0.030, ηp2 = 0.235). Both groups increased the number of repetitions (p < 0.001), however, the experimental group showed a significant difference compared to control group (mean difference: 2.73 repetitions; p = 0.030). There was no time × group interaction in VAS and ROM (p > 0.05). CONCLUSION Our results indicate that treadmill exercise after dry needling improves plantar flexors motor function more than rest after dry needling in patients with surgical ankle fracture.
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Affiliation(s)
- Pablo Becerra-Yañez
- Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ricardo López
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Morín Ortiz
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Martín Pérez
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
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10
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McGowen JM, Hoppes CW, Forsse JS, Albin SR, Abt J, Koppenhaver SL. The Utility of Myotonometry in Musculoskeletal Rehabilitation and Human Performance Programming. J Athl Train 2023; 58:305-318. [PMID: 37418563 PMCID: PMC11215642 DOI: 10.4085/616.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
Myotonometry is a relatively novel method used to quantify the biomechanical and viscoelastic properties (stiffness, compliance, tone, elasticity, creep, and mechanical relaxation) of palpable musculotendinous structures with portable mechanical devices called myotonometers. Myotonometers obtain these measures by recording the magnitude of radial tissue deformation that occurs in response to the amount of force that is perpendicularly applied to the tissue through a device's probe. Myotonometric parameters such as stiffness and compliance have repeatedly demonstrated strong correlations with force production and muscle activation. Paradoxically, individual muscle stiffness measures have been associated with both superior athletic performance and a higher incidence of injury. This indicates optimal stiffness levels may promote athletic performance, whereas too much or too little may lead to an increased risk of injury. Authors of numerous studies suggested that myotonometry may assist practitioners in the development of performance and rehabilitation programs that improve athletic performance, mitigate injury risk, guide therapeutic interventions, and optimize return-to-activity decision-making. Thus, the purpose of our narrative review was to summarize the potential utility of myotonometry as a clinical tool that assists musculoskeletal clinicians with the diagnosis, rehabilitation, and prevention of athletic injuries.
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Affiliation(s)
- Jared M. McGowen
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX
- US Army Medical Professional Training Brigade, San Antonio, TX
| | - Carrie W. Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX
| | - Jeff S. Forsse
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX
| | | | - John Abt
- Children’s Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, TX
| | - Shane L. Koppenhaver
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, TX
- Doctoral Program in Physical Therapy, Baylor University, Waco, TX
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11
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The Effects of Vibration Exposure on Lower-Limb Extensor Muscles' Stiffness, Elasticity, and Strength Responses in Untrained Young Individuals: A Randomized Controlled Trial. J Sport Rehabil 2023; 32:415-423. [PMID: 36708713 DOI: 10.1123/jsr.2022-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The whole-body vibration (WBV) effects on muscle strength show inconsistent results. Moreover, there is no study about the WBV effect on stiffness, elasticity, and muscle strength. Therefore, the study aimed to examine the effect of WBV exposure with static squat posture on the stiffness, elasticity, and strength of the lower-limb extensor muscles. MATERIAL AND METHODS Forty healthy untrained young adults were divided into WBV and control groups. The experimental group received WBV exposure on 2 nonconsecutive days of the week, for 6 weeks. The MyotonPRO device was used for the assessment of the knee extensor and the ankle dorsiflexors' stiffness and elasticity. Isometric muscle strength was evaluated with a hand-held dynamometer. All measurements were done by the same assessor at baseline, and the following 6 weeks. RESULTS Significant group-by-time interactions were found for the elasticity scores of the right (d = 0.84, P = .01) and left (d = 0.77, P = .02) ankle dorsiflexors. Similar to the elasticity measurements, significant group-by-time interactions were observed in the muscle strength scores of the right (d = 0.45, P = .046) and left (d = 1.25, P < .001) ankle dorsiflexors. No significant effects were observed in any of the evaluated muscle stiffness measurements (P > .05), and there was no significant group-by-time interaction in knee-extensor muscle strength and elasticity scores (P > .05). CONCLUSIONS The study results indicate that if the ankle dorsiflexor strength and elasticity are desired to be increased, the 6-week WBV exposure in a static squat posture can be used in healthy individuals.
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Ma YT, Dong YL, Wang B, Xie WP, Huang QM, Zheng YJ. Dry needling on latent and active myofascial trigger points versus oral diclofenac in patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:36. [PMID: 36650486 PMCID: PMC9847151 DOI: 10.1186/s12891-022-06116-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Latent and active myofascial trigger points (MTrPs) in knee-associated muscles may play a key role in pain management among patients with knee osteoarthritis (KOA). The aim of this study was to investigate the effect of dry needling treatment on pain intensity, disability, and range of motion (ROM) in patients with KOA. METHODS This randomized, single-blinded, clinical trial was carried out for 6 weeks of treatment and 6-month follow-up. A total of 98 patients met the entry criteria and were randomly assigned to the dry needling latent and active myofascial trigger point (MTrPs) with the stretching group or the oral diclofenacwith the stretching group. Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and ROM were statistically analyzed before and after treatment and at the 6-month follow-up. RESULTS A total of 42 patients in the dry needling group (DNG) and 35 patients in the diclofenac group (DG), respectively, completed the study, and there was no significant difference in the general data between the two groups. After treatments, both the groups showed a good effect in knee pain, function, and ROM, However, the DNG showed a significantly better result than the DG. Especially in the results of the 6-month follow-up, the DNG showed much better results than the DG. CONCLUSIONS Dry needling on latent and active MTrPs combined with stretching and oral diclofenac combined with stretching can effectively relieve pain, improve function, and restore knee ROM affected by KOA. However, the effects of dry needling and stretching are better and longer lasting than those of oral diclofenac and stretching for at least 6 months. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) in 17/11/2017 with the following code: ChiCTR-INR-17013432.
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Affiliation(s)
- Yan-Tao Ma
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yu-Lin Dong
- Department of Treatment, Yang Zhi Affiliated Rehabilition Hospital of Tongji, Shanghai, China
| | - Bo Wang
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wen-Pin Xie
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Qiang-Min Huang
- grid.412543.50000 0001 0033 4148Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, China ,Department of Pain Management, Shanghai Ciyuan Rehablitation Hospital, Sinophama Holding, Shanghai, China
| | - Yong-Jun Zheng
- grid.413597.d0000 0004 1757 8802Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Olesiejuk M, Marusiak J, Chalimoniuk M. Myofascial Trigger Points therapy decreases myotonometric tone and stiffness of trapezius muscle, benefits headaches and muscle pain in migraine. NeuroRehabilitation 2023; 52:299-310. [PMID: 36641690 DOI: 10.3233/nre-220237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Migraine is a primary headache disorder. Studies have shown that 93% of people with migraine have an increased number of active Ischemic Compression Myofascial Trigger Points (IC-MTrPs) therapy. OBJECTIVE To examine the effects of the IC-MTrPs therapy on: (1) mechanical properties of the upper trapezius muscle (UTM), (2) shoulder girdle and neck (SGN) muscles pain and (3) headaches characteristics in episodic migraine patients without aura. METHODS Thirty-one adult, female, migraine patients without aura underwent seven IC-MTrPs therapy sessions and were tested during maximally five measurement sessions (pre- and post-1'st, post-4'th, post-7'th therapy and 1-month follow-up). Myotonometric measurements of the UTM's tone, stiffness and elasticity, subjective SGN muscles pain, as well as headache's level, frequency and duration were analyzed. RESULTS Myotonometric tone and stiffness of the UTM significantly decreased in post-1'st, post-4'th therapy and in 1-month follow-up measurements versus pre-1'st therapy testing session. The scores for the SGN muscles' pain significantly decreased: (i) in post-4'th and post-7'th therapy versus post-1'st therapy session, and (ii) in post-7'th versus post-4'th therapy measurements. Headache's level, frequency and duration significantly decreased in post-7'th therapy versus pre-1'st therapy measurement session. CONCLUSION IC-MTrPs therapy resulted in a decrease of upper trapezius muscle tone and stiffness, with simultaneous alleviation of shoulder girdle and neck muscle pain and the headaches characteristics in episodic migraine patients without aura.
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Affiliation(s)
- Maciej Olesiejuk
- Department of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Faculty in Biala Podlaska, Biala Podlaska, Poland
| | - Jarosław Marusiak
- Department of Kinesiology, Faculty of Physiotherapy, Wroclaw University of Health and Sport Science, Wroclaw, Poland
| | - Małgorzata Chalimoniuk
- Department of Physical Education and Health in Biala Podlaska, Jozef Pilsudski University of Physical Education in Warsaw, Faculty in Biala Podlaska, Biala Podlaska, Poland
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Schneider E, Moore ES, Stanborough R, Slaven E. Effects of Trigger Point Dry Needling on Strength Measurements and Activation Levels of the Gluteus Medius: A Quasi-Experimental Randomized Control Study. Int J Sports Phys Ther 2022; 17:1404-1416. [PMID: 36518833 PMCID: PMC9718692 DOI: 10.26603/001c.55536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Latent trigger points have been identified as a source of impaired muscle function giving rise to a reduction in force production and alterations in muscle activation patterns and movement efficiency. There is limited investigation into the effectiveness of a treatment in reducing these clinical manifestations. Purpose To investigate whether the application of trigger point dry needling (TDN) to latent trigger points within the gluteus medius musculature affected strength measurements and muscle activation levels immediately following intervention. Design Quasi experimental, single group, pretest-posttest, randomized control study. Methods A control and an intervention side were randomly assigned for each participant (N = 39). Hand held dynamometer (HHD) force measurements and raw surface electromyography (sEMG) amplitude readings were recorded during maximal volitional isometric contractions of the gluteus medius in two separate positions before and after application of TDN. Comparison of within and between group data were conducted. Results A statistically significant interaction between time (pre-TDN to post-TDN) and groups (intervention side and control side), p < 0.001 was found for HHD measurements in both positions. Post hoc analysis revealed a statistically significant difference (p < 0.001) for all comparisons in the side lying neutral (SL0) position, while statistically significant differences (p < 0.001) were found for pre and post-TDN measurements within intervention side as well as between the intervention and control side for post-TDN measurements in the side lying internal rotation (SLIR) position. For sEMG amplitude measurements, statistically significant differences were found only in the SL0 position for within group comparisons on the intervention side (p = 0.009) and for between group comparisons for post-TDN measurements (p = 0.002). Conclusion Application of TDN to latent trigger points within the gluteus medius can significantly increase gluteus muscle force production immediately following intervention while reducing the level of muscle activation required during contraction. Level of Evidence Level 2.
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Affiliation(s)
- Eric Schneider
- Department of Physical Therapy Mount St Joseph University
| | | | | | - Emily Slaven
- Krannert School of Physical Therapy University of Indianapolis
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Lucena-Anton D, Luque-Moreno C, Valencia-Medero J, Garcia-Munoz C, Moral-Munoz JA. Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review. Healthcare (Basel) 2022; 10:healthcare10101862. [PMID: 36292308 PMCID: PMC9602116 DOI: 10.3390/healthcare10101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to analyze the effects of Dry Needling (DN) for the release of myofascial trigger points (MTrPs) in the triceps surae muscles (TSM). A systematic review was performed up to February 2022 in PubMed, PEDro, Scopus, CENTRAL, and Web of Science. Selection criteria were studies involving subjects older than 18 years presenting MTrPs in the TSM, without any concomitant acute or chronic musculoskeletal conditions; DN interventions applied to the MTrPs of the TSM; and results on pain, range of motion (ROM), muscle strength, muscle stiffness, and functional outcomes. The PEDro scale was used to assess the methodological quality of the studies, and the Risk of Bias Tool 2.0 to assess risk of bias. A total of 12 studies were included in the systematic review, involving 426 participants. These results suggest that DN of MTrPs in TSM could have a positive impact on muscle stiffness and functional outcomes. There are inconclusive findings on musculoskeletal pain, ROM, and muscle strength. Significant results were obtained in favor of the control groups on pressure pain thresholds. Despite the benefits obtained on muscle stiffness and functional performance, the evidence for the use of DN of MTrPs in the TSM remains inconclusive.
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Affiliation(s)
- David Lucena-Anton
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Carlos Luque-Moreno
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
- Correspondence:
| | - Jesus Valencia-Medero
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Cristina Garcia-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Jose A. Moral-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, 11009 Cadiz, Spain
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Myotonometric Evaluation of Latent Myofascial Trigger Points and Taut Band in Elite Athletes. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.959275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Albin SR, Hoffman LR, MacDonald CW, Boriack M, Heyn L, Schuler K, Taylor A, Walker J, Koppenhaver SL, Reinking MF. Ultrasonographic Validation for Needle Placement in the Tibialis Posterior Muscle. Int J Sports Phys Ther 2021; 16:1541-1547. [PMID: 34909259 PMCID: PMC8637304 DOI: 10.26603/001c.29854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The tibialis posterior (TP) muscle plays an important role in normal foot function. Safe, efficacious therapeutic approaches addressing this muscle are necessary; however, the location of the muscle in the deep posterior compartment can create challenges. PURPOSE The purpose of this study was to assess the accuracy of needle placement in the TP muscle and determine the needle placement in relation to the neurovascular structures located within the deep compartment. DESIGN Cross Sectional Study. METHODS Needle placement and ultrasound imaging were performed on 20 healthy individuals. A 50 mm or 60 mm needle was inserted between 30 - 50% of the tibial length measured from the medial tibiofemoral joint. The needle was inserted in a medial to lateral direction into the right extremity with the patient in right side lying. Placement of the needle into the TP muscle was verified with ultrasound imaging, and the shortest distance from the needle to the posterior tibial artery and tibial nerve was measured. The depth from the skin to the superficial border of the TP muscle was also measured. RESULTS Ultrasonography confirmed the needle filament was inserted into the TP muscle in all 20 individuals and did not penetrate the neurovascular bundle in any individual. The mean distance from the needle to the tibial nerve and posterior tibial artery was 10.0 + 4.7 mm and 10.2 + 4.7 mm respectively. The superficial border of the TP muscle from the skin was at a mean depth of 25.8 + 4.9 mm. CONCLUSION This ultrasound imaging needle placement study supports placement of a solid filament needle into the TP muscle with avoidance of the neurovascular structures of the deep posterior compartment when placed from a medial to lateral direction at 30-50% of the tibial length. LEVEL OF EVIDENCE 2b.
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18
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Effects of dry needling on mechanical and contractile properties of the upper trapezius with latent myofascial trigger points: A randomized controlled trial. Musculoskelet Sci Pract 2021; 56:102456. [PMID: 34507046 DOI: 10.1016/j.msksp.2021.102456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
Abstract
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.
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Chen Z, Ye X, Shen Z, Wang Y, Wu Z, Chen G, Guan Y, Wu J, Jiang T, Wu H, Liu W, Xu X. Comparison of the Asymmetries in Foot Posture and Properties of Gastrocnemius Muscle and Achilles Tendon Between Patients With Unilateral and Bilateral Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 9:636571. [PMID: 34738007 PMCID: PMC8561212 DOI: 10.3389/fbioe.2021.636571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Asymmetrical foot posture and properties alterations of the gastrocnemius muscle (GM) and Achilles tendon (AT) were observed in knee osteoarthritis (KOA). We aimed to investigate the inter-limbs asymmetries in foot posture and the properties of GM and AT and explore the association between them. Methods: A total of 62 subjects with unilateral or bilateral KOA were included in this study: 30 patients with unilateral pain and 32 patients with bilateral pain were assigned to the bilateral group (BG) and unilateral group (UG), respectively. The relatively serious leg (RSL) and relatively moderate leg (RML) were judged according to the severity of symptoms assessed by using visual analogue scale (VAS) motion. Foot posture and asymmetrical foot posture scores were assessed based on Foot Posture index (FPI-6). Subsequently, all the participants received an assessment for properties of GM and AT, including tone/tension (Hz), stiffness (N/m), and elasticity. We calculated the asymmetry index of AT (Asy-AT) in both legs and the difference of muscle properties between medial and lateral gastrocnemius (D-MLG) in the ipsilateral limb. Results: Asymmetry of foot posture was categorized into three types including normal, asymmetry, and severe asymmetry. The percentage of subjects classified as normal was higher in the BG (62.5%) than in the UG (36.67%), p < 0.05. Tension of AT and tone of lateral gastrocnemius (LG) in RSL were higher than those in RML (15.71 ± 0.91 vs. 15.23 ± 1.01; 25.31 ± 2.09 vs. 23.96 ± 2.08, p < 0.01 and p < 0.01, respectively), and stiffness of AT in the RSL was higher than that in RML (676.58 ± 111.45 vs. 625.66 ± 111.19, p < 0.01). Meanwhile, a positive relationship was found between ipsilateral FPI and tone of MG and LG in the left leg (0.246 per degree, 95% CI: −0.001, 0.129; p = 0.054 and 0.293 per degree, 95% CI: −0.014, 0.157; p = 0.021, respectively) and right leg (0.363 per degree, 95% CI: 0.033, 0.146; p = 0.004 and 0.272 per degree, 95% CI: 0.007, −0.144; p = 0.032, respectively). Moreover, a positive link was observed between asymmetrical FPI scores and K/L grade (0.291 per degree, 95% CI: 0.018, 0.216; p = 0.022). Furthermore, a significantly greater Asy-AT(tension) was detected in the UG than that in the BG (UG vs. UG: 8.20 ± 5.09% vs. 5.11 ± 4.72%, p < 0.01). Additionally, an increased asymmetrical FPI score (i.e., more severe asymmetry) was significantly associated with increases in Asy-AT(tension) and Asy-AT(stiffness) (0.42 per degree, 95% CI: 0.533, 1.881; p = 0.001 and 0.369 per degree, 95% CI: 0.596, 2.82; p = 0.003, respectively). Conclusions: The stiffness and tension of AT and the tone of LG in RSL were higher than those in RML in KOA patients, and inter-limbs foot posture and tension of AT were more asymmetrical in unilateral KOA patients compared to patients with bilateral KOA. Notably, foot posture, as an important biomechanical factor, was significantly associated with properties of GM, AT, and K/L grade in KOA patients.
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Affiliation(s)
- Zehua Chen
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen Shen
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Yi Wang
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zugui Wu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoqian Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Yingxin Guan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Zhuhai Hospital of Guangdong Province Traditional Chinese Medical Hospital, Zhuhai, China
| | - Jiatao Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Zhuhai Hospital of Guangdong Province Traditional Chinese Medical Hospital, Zhuhai, China
| | - Tao Jiang
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Huai Wu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Wengang Liu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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20
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Cruz-Montecinos C, Cerda M, Becerra P, Tapia C, Núñez-Cortés R, Latorre-García R, Freitas SR, Cuesta-Vargas A. Qualitative ultrasonography scale of the intensity of local twitch response during dry needling and its association with modified joint range of motion: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:790. [PMID: 34521384 PMCID: PMC8442322 DOI: 10.1186/s12891-021-04592-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relevance of local twitch response (LTR) during dry needling technique (DNT) is controversial, and it is questioned whether LTR is necessary for successful outcomes. Furthermore, because the LTR during the deep DNT may be evoked with different intensities, it is unknown whether the magnitude of LTR intensity is associated with optimal clinical results, especially concerning to the effects of joint maximal range of motion (ROM). This study aimed to (i) determine whether visual inspections can quantify the LTR intensity during the DNT through a qualitative ultrasonography scale of LTR intensity (US-LTR scale), and (ii) assess the differences of US-LTR scale associated with changes in the maximal joint ROM. METHODS Using a cross-sectional design, seven asymptomatic individuals were treated with DNT in the latent myofascial trigger point in both medial gastrocnemius muscles. During DNT, three consecutive LTRs were collected. The US-LTR scale was used to classify the LTRs into strong, medium, and weak intensities. The categories of US-LTR were differentiated by the velocity of LTRs using the optical flow algorithm. ROM changes in ankle dorsiflexion and knee extension were assessed before and immediately after DNT. RESULTS The US-LTR scale showed the third LTR was significantly smaller than the first one (p < 0.05). A significant difference in velocity was observed between US-LTR categories (p < 0.001). A significant difference in the ROM was observed between the strong and weak-medium intensity (p < 0.05). CONCLUSIONS The present findings suggest that the LTR intensity can be assessed using a qualitative US-LTR scale, and the effects of DNT on joint maximal ROM is maximized with higher LTR intensity. This study reports a novel qualitative method for LTR analysis with potential applications in research and clinical settings. However, further research is needed to achieve a broader application.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago, Chile
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Biomedical Neuroscience Institute, Santiago, Chile
| | - Pablo Becerra
- Laboratory of Biomechanics and Kinesiology, San José Hospital, Santiago, Chile
| | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rodrigo Latorre-García
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandro R Freitas
- Neuromuscular Research Lab, CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Antonio Cuesta-Vargas
- Departamento de Fisioterapia, Andalucía Tech, Catedra de Fisioterapia y Discapacidad, Instituto de Investigación Biomedica de Málaga (IBIMA), Clinimetria (F-14), Universidad de Málaga, Málaga, Spain.
- School of Clinical Science, Faculty of Health at Queensland University Technology, QLD, Brisbane, Australia.
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Pérez-Bellmunt A, Casasayas-Cos O, López-de-Celis C, Rodríguez-Sanz J, Rodríguez-Jiménez J, Ortiz-Miguel S, Meca-Rivera T, Fernández-de-las-Peñas C. Effects of Dry Needling of Latent Trigger Points on Viscoelastic and Muscular Contractile Properties: Preliminary Results of a Randomized Within-Participant Clinical Trial. J Clin Med 2021; 10:jcm10173848. [PMID: 34501299 PMCID: PMC8432234 DOI: 10.3390/jcm10173848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023] Open
Abstract
This study aimed to evaluate changes in neuromuscular function and pain perception in latent trigger points (TrPs) in the gastrocnemius muscle after a single session of dry needling. A randomized within-participant clinical trial was conducted. Fifty volunteers with latent TrPs in the gastrocnemius muscles were explored. Each extremity was randomly assigned to a control or experimental (dry needling) group. Viscoelastic parameters and contractile properties were analyzed by tensiomyography. Ankle dorsiflexion range of motion was assessed with the lunge test. Pressure pain thresholds (PPT) and pain perceived were also analyzed. The results observed that three viscoelastic proprieties (myotonometry) showed significant differences in favor of the experimental extremity in the lateral gastrocnemius: stiffness (p = 0.02), relaxation (p = 0.045), and creep (p = 0.03), but not in the medial gastrocnemius. No changes in tensiomyography outcomes were found. The control extremity showed a higher increase in PPTs (i.e., decrease in pressure pain sensitivity) than the experimental extremity (p = 0.03). No significant effects for range of motion or strength were observed. In general, gender did not influence the effects of dry needling over latent TrPs in the gastrocnemius muscle. In conclusion, a single session of dry needling was able to change some parameters of neuromuscular function, such as muscle tone, relaxation, pressure pain sensitivity, and creep in the lateral (but not medial) gastrocnemius but did not improve strength or range of motion.
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Affiliation(s)
- Albert Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Oriol Casasayas-Cos
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Carlos López-de-Celis
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Correspondence: (C.L.-d.-C.); (C.F.-d.-l.-P.)
| | - Jacobo Rodríguez-Sanz
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Sara Ortiz-Miguel
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Toni Meca-Rivera
- Basic Sciences Department, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain; (A.P.-B.); (O.C.-C.); (J.R.-S.); (S.O.-M.); (T.M.-R.)
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Correspondence: (C.L.-d.-C.); (C.F.-d.-l.-P.)
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