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Intelangelo L, Mendoza C, Lassaga I, Barbosa AC, Biurrun Manresa J, Mista C. No Evidence of Short-term Changes in Muscle Activity Elicited by Dry Needling in Chronic Unilateral Shoulder Pain Patients. Clin J Pain 2023; 39:595-603. [PMID: 37440340 DOI: 10.1097/ajp.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The aim of the study was to assess short-term changes in shoulder muscle activity elicited by dry needling in chronic unilateral shoulder pain (USP) patients. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted, in which 30 volunteers with USP were recruited and randomly assigned to either real or sham dry needling conditions. Pain intensity scores, pressure pain threshold, glenohumeral internal rotation angles, and electromyographic activity during isotonic shoulder tasks (shoulder flexion and extension) were assessed before, immediately, and 72 hours after the intervention in the infraspinatus and deltoid muscles. RESULTS A single application of real dry needling resulted in lower pain intensity scores and a larger range in glenohumeral internal rotation 72 hours after the intervention in comparison with sham dry needling. No differences in pressure pain threshold or muscle activity were observed due to the intervention. DISCUSSION A single application of real dry needling resulted in clinically significant changes in the short term. No differences were detected in muscle activation in the infraspinatus or deltoid muscles. Complementary interventions and longer follow-up times may be required to observe changes in muscle activity.
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Affiliation(s)
- Leonardo Intelangelo
- Musculoskeletal Research Unit-UIM, University Center for Assistance, Teaching, and Research-CUADI, University of Gran Rosario-UGR, Rosario, Santa Fe
| | - Cristian Mendoza
- Musculoskeletal Research Unit-UIM, University Center for Assistance, Teaching, and Research-CUADI, University of Gran Rosario-UGR, Rosario, Santa Fe
| | - Ignacio Lassaga
- Musculoskeletal Research Unit-UIM, University Center for Assistance, Teaching, and Research-CUADI, University of Gran Rosario-UGR, Rosario, Santa Fe
| | - Alexandre C Barbosa
- Department of Physical Therapy, Musculoskeletal Research Group-NIME, Federal University of Juiz de Fora, São Pedro, Governador Valadares, Brazil
| | - José Biurrun Manresa
- Institute for Research and Development on Bioengineering and Bioinformatics (IBB), CONICET-UNER
- Centre for Rehabilitation Engineering and Neuromuscular and Sensory Research (CIRINS), Faculty of Engineering, National University of Entre Ríos, Oro Verde, Entre Ríos, Argentina
| | - Christian Mista
- Institute for Research and Development on Bioengineering and Bioinformatics (IBB), CONICET-UNER
- Centre for Rehabilitation Engineering and Neuromuscular and Sensory Research (CIRINS), Faculty of Engineering, National University of Entre Ríos, Oro Verde, Entre Ríos, Argentina
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Baumann AN, Indermuhle T, Oleson CJ, Callaghan ME, Rogers H, Pennacchio C, Baldwin KD, Leland JM. Clinical Outcomes Associated With the Addition of a Physical Therapist Assistant to a Rehabilitation Team When Treating Musculoskeletal Shoulder Pain in the Outpatient Setting: A Retrospective Cohort Study. Cureus 2023; 15:e42680. [PMID: 37649949 PMCID: PMC10464543 DOI: 10.7759/cureus.42680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Musculoskeletal shoulder pain (MSP) is a common condition frequently treated in an outpatient setting by a physical therapy rehabilitation team. Treatment teams can consist of physical therapists (PTs) with or without physical therapist assistants (PTAs). It is currently unknown how different physical therapy team compositions can impact patient outcomes in the outpatient setting. The purpose of this study is to examine how the addition of PTAs to a physical therapy treatment team would impact clinical outcomes when treating patients with MSP in the outpatient setting. Methods This study is a retrospective cohort analysis comparing clinical outcomes for pain, active range of motion (AROM), and disability for patients with MSP when treated by physical therapy treatment teams with or without the presence of PTAs. Inclusion criteria were patients treated for MSP in an outpatient physical therapy clinic without a history of shoulder surgery. Depending on the rehabilitation team composition, patients were divided into a PT-only group or a PTA group. Results Total patients (n = 238) had a mean age of 62.6 ± 12.6 years (median: 64 years) with a mean total number of physical therapy visits of 7.8 ± 4.9 visits (median: 7.0 visits). Of the entire cohort, the PT-only group had 100 patients and the PTA group had 138 patients. There was no significant difference in the magnitude of pain improvement (mean: 1.5 versus 1.9 points, p = 0.177), the magnitude of abduction AROM improvement (mean: 17.6 versus 13.9 degrees, p = 0.173), and the magnitude of disability improvement (mean: 18.9 versus 13.4 percentage points, p = 0.221) between the PT-only group and the PTA group. However, the PT-only group had significantly fewer total visits as compared to the PTA group (6.7 versus 8.6 visits, p < 0.001). Conclusion The addition of PTAs to a rehabilitation team when treating patients with MSP in the outpatient setting does not appear to adversely impact pain, AROM, or disability outcomes. However, patients treated only by PTs had significantly less visits with similar outcomes. More research is needed to determine the interplay between cost, healthcare utilization, and patient outcomes to maximize quality care.
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Affiliation(s)
- Anthony N Baumann
- Department of Rehabilitation Services, University Hospitals, Cleveland, USA
| | - Thad Indermuhle
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Caleb J Oleson
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Megan E Callaghan
- College of Medicine, Case Western Reserve University, Cleveland, USA
| | - Hudson Rogers
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | | | - Keith D Baldwin
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, USA
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Ware JW, Venere K, Miller SA, Freeman H, Scalzitti DA, Hoogeboom T. A Systematic Appraisal of Conflicts of Interest and Researcher Allegiance in Clinical Studies of Dry Needling for Musculoskeletal Pain Disorders. Phys Ther 2023; 103:pzad023. [PMID: 37384639 DOI: 10.1093/ptj/pzad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and methods of conflicts of interest (COI) reporting in published dry needling (DN) studies and to determine the frequency of researcher allegiance (RA). METHODS A pragmatic systematic search was undertaken to identify DN studies that were included in systematic reviews. Information regarding COI and RA were extracted from the full text of the published DN reports, and study authors were sent a survey inquiring about the presence of RA. A secondary analysis also was undertaken based on study quality/risk of bias scores that were extracted from the corresponding systematic reviews and study funding extracted from each DN study. RESULTS Sixteen systematic reviews were identified, containing 60 studies of DN for musculoskeletal pain disorders, 58 of which were randomized controlled trials. Of the DN studies, 53% had a COI statement. None of these studies disclosed a COI. Nineteen (32%) authors of DN studies responded to the survey. According to the RA survey, 100% of DN studies included at least 1 RA criterion. According to the data extraction, 1 RA criterion was met in 45% of the DN studies. The magnitude of RA per study was 7 times higher according to the surveys than in the published reports. CONCLUSION These results suggest that COI and RA might be underreported in studies of DN. In addition, authors of DN studies might be unaware of the potential influence of RA on study results and conclusions. IMPACT Improved reporting of COI/RA might improve credibility of results and help identify the various factors involved in complex interventions provided by physical therapists. Doing so could help optimize treatments for musculoskeletal pain disorders provided by physical therapists.
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Affiliation(s)
- John W Ware
- Infirmary Therapy Services, Mobile, Alabama, USA
| | - Kenny Venere
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Stephanie A Miller
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Heather Freeman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - David A Scalzitti
- Department of Health, Human Function, & Rehabilitation Sciences, George Washington University, Washington, DC, USA
| | - Thomas Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Wang J, Zhang Y, Cui X, Shen L. Ultrasound-guided pulsed radiofrequency versus dry needling for pain management in chronic neck and shoulder myofascial pain syndrome patients at a tertiary hospital in China: a randomised controlled trial protocol. BMJ Open 2023; 13:e071422. [PMID: 37225266 DOI: 10.1136/bmjopen-2022-071422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Myofascial pain syndrome (MPS), especially in the neck and shoulder region, is one of the most common chronic pain disorders worldwide. Dry needling (DN) and pulsed radiofrequency (PRF) are the two effective methods for treating MPS. We aimed to compare the effects of DN and PRF in chronic neck and shoulder MPS patients. METHODS AND ANALYSIS This is a prospective, single-centre, randomised, controlled trial in a tertiary hospital. We plan to recruit 108 patients aged 18-70 years who are diagnosed with chronic MPS in the neck, shoulder and upper back regions and randomly allocate them to either the DN or PRF group at a 1:1 ratio. The DN group will receive ultrasound-guided intramuscular and interfascial DN 8-10 times per pain point or until local twitch responses are no longer elicited and 30 min of indwelling. The PRF group will receive ultrasound-guided intramuscular (0.9% saline 2 mL, 42℃, 2 Hz, 2 min) and interfascial (0.9% saline 5 mL, 42℃, 2 Hz, 2 min) PRF. Follow-up will be performed by the research assistant at 0, 1, 3 and 6 months postoperatively. The primary outcome is the postoperative 6-month pain visual analogue score (0-100 mm). Secondary outcomes include pressure pain threshold measured by an algometer, Neck Disability Index, depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), sleep status (Likert scale) and overall quality of life (36-Item Short Form Survey). Between-group comparisons will be analysed using either a non-parametric test or a mixed effects linear model. ETHICS AND DISSEMINATION This study was approved by the medical ethics committee of Peking Union Medical College Hospital (JS-3399). All participants will give written informed consent before participation. The results from this study will be shared at conferences and disseminated in international journals. TRIAL REGISTRATION NUMBER NCT05637047, Pre-results.
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Affiliation(s)
- Jin Wang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Beijing, China
| | - Xulei Cui
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Le Shen
- Department of Anesthesiology, Peking Union Medical College Hospital, State Key Laboratory of Complex Severe and Rare Disease, Beijing, China
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Kearns GA, Brismée JM, Riley SP, Wang-Price S, Denninger T, Vugrin M. Lack of standardization in dry needling dosage and adverse event documentation limits outcome and safety reports: a scoping review of randomized clinical trials. J Man Manip Ther 2023; 31:72-83. [PMID: 35607259 PMCID: PMC10013441 DOI: 10.1080/10669817.2022.2077516] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Examine: (1) whether variability in dry needling (DN) dosage affects pain outcomes, (2) if effect sizes are clinically important, and (3) how adverse events (AE) were documented and whether DN safety was determined. METHODS Nine databases were searched for randomized controlled trials (RCTs) investigating DN in symptomatic musculoskeletal disorders. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Included RCTs met PEDro criteria #1 and scored > 7/10. Data extraction included DN dosage, pain outcome measures, dichotomous AE reporting (yes/no), and AE categorization. Clinically meaningful differences were determined using the minimum clinically important difference (MCID) for pain outcomes . RESULTS Out of 22 identified RCTs, 11 demonstrated significant between-group differences exceeding the MCID, suggesting a clinically meaningful change in pain outcomes. Nine documented whether AE occurred. Only five provided AEs details and four cited a standard means to report AE. DISCUSSION There was inconsistency in reporting DN dosing parameters and AE. We could not determine if DN dosing affects outcomes, whether DN consistently produces clinically meaningful changes, or establish optimal dosage. Without more detailed reporting, replication of methods in future investigations is severely limited. A standardized method is lacking to report, classify, and provide context to AE from DN. Without more detailed AE reporting in clinical trials investigating DN efficacy, a more thorough appraisal of relative risk, severity, and frequency was not possible. Based on these inconsistencies, adopting a standardized checklist for reporting DN dosage and AE may improve internal and external validity and the generalizability of results.
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Affiliation(s)
- Gary A Kearns
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, School of Health Professions, Lubbock, TX, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, Texas Tech University Health Sciences Center, School of Health Professions, Lubbock, TX, USA
| | - Sean P Riley
- University of Hartford, Doctor of Physical Therapy Program West Hartford, CT, USA
| | - Sharon Wang-Price
- Doctor of Physical Therapy Program, Texas Women's University, Dallas, TX, USA
| | - Thomas Denninger
- Senior Director of Market Research and Development, ATI Physical Therapy, Greenville, SC, USA
| | - Margaret Vugrin
- Texas Tech University Health Sciences Library, Lubbock, TX, USA
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Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, Lescroart B, Cagnie B. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med 2023; 12:jcm12031205. [PMID: 36769852 PMCID: PMC9917679 DOI: 10.3390/jcm12031205] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
The number of systematic reviews (SR) summarizing the literature regarding the clinical effects of Dry Needling (DN) has increased rapidly. Yet, rigorous evidence about the clinical effectiveness of this technique is still lacking. The aim of this umbrella review is to summarize the evidence about the clinical effects of trigger point DN on musculoskeletal disorders across all body regions. PubMed, Web of Science and Embase were searched to identify SRs examining the effect of DN (as a stand-alone intervention or combined with another treatment modality) compared to sham/no intervention or a physical therapy (PT) intervention with at least one clinical outcome in the domain of pain or physical functioning. Risk of bias (RoB) was assessed with the AMSTAR-2 tool. Quantification of the overlap in primary studies was calculated using the corrected covered area (CCA). The electronic search yielded 2286 results, of which 36 SRs were included in this review. Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region. Some SRs favored wet needling (WN) over DN for short-term pain reductions. Results on physical functioning outcomes were contradictory across body regions. Limited data is available for mid- and long-term effects. DN has a short-term analgesic effect in all body regions and may be of additional value to the interventions that are used to date in clinical practice. Several studies have shown an additional treatment effect when combining DN to physiotherapeutic interventions compared to these interventions in isolation. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence.
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Affiliation(s)
- Marjolein Chys
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Correspondence:
| | | | - Indra De Greef
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Pain in Motion International Research Group, 1000 Brussels, Belgium
| | - Wouter Kindt
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yassir Kouzouz
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Bavo Lescroart
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
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7
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Chen YL, Liang YD, Guo KF, Huang Z, Feng WQ. Application of Acupuncture for Shoulder Pain Over the Past 22 Years: A Bibliometric Analysis. J Pain Res 2023; 16:893-909. [PMID: 36942307 PMCID: PMC10024538 DOI: 10.2147/jpr.s397168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose Acupuncture is widely used to relieve shoulder pain. A survey was conducted in order to recognize hotspots and frontiers of acupuncture for shoulder pain from the year 2000-2022. Methods The Web of Science Core Collection was used to collect literature related to acupuncture therapy for shoulder pain, which spanned January 2000 to August 2022. The number of publications yearly, countries/institutions, journals, and keywords was analyzed and visualized in shoulder pain with acupuncture therapy by CiteSpace v.5.7.R5. Results We totally analyzed 214 articles that met the inclusion criteria. The overall trend of publication volume continues to increase. The most productive authors in the field were César Fernández las Peñas and José L Arias-Buría, and the most influential author was Green S. Kyung Hee University and the People's Republic of China had the highest volume of publications, respectively. The most influential journal is Pain with high citation and impact factor. The hot keywords were "acupuncture", "shoulder pain", "dry needling", "randomized trial", and "injection". The research frontier in acupuncture for treating chronic shoulder pain was mainly "mechanism". Conclusion Over the last 22 years, the findings of this bibliometric analysis have provided research trends and frontiers in clinical research on acupuncture therapy for patients with shoulder pain, which identifying hot topics and exploring new directions for the future may be helpful to researchers. Studying mechanisms underlying acupuncture therapy for shoulder pain remains a focus of future research.
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Affiliation(s)
- Yu-Ling Chen
- Rehabilitation Department of the Panyu Central Hospital, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
- Rehabilitation Department of the Panyu Central Hospital, Guangzhou, People’s Republic of China
- Department of Acupuncture and Moxibustion of the YiBin Hospital of Traditional Chinese Medicine, YiBin, People’s Republic of China
| | - Yu-Dan Liang
- Department of Acupuncture and Rehabilitation, the Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen, People’s Republic of China
| | - Kai-Feng Guo
- Rehabilitation Department of the Panyu Central Hospital, Guangzhou, People’s Republic of China
| | - Zhen Huang
- Rehabilitation Department of the Panyu Central Hospital, Guangzhou, People’s Republic of China
- Correspondence: Zhen Huang, Rehabilitation Department of the Panyu Central Hospital, No. 8 Fuyu Road, Qiaonan District, Guangzhou, 511400, People’s Republic of China, Tel +86 18922238059, Email
| | - Wen-Qi Feng
- Department of Acupuncture and Moxibustion of the YiBin Hospital of Traditional Chinese Medicine, YiBin, People’s Republic of China
- Wen-Qi Feng, Department of Acupuncture and Moxibustion of the YiBin Hospital of Traditional Chinese Medicine, No. 2 Dawan Road, Nanan District, YiBin, 644000, People’s Republic of China, Tel +86 13629031868, Email
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Nuhmani S, Khan MH, Ahsan M, Abualait TS, Muaidi Q. Dry needling in the management of tendinopathy: A systematic review of randomized control trials. J Bodyw Mov Ther 2023; 33:128-135. [PMID: 36775507 DOI: 10.1016/j.jbmt.2022.09.021] [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: 05/31/2021] [Revised: 02/24/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objective of the study is to evaluate the best available evidence on the effectiveness of DN in the management of tendinopathy. METHODS Seven randomized control trials were selected following an electronic search in PubMed, Web of Science, Scopus, and SPORTDiscus databases. To be included in the current systematic review, the study had to be an RCT conducted on human participants, which investigated the effect of the DN technique on the management of tendinopathies. Only studies in the English language published in peer-reviewed journals between 1999 and 2020 were included. The methodological quality of the studies was assessed using the PEDro scale. RESULTS The PEDro score of the studies ranged from 5 to 9 with a mean score of 6.7 ± 1.2 (mean ± SD). A total of 357 participants were enrolled in the seven included studies, which were on greater trochanteric pain syndrome, lateral epicondylitis, supraspinatus tendinopathy and Achilles tendinopathy. DN was compared with various interventions, including platelet-rich plasma injection, autologous blood injection and non-steroidal anti-inflammatory medication. All the selected studies reported a significant positive effect of DN on pain intensity and other outcome measures, such as patient-specific functional score, disability index, range of motion and health-related quality of life. CONCLUSION The results indicate that DN appears to be as effective as other treatment methods at relieving pain and other symptoms of tendinopathy immediately after treatment and up to 6 months. DN can be considered among the many options available for the management of tendinopathy.
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Affiliation(s)
- Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Moazzam Hussain Khan
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Mohammad Ahsan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Turki Saeed Abualait
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Qassim Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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Xie Y, Pan J, Chen J, Zhang D, Jin S. Acupuncture combined with repeated transcranial magnetic stimulation for upper limb motor function after stroke: A systematic review and meta-analysis. NeuroRehabilitation 2023; 53:423-438. [PMID: 38143390 DOI: 10.3233/nre-230144] [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: 12/26/2023]
Abstract
BACKGROUND Upper limb motor dysfunction after stroke is an important factor affecting patients' motor function and daily life. Acupuncture and repetitive transcranial magnetic stimulation are effective methods for stroke rehabilitation. However, a systematic and comprehensive overview of the combined efficacy of the two is lacking. OBJECTIVE Through a systematic review and meta-analysis of randomized controlled trials, this study aimed to assess the effectiveness of acupuncture combined with repetitive transcranial magnetic stimulation on upper extremity motor function in post-stroke patients. METHODS The relevant randomized controlled trials on acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of upper limb motor disorders after stroke were searched in PubMed, Embase, Cochrane Library, Web of Science CNKI, VIP, Wanfang, and CBM databases. After screening clinical trials that met the inclusion criteria, data extraction was conducted independently by two investigators. Meta-analysis was performed using RevMan 5.4 software. RESULTS After the screening, 18 articles were included, with a total of 1083 subjects. The results of meta-analysis showed that combination therapy could effectively improve the patients' upper limb motor function (MD = 7.77, 95%CI [6.32, 9.22], P < 0.05), ability of daily living (MD = 8.53, 95%CI [6.28, 10.79], P < 0.05), and hemiplegic shoulder pain (MD = - 1.72, 95%CI [- 2.26, - 1.18], P < 0.05). Meanwhile, for neurophysiological indexes, combined treatment could significantly shorten the latency of motor evoked potential and central motor conduction time (MD = - 1.42, 95%CI [- 2.14, - 0.71], P < 0.05); (MD = - 0.47, 95%CI [- 0.66, - 0.29], P < 0.05), and also could increase the amplitude of motor evoked potential (SMD = 0.71, 95%CI [0.28, 1.14], P < 0.05). CONCLUSION According to the results of the meta-analysis, we can conclude that acupuncture combined with repeated transcranial magnetic stimulation can significantly improve the upper limb motor function and daily living ability of stroke patients.
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Affiliation(s)
- Yulong Xie
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - JuanHong Pan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jia Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Di Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Song Jin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Yehoshua I, Rimon O, Mizrahi Reuveni M, Peleg R, Adler L. Dry needling for the treatment of acute myofascial pain syndrome in general practitioners' clinics: a cohort study. BMC PRIMARY CARE 2022; 23:339. [PMID: 36572860 PMCID: PMC9792314 DOI: 10.1186/s12875-022-01951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Musculoskeletal pain is one of the leading complaints in the ambulatory setting. There are many ways to treat it, including pharmacologic and non-pharmacologic approaches. Dry needling (DN) is an option that is easy to learn, cheap and has a good safety profile. The aim of this study was to assess the association between DN performed by GPs for acute myofascial pain syndrome (MPS) and pain relief and to evaluate factors associated with treatment success. METHODS In this prospective cohort study, two GPs performed DN in their clinics. Patients were asked to rank their pain using the Short-Form McGill Pain Questionnaire (SF-MPQ) before, 10-min and 1-week after the procedure. The SF-MPQ index consists of 3 parts; visual analog scale (VAS), pain rating index (PRI) and present pain intensity (PPI). Logistic regressions were performed to assess the variables associated with short- and medium- term success. RESULTS Fifty two patients were recruited from September 2019 until August 2020. VAS was 6.0 ± 2.3 (before), 4.1 ± 2.5 (10-min after) and 2.6 ± 2.71 (1-week after), P < 0.05. PRI was 17 ± 9.1 (before), 10.8 ± 8.5 (10-min after) and 5.1 ± 6.5 (1-week after), P < 0.05. PPI was 2.6 ± 1.0 (before), 1.7 ± 1.0 (10-min after) and 1.1 ± 1.2 (1-week after), P < 0.05. Short-term success was associated with the physician who performed the procedure (OR 10.08, 95% CI 1.15,88.4) and with the use of a single needle (vs. multiple needles inserted) (OR 4.55, 95% CI 1.03,20.11). Medium-term success was associated with being a native born (non-immigrant), OR 8.59, 95% CI 1.11,66.28 and with high level of initial pain, OR 11.22, 95% CI 1.82,69.27. CONCLUSION Our study demonstrated improvement in acute pain 10-min and 1-week after DN performed by a GP, in all parts of the SF-MPQ. Therefore, we believe DN is a good therapeutic option for GPs to aid patients suffering from MPS.
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Affiliation(s)
- Ilan Yehoshua
- grid.425380.8Department of Family Medicine, Maccabi Healthcare Service, 27 Hamered Street, Tel Aviv, Israel ,grid.7489.20000 0004 1937 0511Ben Gurion University, Beer Sheva, Israel
| | - Oded Rimon
- grid.7489.20000 0004 1937 0511Ben Gurion University, Beer Sheva, Israel
| | - Miri Mizrahi Reuveni
- grid.425380.8Department of Family Medicine, Maccabi Healthcare Service, 27 Hamered Street, Tel Aviv, Israel
| | - Roni Peleg
- grid.7489.20000 0004 1937 0511Ben Gurion University, Beer Sheva, Israel
| | - Limor Adler
- grid.425380.8Department of Family Medicine, Maccabi Healthcare Service, 27 Hamered Street, Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Correlation between thoracic kyphosis and dry needle length required to reach the pleural space needling the upper trapezius: A cadaveric fluoroscopic assessment. Musculoskelet Sci Pract 2022; 62:102622. [PMID: 35841842 DOI: 10.1016/j.msksp.2022.102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is unknown whether greater prone thoracic kyphosis increases pneumothorax risk during upper trapezius dry needling. OBJECTIVES To fluoroscopically assess for a correlation between prone thoracic kyphosis and needle length required to reach the pleural space dry needling the upper trapezius in prone. DESIGN Cadaveric study. METHODS Prone thoracic kyphosis was assessed using dual bubble inclinometers. A 30 mm dry needle was inserted into the midsubstance of the upper trapezius perpendicular to the thoracic kyphosis. A single C-arm fluoroscopic image was obtained. This procedure was repeated with 40, 50, and 60 mm needles. Images were independently viewed by a radiologist to make a binary decision (yes vs. no) whether the needle had potentially broached the pleural space. RESULTS Fifteen cadaveric specimens with a mean age of 74.9 ± 9.7 and mean kyphosis of 21.5° ±7.7 were used. A 30 mm needle never reached the pleural space. The pleural space was potentially broached on one, four and six occasions by the 40, 50, and 60 mm needle respectively. The correlation between needle depth penetration and kyphosis was not significant (r = 0.03, p = 0.93). Longer needles (50 and 60 mm) were significantly (p = 0.0049) more likely to reach the pleural space than shorter needles (30 and 40 mm). CONCLUSION Thoracic kyphosis was not correlated with needle length required to reach the pleural space. Clinicians may consider selecting shorter needles (<40 mm) to mitigate potential risk while dry needling the upper trapezius in prone.
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Khanittanuphong P, Saesim A. Comparison of the effectiveness between dry needling with and without needle retention in myofascial trigger points in upper trapezius muscle: A randomized comparative trial. J Back Musculoskelet Rehabil 2022; 35:1247-1255. [PMID: 35570477 DOI: 10.3233/bmr-210177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dry needling (DN) is commonly used to treat myofascial trigger points (MTrPs). OBJECTIVE To compare the effect between DN with and without needle retention in the treatment of MTrPs in the upper trapezius muscle. METHODS Fifty-four patients who had active MTrPs in the upper trapezius muscle were randomly allocated into the DN group or the DN with retention group. The DN group received DN only, while the DN with retention group received DN with needle retention for 30 minutes. The visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded both before and after 7 and 14 days of the treatment sessions. RESULTS Both groups showed a significant decrease of the VAS at 7 and 14 days (mean difference DN group -53.0, DN with retention group -57.0, p< 0.001). The PPT was also significantly improved in both groups (mean difference DN group 109.8 kPa, DN with retention group 132.3 kPa, p< 0.001). However, there were no significant differences in the VAS or PPT between the groups. CONCLUSIONS Both DN and DN with retention had significant improvement of pain intensity in the treatment of MTrPs in the upper trapezius muscle at 14 days. However, pain reduction was not significantly different between the interventions.
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Para-García G, García-Muñoz AM, López-Gil JF, Ruiz-Cárdenas JD, García-Guillén AI, López-Román FJ, Pérez-Piñero S, Abellán-Ruiz MS, Cánovas F, Victoria-Montesinos D. Dry Needling Alone or in Combination with Exercise Therapy versus Other Interventions for Reducing Pain and Disability in Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10961. [PMID: 36078676 PMCID: PMC9518516 DOI: 10.3390/ijerph191710961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
This systematic review and meta-analysis examined the effects of dry needling alone or in combination with exercise therapy for reducing pain and disability in people with subacromial pain syndrome. Systematic searches of randomized clinical trials (RCTs) were performed in five different databases. A meta-analysis was carried out with the data obtained, and the risk of bias and quality of the studies was assessed using the Cochrane ROB 2.0 and GRADE tools. Finally, five RCTs (n = 315) were included in the meta-analysis and qualitative analysis. Our results determine that dry needling alone or combined with exercise therapy showed improvements in pain in the short-term (5RCTs: SMD: -0.27; [-0.49, -0.05]; low-quality) and mid-term (4RCTs: SMD: -0.27; [-0.51, -0.04]; low-quality) compared to a range of interventions. However, no differences were shown for disability at short-term (3 RCTs: SMD: -0.97; [-2.04, 0.11]; very-low quality) and mid-term (3 RCTs: SMD: -0.85; [-1.74, 0.04]; very-low quality). Dry needling alone or in combination with exercise therapy may result in a slight reduction in pain in the short-term and mid-term. However, the evidence about the effect of this therapy on disability in the short- or mid-term is very uncertain compared to the range of interventions analyzed in this systematic review (Registration: INPLASY202260112).
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Affiliation(s)
- Gonzalo Para-García
- Physiotherapy Department, Faculty of Health Sciences, Universidad Católica de Murcia, 30107 Murcia, Spain
| | - Ana María García-Muñoz
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
| | - José Francisco López-Gil
- Health and Social Research Center, Universidad de Castilla-La Mancha (UCLM), 16002 Cuenca, Spain
| | - Juan Diego Ruiz-Cárdenas
- ECOFISTEM Research Group, Faculty of Health Sciences, Catholic University of Murcia, 30107 Murcia, Spain
| | - Ana Isabel García-Guillén
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
| | - Francisco Javier López-Román
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
- Primary Care Research Group, Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain
| | - Silvia Pérez-Piñero
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
| | - María Salud Abellán-Ruiz
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
| | - Fernando Cánovas
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
| | - Desirée Victoria-Montesinos
- Health Sciences Department, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Carretera de Guadalupe s/n, 30107 Murcia, Spain
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Wang Y, Xu Y, Peng Y, Liao S, Dai G, Li T. Acupuncture for Atraumatic Shoulder Conditions: Protocol for a Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:720551. [PMID: 35330586 PMCID: PMC8940297 DOI: 10.3389/fmed.2022.720551] [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: 06/04/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Shoulder pain is one of the most common musculoskeletal disorders among adults and is caused by a variety of shoulder conditions. The popularity of different acupuncture methods in the nonsurgical treatment of shoulder pain has recently increased. However, evidence regarding the efficacy of acupuncture for shoulder pain is inconsistent, and there is a lack of supporting evidence regarding the overall efficacy of different acupuncture methods for shoulder pain. Methods and Analysis A systematic review will be conducted to assess the effectiveness of a wide range of acupuncture techniques for atraumatic shoulder conditions. The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Ovid MEDLINE, Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases will be searched to identify eligible studies. Studies will be selected according to preset inclusion and exclusion criteria and relevant data will be extracted from the final included studies. The heterogeneity, risk of bias, publication bias and evidence quality of the studies will be assessed, and a subgroup analysis and sensitivity analysis will be performed. Systematic Review Registration PROSPERO registration number CRD42021249625.
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Affiliation(s)
- Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, Chengdu, China
| | - Yu Peng
- School of Sports Medicine and Health, Postgraduate School, Chengdu Sport Institute, Chengdu, China
| | - Shichuan Liao
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Tao Li
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
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Javier-Ormazábal A, González-Platas M, González-Sierra E, González-Sierra M. Invasive Physiotherapy as a Treatment of Spasticity: A Systematic Review. Degener Neurol Neuromuscul Dis 2022; 12:23-29. [PMID: 35264894 PMCID: PMC8901191 DOI: 10.2147/dnnd.s350192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Nowadays, a set of novel physiotherapy techniques have emerged, in which the physical agent used to try to reduce spasticity is applied percutaneously, specifically, through the patient’s skin. The aim of this work is to encompass all the invasive techniques used in spasticity in a single article, updating the existing bibliography. Methodology A systematic review was carried out between December 2020 and April 2021 in the Web of Science, Scopus and PubMed databases, selecting the clinical trials that used acupuncture, electroacupuncture or dry needling as a treatment for spasticity. Sixteen clinical trials were included, summarizing all the study characteristics and the outcome measures, at last the evidence was described for their results. Results Most of the studies find a difference of significant decrease in spasticity between the subjects of the experimental groups. Only four studies found no significant changes in spasticity. All the studies are carried out together with the conventional physiotherapy treatment in spasticity. Conclusion Treatment with invasive physiotherapy, combined with conventional physiotherapy, seems to have positive effects in reducing spasticity, although more studies are needed to improve the heterogeneity of the interventions and to assess their long-term effectiveness.
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Affiliation(s)
- Alberto Javier-Ormazábal
- Rehabilitation Service, Hospital Universitario de Canarias, San Cristobal de la Laguna, Islas Canarias, Spain
- Correspondence: Alberto Javier-Ormazábal, Calle La Rosa no. 4, San Cristóbal de La Laguna, S/C de Tenerife38203, Spain, Email
| | - Montserrat González-Platas
- Neurology Service, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Islas Canarias, Spain
| | | | - Marta González-Sierra
- Home Hospitalization, Service Hospital Universitario de Canarias, San Cristóbal de La Laguna, Islas Canarias, Spain
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Blanco-Díaz M, Ruiz-Redondo R, Escobio-Prieto I, De la Fuente-Costa M, Albornoz-Cabello M, Casaña J. A Systematic Review of the Effectiveness of Dry Needling in Subacromial Syndrome. BIOLOGY 2022; 11:biology11020243. [PMID: 35205109 PMCID: PMC8869493 DOI: 10.3390/biology11020243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Dry needling, used by physical therapists, is a treatment modality used for the management of musculoskeletal pain. It is a technique in which a fine needle is used to penetrate the skin, subcutaneous tissues and muscles, with the aim of mechanically disrupting the inner tissues. This technique is called dry needling as the procedure does not involve the injection of any substance. Subacromial syndrome is defined as any kind of non-traumatic, usually unilateral, shoulder problem that causes pain around the acromion, that usually gets worse during or after lifting the arm. It should not be treated with surgical methods as the first option, but with different physiotherapy techniques. In this review, an overview of the effects of dry needling combined with conventional physiotherapy in patients with subacromial syndrome is presented. One of the key focal points is that dry needling combined with physiotherapy is effective and safe in reducing the pain and disability caused by this pathology. Abstract Our aim was to evaluate the effectiveness of dry needling (DN) combined with conventional physiotherapy in the recovery of patients with subacromial syndrome (SAS). A search was made of the main open access health science databases. The publication date was not limited for systematic reviews but was for randomized clinical trials (RCTs), which were limited to the last five years (from 2016) in English or in Spanish. Ninety-four studies were selected. In order to assess the quality of the studies, the JADAD scale or Oxford quality scoring system was used. A total of 402 patients were analyzed in all the studies in which the application of conventional physiotherapy was compared to the DN, either in a combination or in isolation. Improvements were obtained in pain intensity (Visual Analogic Scale—VAS), Range of Movement (ROM), Pressure Pain Threshold (PPT), functionality with Disabilities of the Arm, Shoulder and Hand (DASH) and the Shoulder Pain and Disability Index (SPADI), and in the cost–benefit ratio. DN is effective and safe in reducing the pain and disability produced by SAS, with the best combination of treatment turning out to be conventional physiotherapy together with DN, obtaining more stable and longer-lasting benefits than merely applying the techniques in isolation.
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Affiliation(s)
- María Blanco-Díaz
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Asturias, Spain; (M.B.-D.); (R.R.-R.); (M.D.l.F.-C.)
| | - Rubén Ruiz-Redondo
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Asturias, Spain; (M.B.-D.); (R.R.-R.); (M.D.l.F.-C.)
| | - Isabel Escobio-Prieto
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
- Correspondence:
| | - Marta De la Fuente-Costa
- Faculty of Medicine and Health Sciences, University of Oviedo, 33006 Oviedo, Asturias, Spain; (M.B.-D.); (R.R.-R.); (M.D.l.F.-C.)
| | - Manuel Albornoz-Cabello
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain;
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
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Ahn CB, Noh JY, Yoon HM, Kim CH, Song UK. Shoulder Pain Treated by Manual Acupuncture and Pharmacopuncture Following Origin/Insertion Technique of Applied Kinesiology: A Case Series of Two Patients. J Pharmacopuncture 2021; 24:206-212. [PMID: 35028172 PMCID: PMC8716707 DOI: 10.3831/kpi.2021.24.4.206] [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: 10/10/2021] [Revised: 10/13/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to report on the improvement of shoulder pain resulting from disorders of the rotator cuff such as impingement syndrome and adhesive capsulitis, by manual acupuncture (MA) and pharmacopuncture (PA) following origin/insertion technique (OIT) of applied kinesiology (AK). Two patients were treated with MA and PA after OIT on shoulder muscles. The Numerical Rating Scale and the assessment of the Japanese Orthopedic Association scores were used to assess the pain, and ultrasound images were taken to compare treatment outcome. This study showed that MA and PA following OIT may be an effective treatment for impingement syndrome and adhesive capsulitis.
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Affiliation(s)
- Chang-Beohm Ahn
- Department of Acupuncture & Moxibustion Medicine, Samse Korean Medicine Hospital, Busan, Republic of Korea
| | - Joon-Yong Noh
- Department of Acupuncture & Moxibustion Medicine, Samse Korean Medicine Hospital, Busan, Republic of Korea
| | - Hyun-Min Yoon
- Department of Acupuncture & Moxibustion, College of Oriental Medicine, Dongeui University, Busan, Republic of Korea
| | - Cheol-Hong Kim
- Department of Acupuncture & Moxibustion, College of Oriental Medicine, Dongeui University, Busan, Republic of Korea
| | - Ung-Kwan Song
- Department of Family Medicine, Samse Medicine Hospital, Busan, Republic of Korea
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Laramée A, Léonard G, Morin M, Roch M, Gaudreault N. Neurophysiological and psychophysical effects of dry versus sham needling of the infraspinatus muscle in patients with chronic shoulder pain: a randomized feasibility study. Arch Physiother 2021; 11:23. [PMID: 34663474 PMCID: PMC8524890 DOI: 10.1186/s40945-021-00118-x] [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: 02/24/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Dry needling (DN) is increasingly used for treating myofascial trigger points (MTrPs) and has shown significant effects on pain and function. This study aimed to assess feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the effects of infraspinatus DN on corticospinal excitability and mechanical pain sensitivity. METHOD This randomized feasibility study included adults with chronic non-traumatic shoulder pain and a infraspinatus MTrP. Participants were randomized to receive real DN or sham DN in the infraspinatus MTrP. Feasibility outcomes included data pertaining to recruitment, retention of participants, completeness and safety of assessment procedures. Neurophysiological and psychophysical outcomes included corticospinal excitability and mechanical pain sensitivity measured by active motor threshold (aMT) and pressure pain threshold (PPT), respectively. They were assessed at baseline, immediately after and 24 h post-intervention. RESULTS Twenty-one participants were recruited over a 6-month period. Nineteen participants completed the treatment and follow-up assessment. Motor evoked potential responses were discernible in all but 1 participant. Only 1 minor adverse event related to transcranial magnetic stimulation (mild headache) affected the measurements. No DN adverse effects were recorded in both groups. An overall completeness rate of 81% was reached, with 70% completeness in the DN group and 91% in the sham group. Data analysis revealed that real DN increased corticospinal excitability (reduced aMT) 24 h post-intervention (Mdn = - 5.96% MSO, IQR = 5.17, p = 0.04) and that sham DN triggered similar responses immediately after the intervention (Mdn = - 1.93% MSO, IQR = 1.11, p = 0.03). Increased mechanical pain sensitivity (reduced PPT) was significant only in the sham group, both immediately (Mdn = - 0.44 kg/cm2, IQR = 0.49, p = 0.01) and 24 h post-intervention (Mdn = - 0.52 kg/cm2, IQR = 1.02, p = 0.02). Changes in corticospinal excitability was positively correlated with changes in mechanical pain sensitivity in the DN group, both immediately (r = 0.77, p = 0.02) and 24 h post-intervention (r = 0.75, p = 0.05). CONCLUSION The present study demonstrates the feasibility of quantifying the neurophysiological and psychophysical effects of DN, and provides recommendations and guidelines for future studies. Moreover, it provides preliminary evidence that DN may increase corticospinal excitability of the infraspinatus muscle in patients with chronic shoulder pain and that the relationship of neurophysiological and psychophysical effects is promising to better understand its mechanisms of action. TRIAL REGISTRATION NCT04316793 ; retrospectively registered November 3, 2020.
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Affiliation(s)
- Antoine Laramée
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada
| | - Guillaume Léonard
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Centre de Recherche sur le Vieillissement (CdRV), 1036 Rue Belvédère S, Sherbrooke, Québec, Canada
| | - Mélanie Morin
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada
| | - Mélanie Roch
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada
| | - Nathaly Gaudreault
- University of Sherbrooke, School of Medicine and Health Sciences, School of Rehabilitation, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada
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Myburgh C, Kildsgaard K, Damsgaard T, Corfixen K, Boyle E. Consistency of Dry-Needling Interventions Across High-Quality Randomized Trials: A Critical Systematic Exploration of Intervention Reporting and Fidelity. J Manipulative Physiol Ther 2021; 44:546-557. [DOI: 10.1016/j.jmpt.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022]
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Sánchez-Infante J, Navarro-Santana MJ, Bravo-Sánchez A, Jiménez-Diaz F, Abián-Vicén J. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6145047. [PMID: 33609356 DOI: 10.1093/ptj/pzab070] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The main objective of this systematic review and meta-analysis was to determine the short-, medium-, and long-term effectiveness of dry needling (DN) applied by physical therapists to myofascial trigger points for the treatment of pain. METHODS PubMed, Scopus, SportDiscus, and Web of Science databases were searched from their inception to February 2020. Randomized controlled trials that compared DN with other treatments or placebo and measured pain with a visual analog Scale or another numerical pain rating scale were included. Two authors used a personalized form to collect the following data relevant to the objectives of the review from each article independently: study design, purpose, sample size, diagnosis, characteristics of DN intervention, characteristics of placebo intervention, outcome measures, period of assessment, body region, DN technique, and number of sessions. The initial search identified 1771 articles. After the selection, 102 articles were assessed for eligibility; 42 of these articles measuring pain were used for the meta-analysis. Four meta-analyses were performed according to the follow-up period from the last reported treatment. RESULTS This meta-analysis found a large effect to decrease pain within 72 hours (standardized mean difference [SMD] = -0.81; 95% CI = -1.21 to -0.40), a moderate effect in 1 to 3 weeks (SMD = -0.69; 95% CI = -1.02 to -0.35), a large effect in 4 to 12 weeks (SMD = -0.85; 95% CI = -1.30 to -0.40), and a large effect in 13 to 24 weeks (SMD = -0.81; 95% CI = -1.64 to -0.03). The risk of bias was generally low; however, the heterogeneity of the results downgraded the level of evidence. CONCLUSIONS Low-quality evidence that the immediate to 72-hour (large) effect, 4- to 12-week (large) effect, 13- to 24-week (large) effect, and moderate-quality 1- to 3-week (moderate) effect suggested that DN performed by physical therapists was more effective than no treatment, sham DN, and other therapies for reducing pain. IMPACT DN is commonly used by physical therapists to treat musculoskeletal pain, and it is very important for physical therapists to know the clinical conditions and time periods for which DN is effective in reducing pain in their patients.
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Affiliation(s)
- Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, University of Complutense de Madrid, Madrid, Spain
| | - Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Jiménez-Diaz
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
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Kang L, Liu P, Peng A, Sun B, He Y, Huang Z, Wang M, Hu Y, He B. Application of traditional Chinese therapy in sports medicine. SPORTS MEDICINE AND HEALTH SCIENCE 2021; 3:11-20. [PMID: 35782678 PMCID: PMC9219272 DOI: 10.1016/j.smhs.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/31/2023] Open
Abstract
Chinese herbs have been used as dietary supplements to improve exercise performance. However, evidence-based studies for the use of Chinese herbs in sports remain scarce. Traditional Chinese therapy (TCT), a form of traditional Chinese non-pharmacological intervention, has remained in use for thousands of years in sports medicine. TCT is beneficial for sports injuries and in enhancing skill development, and is becoming increasingly popular among athletes, fitness enthusiasts, and individuals who regularly exercise. The therapeutic effects of TCT have been demonstrated by clinical and experimental studies, but using these modalities still is associate with potentially adverse effects. Further well-designed studies are necessary to confirm the efficacy of TCT in sports medicine. This review aims to summarize the application of TCT, discuss the issues surrounding TCT clinical research, and provide suggestions for applying traditional Chinese methods in the field of sports medicine.
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Affiliation(s)
- Liang Kang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Peijie Liu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Aishi Peng
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Bingxin Sun
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Yumei He
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Zenghao Huang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Minjia Wang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Yushi Hu
- Sport Hospital Affiliated to Chengdu Sport University, Chengdu, 610041, China
| | - Benxiang He
- Sport Hospital Affiliated to Chengdu Sport University, Chengdu, 610041, China
- Corresponding author. Sport Hospital Affiliated to Chengdu Sports University, 610041, No. 251, Wuhou Temple Street, Wuhou District, Chengdu, China.
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Acupuncture for Symptomatic Rotator Cuff Disease: A Systematic Review and Meta-Analysis. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2020.00458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objective was to evaluate the effectiveness and safety of acupuncture for patients with rotator cuff diseases.<br/>There were 12 electronic databases and 3 trial registries searched up to November 30<sup>th</sup>, 2019. All randomized trials were eligible, regardless of language, date of publication, or settings. The primary outcomes were pain, shoulder function, and proportion of improved participants assessed within 12 weeks of randomization of the trial. The Cochrane risk of bias for the studies was assessed. Effects sizes were presented as a risk ratio, mean difference, or standardized mean difference with a 95% confidence intervals. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to rate certainty of evidence.<br/>Of the 3,686 records screened, 28 randomized trials (2,216 participants) were included in this review. The types of acupuncture included manual acupuncture, dry needling, electroacupuncture, acupotomy, warm needle acupuncture, and fire needle acupuncture. All of the studies had an unclear or high risk of bias related to more than 1 domain. Significant benefits of acupuncture in terms of pain and shoulder function were observed in all comparisons, however, the proportion of improved participants was not described in 2 comparisons. There was substantial heterogeneity among meta-analyzed trials. No serious harm was observed. For primary outcomes, the overall certainty of evidence was very low.<br/>There was very low certainty of evidence for the benefits of acupuncture for patients with rotator cuff diseases. The safety of acupuncture remains unclear due to the incompleteness of reporting. Future welldesigned randomized trials with transparent reporting are required.
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Navarro-Santana MJ, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, Fernández-de-Las-Peñas C, Plaza-Manzano G. Effects of Trigger Point Dry Needling for Nontraumatic Shoulder Pain of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6042194. [PMID: 33340405 DOI: 10.1093/ptj/pzaa216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/08/2020] [Accepted: 10/28/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effects of trigger point (TrP) dry needling alone or as an adjunct to other interventions on pain intensity and related disability in nontraumatic shoulder pain. METHODS Ten databases were searched from inception to January 2020 for randomized clinical trials in which at least 1 group received TrP dry needling for shoulder pain of musculoskeletal origin with outcomes collected on pain intensity and related disability. Data extraction including participant and therapist details, interventions, blinding strategy, blinding assessment outcomes, and results were extracted by 2 reviewers. The risk of bias (Cochrane Risk of Bias, Cochrane Guidelines), methodological quality (Physiotherapy Evidence Database score), and evidence level (Grading of Recommendations Assessment, Development, and Evaluation approach) were assessed. The search identified 551 publications with 6 trials eligible for inclusion. RESULTS There was moderate-quality evidence that TrP dry needling reduces shoulder pain intensity with a small effect (mean difference = -0.49 points, 95% CI = -0.84 to -0.13; standardized mean difference = -0.25, 95% CI = -0.42 to -0.09) and low-quality evidence that TrP dry needling improves related disability with a large effect (mean difference = -9.99 points, 95% CI -15.97 to -4.01; standardized mean difference = -1.14, 95% CI -1.81 to -0.47) compared with a comparison group. The effects on pain were only found at short term. The Cochrane Risk of Bias was generally low, but the heterogenicity of the results downgraded the evidence level. CONCLUSION Moderate- to low-quality evidence suggests positive effects of TrP dry needling for pain intensity (small effect) and pain-related disability (large effect) in nontraumatic shoulder pain of musculoskeletal origin, mostly at short term. Future clinical trials investigating long-term effects are needed. IMPACT Dry needling is commonly used for the management of musculoskeletal pain. This is the first meta-analysis to examine the effects of dry needling on nontraumatic shoulder pain.
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Affiliation(s)
- Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Rehabilitación San Fernando, Madrid, Spain
| | | | - Joshua A Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Physical Therapist, Rehabilitation Services, Concord Hospital, Concord, New Hampshire, USA.,Faculty, Manual Therapy Fellowship Program, Regis University, Denver, Colorado, USA
| | - Jose L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
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Bynum R, Garcia O, Herbst E, Kossa M, Liou K, Cowan A, Hilton C. Effects of Dry Needling on Spasticity and Range of Motion: A Systematic Review. Am J Occup Ther 2021; 75:7501205030p1-7501205030p13. [PMID: 33399051 DOI: 10.5014/ajot.2021.041798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE This systematic review summarizes existing studies on dry needling for spasticity and range of motion (ROM) and discusses its potential for use as an occupational therapy intervention. OBJECTIVE To examine existing studies on the effects of dry needling on spasticity and ROM. DATA SOURCES Article citations and abstracts from Scopus, Cochrane Library, PubMed, CINAHL, and a university library search. STUDY SELECTION AND DATA COLLECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in abstracting data. Peer-reviewed journal articles published in English between January 2007 and June 2019 were searched. Of 270 identified studies, 10 met the inclusion criteria. Studies were divided into categories on the basis of outcome measures (Modified Modified Ashworth Scale and ROM). Pain outcome measures were excluded because a systematic review addressing this outcome has recently been completed. FINDINGS Strong evidence was found to support the use of dry needling to decrease spasticity and increase ROM. CONCLUSIONS AND RELEVANCE This systematic review suggests that dry needling is an effective physical agent modality to decrease spasticity and increase ROM, both of which are potentially beneficial to functional outcomes. WHAT THIS ARTICLE ADDS This article provides information that may be helpful in determining the appropriateness of dry needling as an occupational therapy intervention.
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Affiliation(s)
- Rachel Bynum
- Rachel Bynum, MOT, OTR, is Graduate, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Olivia Garcia
- Olivia Garcia, MOT, OTR, is Occupational Therapist, Winter Pediatric Therapy, Houston, TX. At the time of the study, Garcia was Graduate Student, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Emily Herbst
- Emily Herbst, MOT, OTR, is Occupational Therapist, Encompass Health Rehabilitation Hospital, Round Rock, TX. At the time of the study, Herbst was Graduate Student, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Mary Kossa
- Mary Kossa, MOT, OTR, is Graduate, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Katrina Liou
- Katrina Liou, MOT, OTR, is Graduate, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - April Cowan
- April Cowan, OTD, OTR, CHT, is Associate Professor of Instruction, Occupational Therapy Department, University of Texas Medical Branch, Galveston
| | - Claudia Hilton
- Claudia Hilton, PhD, MBA, OTR, FAOTA, is Associate Professor, Occupational Therapy Department, University of Texas Medical Branch, Galveston;
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The Long-Term Effectiveness of Trigger Point Dry Needling and Exercise for Individuals With Shoulder Pain: A Critically Appraised Topic. J Sport Rehabil 2020; 30:333-338. [PMID: 32871549 DOI: 10.1123/jsr.2019-0525] [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: 12/12/2019] [Revised: 05/11/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Shoulder pain is a very common symptom encountered in outpatient physical therapy practice. In addition to therapeutic exercise and manual therapy interventions, trigger point dry needling (TDN) has emerged as a possible treatment option for reducing shoulder pain and improving function. Dry needling consists of inserting a thin stainless-steel filament into a myofascial trigger point with the intention of eliciting a local twitch response of the muscle. It is theorized that this twitch response results in reduced muscle tension and can aid in reduced pain and disability. To this point, multiple studies have found TDN to be effective at reducing pain and improving function in the short-term, but the long-term outcomes remain unknown. Clinical Question: Does the addition of TDN to an exercise program result in better long-term pain intensity and disability reduction in patients with shoulder pain? Summary of Findings: Improvement in long-term pain and function can be expected regardless of the addition of TDN to an evidence-based exercise program for patients with shoulder pain. Clinical Bottom Line: Either TDN or an evidence-based therapeutic exercise program elicits improved long-term pain and disability reduction in patients with shoulder pain, which suggests that clinicians can confidently use either approach with their patients. Strength of Recommendation: Strong evidence (level 2 evidence with PEDro scores >8/10) suggesting that TDN does not outperform therapeutic exercise regarding long-term pain reduction.
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26
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Vulfsons S, Minerbi A. The Case for Comorbid Myofascial Pain-A Qualitative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145188. [PMID: 32709141 PMCID: PMC7400256 DOI: 10.3390/ijerph17145188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
Myofascial pain syndrome is widely considered to be among the most prevalent pain conditions, both in the community and in specialized pain clinics. While myofascial pain often arises in otherwise healthy individuals, evidence is mounting that its prevalence may be even higher in individuals with various comorbidities. Comorbid myofascial pain has been observed in a wide variety of medical conditions, including malignant tumors, osteoarthritis, neurological conditions, and mental health conditions. Here, we review the evidence of comorbid myofascial pain and discuss the diagnostic and therapeutic implications of its recognition.
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Affiliation(s)
- Simon Vulfsons
- Correspondence: ; Tel.: +972-47772234; Fax: +972-47773505
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27
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Rodríguez-Huguet M, Góngora-Rodríguez J, Rodríguez-Huguet P, Ibañez-Vera AJ, Rodríguez-Almagro D, Martín-Valero R, Díaz-Fernández Á, Lomas-Vega R. Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial. J Clin Med 2020; 9:jcm9061837. [PMID: 32545583 PMCID: PMC7356532 DOI: 10.3390/jcm9061837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n = 18) or a TDN group (n = 18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p = 0.002). The improvement achieved in the PE group was greater in the NPRS (p < 0.001), proximal PPT, middle PPT, distal PPT (all p < 0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up.
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Affiliation(s)
- Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain;
- Hospital de La Línea de la Concepción, 11300 Cádiz, Spain
| | | | - Pablo Rodríguez-Huguet
- Andalusian Regional Public Health Service Hospital of Jerez de la Frontera, 11407 Cadiz, Spain;
| | - Alfonso Javier Ibañez-Vera
- Department of Health Sciences, University of Jaén, Campus las Lagunillas, 23071 Jaen, Spain; (D.R.-A.); (Á.D.-F.); (R.L.-V.)
- Correspondence: ; Tel.: +34-953-213519
| | - Daniel Rodríguez-Almagro
- Department of Health Sciences, University of Jaén, Campus las Lagunillas, 23071 Jaen, Spain; (D.R.-A.); (Á.D.-F.); (R.L.-V.)
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain;
| | - Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaén, Campus las Lagunillas, 23071 Jaen, Spain; (D.R.-A.); (Á.D.-F.); (R.L.-V.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Campus las Lagunillas, 23071 Jaen, Spain; (D.R.-A.); (Á.D.-F.); (R.L.-V.)
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Dommerholt J, Thorp JN, Chou LW, Hooks T. A critical overview of the current myofascial pain literature - January 2020. J Bodyw Mov Ther 2020; 24:213-224. [PMID: 32507147 DOI: 10.1016/j.jbmt.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We are starting 2020 with 6 basic research studies, 9 review articles, 14 dry needling/injection studies, and one manual therapy paper for a total of 30 new papers. Topics range from studies on mechanisms, inflammatory mediators in myofascial pain, fascia, screening, Platelet-rich plasma intramuscular injections, and temporal summation to clinical studies on patients with tension-type headache, chronic pelvic pain, knee osteoarthritis, plantar fasciitis, generalized musculoskeletal pain, neck pain, breast cancer, tendinopathies, thoracic outlet syndrome, and canine dry needling, among others.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Jacob N Thorp
- Myopain Seminars, Bethesda, MD, USA; Charleston Southern University, North Charleston, SC, USA.
| | | | - Todd Hooks
- Myopain Seminars, Bethesda, MD, USA; New Orleans Pelicans, New Orleans, LA, USA.
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29
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Choi S, Kim KH. Acupuncture for symptomatic rotator cuff disease: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18716. [PMID: 31914084 PMCID: PMC6959934 DOI: 10.1097/md.0000000000018716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rotator cuff disease (RCD) consists of subacromial impingement syndrome, rotator cuff tendinopathy or tendinitis, partial or full rotator cuff tear, calcific tendinitis, and subacromial bursitis. Acupuncture has been suggested as a meaningful nonsurgical intervention for managing shoulder pain and dysfunction. However, previous reviews have not completely addressed the role of acupuncture in the management of RCDs. The objective of this systematic review is to evaluate the effectiveness and safety of acupuncture for managing symptoms in patients with RCD. METHODS We will search the following databases from their inception to November 30, 2019: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDro), 3 Chinese databases (China Academic Journal Full-text Database (CAJ), China Doctoral Dissertations Full-text database and China Masters' Thesis Full-text Database), 6 Korean databases (Korean studies Information Service System (KISS), National Digital Science Library (NDSL), Research Information Sharing Service (RISS), Korean Medical Database (KMBASE), Korea Institute of Science and Technology Information (KISTI), Oriental Medicine Advanced Searching Integrated System (OASIS)), and 3 trial registries (ClinicalTrials.gov, International Standard Randomized Controlled Trials Number (ISRCTN) Registry, WHO International Clinical Trials Registry Platform (ICTRP)). We will include randomized controlled trials of acupuncture for RCD. There will be no restrictions related to setting or location. The primary outcome is pain intensity and shoulder dysfunction measured on validated scales within 12 weeks. Quality assessment will be performed using the Cochrane risk of bias tool. Dichotomous outcomes will be presented as risk ratios (RR), and continuous outcomes will be presented as weighted or standardized mean differences (SMD). Each outcome will be calculated with 95% confidence intervals. DISCUSSION The updated evidence that would be provided by this review will offer useful information for patients and practitioners, and also have implications for future studies and the development of clinical practice guidelines of RCD.Registration: Open Science Framework (OSF) Preregistration. 2019, December 5. osf.io/n2e6t.
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Affiliation(s)
- Seoyoung Choi
- Department of Acupuncture & Moxibustion Medicine, Pusan National University Korean Medicine Hospital
| | - Kun Hyung Kim
- Department of Acupuncture & Moxibustion Medicine, Pusan National University Korean Medicine Hospital
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Republic of Korea
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30
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Paley CA, Johnson MI. Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews. MEDICINA (KAUNAS, LITHUANIA) 2019; 56:E6. [PMID: 31878346 PMCID: PMC7023333 DOI: 10.3390/medicina56010006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/23/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
Background and Objectives: It is estimated that 28 million people in the UK live with chronic pain. A biopsychosocial approach to chronic pain is recommended which combines pharmacological interventions with behavioural and non-pharmacological treatments. Acupuncture represents one of a number of non-pharmacological interventions for pain. In the current climate of difficult commissioning decisions and constantly changing national guidance, the quest for strong supporting evidence has never been more important. Although hundreds of systematic reviews (SRs) and meta-analyses have been conducted, most have been inconclusive, and this has created uncertainty in clinical policy and practice. There is a need to bring all the evidence together for different pain conditions. The aim of this review is to synthesise SRs of RCTs evaluating the clinical efficacy of acupuncture to alleviate chronic pain and to consider the quality and adequacy of the evidence, including RCT design. Materials and Methods: Electronic databases were searched for English language SRs and meta-analyses on acupuncture for chronic pain. The SRs were scrutinised for methodology, risk of bias and judgement of efficacy. Results: A total of 177 reviews of acupuncture from 1989 to 2019 met our eligibility criteria. The majority of SRs found that RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. Heterogeneity between RCTs was such that meta-analysis was often inappropriate. Conclusions: The large quantity of RCTs on acupuncture for chronic pain contained within systematic reviews provide evidence that is conflicting and inconclusive, due in part to recurring methodological shortcomings of RCTs. We suggest that an enriched enrolment with randomised withdrawal design may overcome some of these methodological shortcomings. It is essential that the quality of evidence is improved so that healthcare providers and commissioners can make informed choices on the interventions which can legitimately be provided to patients living with chronic pain.
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Affiliation(s)
- Carole A. Paley
- Research and Development Dept, Airedale National Health Service (NHS) Foundation Trust, Skipton Road, Steeton, Keighley BD20 6TD, UK
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds LS1 3HE, UK;
| | - Mark I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds LS1 3HE, UK;
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Understanding Acupoint Sensitization: A Narrative Review on Phenomena, Potential Mechanism, and Clinical Application. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6064358. [PMID: 31485246 PMCID: PMC6710800 DOI: 10.1155/2019/6064358] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
As part of traditional Chinese medicine, acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. When the body is suffering from disease or injury, corresponding acupoints are believed to be activated and manifest in several sensitized forms, including expansion of the receptive field, pain sensitization, and heat sensitization. Such phenomena are believed to gradually disappear concomitantly with recovery from the disease. Acupoint states are therefore changeable according to health status, a phenomenon known as acupoint sensitization. This review aims to provide an overview of acupoint sensitization based on existing research results and determine priorities for future research. Systematic literature retrieval was conducted in Medline, Embase, Cochrane Library, CINAHL, and AMED from inception to 18 July 2018. Current evidence from research findings to date indicate that acupoint sensitization is based on neurogenic inflammation and that stimulation of sensitized acupoints presents a potential trend of generating a better clinical effect when compared with stimulation of unsensitized points.
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Fernández-de-Las-Peñas C, Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019; 12:1899-1911. [PMID: 31354339 PMCID: PMC6590623 DOI: 10.2147/jpr.s154728] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023] Open
Abstract
Myofascial pain syndrome is a pain condition characterized by the presence of trigger points. Current evidence, mostly experimental studies, clearly supports a role of trigger points on peripheral and central sensitization since they are able to contribute to sensitization of peripheral nociceptors, spinal dorsal horn neurons, and the brainstem. Several interventions are proposed for treating trigger points, dry needling being one of the most commonly used by clinicians. There is no consensus on the clinical application of trigger point dry needling: some authors propose that local twitch responses should be elicited during the needling intervention to be effective, whereas others do not. The application of trigger point dry needling is able to reduce the excitability of the central nervous system by reducing peripheral nociception associated to the trigger point, by reducing dorsal horn neuron activity, and by modulating pain-related brainstem areas. However, the effects are mainly observed in the short-term, and effect sizes are moderateto small. Therefore, the current review proposes that the application of trigger point dry needling should be integrated into current pain neuroscience paradigm by combining its application with pain neuroscience education, graded exercise and manual therapy. Additionally, patient’s expectations, beliefs, previous experiences and patient–clinician interaction should be considered when integrating trigger point dry needling into a comprehensive treatment approach.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Jo Nijs
- Faculty of Physical Education and Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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Ribeiro DC, Belgrave A, Naden A, Fang H, Matthews P, Parshottam S. The prevalence of myofascial trigger points in neck and shoulder-related disorders: a systematic review of the literature. BMC Musculoskelet Disord 2018; 19:252. [PMID: 30045708 PMCID: PMC6060458 DOI: 10.1186/s12891-018-2157-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 06/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Neck and shoulder disorders may be linked to the presence of myofascial trigger points (MTrPs). These disorders can significantly impact a person’s activities of daily living and ability to work. MTrPs can be involved with pain sensitization, contributing to acute or chronic neck and shoulder musculoskeletal disorders. The aim of this review was to synthesise evidence on the prevalence of active and latent MTrPs in subjects with neck and shoulder disorders. Methods We conducted an electronic search in five databases. Five independent reviewers selected observational studies assessing the prevalence of MTrPs (active or latent) in participants with neck or shoulder disorders. Two reviewers assessed risk of bias using a modified Downs and Black checklist. Subject characteristics and prevalence of active and latent MTrPs in relevant muscles was extracted from included studies. Results Seven articles studying different conditions met the inclusion criteria. The prevalence of MTrPs was compared and analysed. All studies had low methodologic quality due to small sample sizes, lack of control groups and blinding. Findings revealed that active and latent MTrPs were prevalent throughout all disorders, however, latent MTrPs did not consistently have a higher prevalence compared to healthy controls. Conclusions We found limited evidence supporting the high prevalence of active and latent MTrPs in patients with neck or shoulder disorders. Point prevalence estimates of MTrPs were based on a small number of studies with very low sample sizes and with design limitations that increased risk of bias within included studies. Future studies, with low risk of bias and large sample sizes may impact on current evidence. Electronic supplementary material The online version of this article (10.1186/s12891-018-2157-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy - University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Angus Belgrave
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy - University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Ana Naden
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy - University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Helen Fang
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy - University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Patrick Matthews
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy - University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Shayla Parshottam
- Centre for Health, Activity and Rehabilitation Research (CHARR), School of Physiotherapy - University of Otago, PO Box 56, Dunedin, 9054, New Zealand
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