1
|
McConnell RC, Williams CL, Falyar CR. Navigating the layers of concern for safe dry needling of the rectus abdominis: a cadaveric study. J Man Manip Ther 2024:1-7. [PMID: 38768018 DOI: 10.1080/10669817.2024.2355007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVES To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. METHODS Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. RESULTS Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. DISCUSSION/CONCLUSION Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice.
Collapse
Affiliation(s)
- Ryan C McConnell
- Department of Physical Therapy, Belmont University, Nashville, TN, USA
| | | | - Christian R Falyar
- Department of Nurse Anesthesia, Middle Tennessee School of Anesthesia, Madison, TN, USA
| |
Collapse
|
2
|
Forogh B, Ghaseminejad Raeini A, Jebeli Fard R, Mirghaderi P, Nakhostin-Ansari A, Nakhostin-Ansari N, Bahari H, Hoveidaei AH. Efficacy of trigger point dry needling on pain and function of the hip joint: a systematic review of randomized clinical trials. Acupunct Med 2024; 42:63-75. [PMID: 38149616 DOI: 10.1177/09645284231207870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE The objective of this study was to assess the evidence for the impact of dry needling (DN) on hip pain and function. METHODS Medline/PubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL databases were searched systematically through June 2022 for randomized clinical trials (RCTs) investigating the impact of DN on hip pain and function. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias. Descriptive analysis was conducted to explain the outcomes and adverse events of DN in hip joint diseases. Meta-analysis was not feasible due to significant heterogeneity. RESULTS A total of seven eligible studies (including 273 patients) were included out of 2152 screened records. Five studies were in participants with hip osteoarthritis (OA; n = 3), greater trochanteric pain syndrome (GTPS; n = 1) or piriformis syndrome (n = 1); the other two studies were conducted in healthy athletes (n = 2). Two articles assessed changes in participants' short-term visual analog scale (VAS) scores (<1 week), one of which showed that DN significantly reduced pain (P < 0.05). One-week VAS scores were analyzed in three studies, all of which demonstrated reduced scores following DN (P < 0.05). Hip range of motion (ROM) and muscle force were also improved following DN. No serious side effects were reported. CONCLUSION DN may be safe and effective at relieving hip pain and improving hip function. DN performs significantly better than several different types of control intervention (including sham DN, no treatment, corticosteroid injections and laser). Strong evidence (high degree of certainty around the results) is lacking, and future studies should ideally use longer follow-up periods and larger sample sizes. REVIEW REGISTRATION NUMBER CRD42022297845 (PROSPERO).
Collapse
Affiliation(s)
- Bijan Forogh
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Ghaseminejad Raeini
- Surgical Research Society, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roham Jebeli Fard
- Surgical Research Society, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Mirghaderi
- Surgical Research Society, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin-Ansari
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
- Physiotherapy Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Bahari
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Human Hoveidaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Baumann AN, Fiorentino A, Oleson CJ, Leland JM. The Impact of Dry Needling With Electrical Stimulation on Pain and Disability in Patients With Musculoskeletal Shoulder Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus 2023; 15:e41404. [PMID: 37546088 PMCID: PMC10402652 DOI: 10.7759/cureus.41404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Musculoskeletal shoulder pain (MSP) is a common orthopedic condition frequently treated by orthopedic surgeons and physical therapists in an interdisciplinary manner. Dry needling with electrical stimulation (DNES) is an increasingly popular intervention used for the conservative treatment of MSP during physical therapy. To date, no systematic review and meta-analysis have examined the impact of DNES on outcomes in patients with MSP. This study aims to explore the effectiveness and safety of DNES in patients with MSP to improve patient outcomes. A systematic review and meta-analysis were conducted using PubMed, MEDLINE, CINAHL, and Web of Science from database inception to March 10, 2023. Inclusion criteria were studies with DNES as an intervention, recorded patient outcomes, and randomized controlled trials (RCTs) only. DNES with or without conventional physical therapy (CPT) was compared to CPT alone, which included interventions such as exercise, manual therapy, dry needling without electrical stimulation, and/or interferential current. A total of five RCTs were analyzed from 144 articles retrieved on the initial search. Included patients (n=342) had an average age of 48.75 ± 5.92 years, an average follow-up time of 3.40 ± 1.42 months, and 184 patients receiving DNES with or without CPT. Patients treated with DNES with or without CPT (n=163) had a frequency-weighted mean decrease in pain of 4.8 ± 1.4 points, whereas patients treated with CPT alone (n=158) had a frequency-weighted mean decrease in pain of 3.3 ± 2.2 points. For meta-analysis of pain outcomes (n=321 total patients), DNES with or without CPT improved pain by 1.40/10 points as compared to CPT alone with no significant difference between groups (p=0.203; Cohen's d effect size (ES): 4.352; 95% CI: -2.343, 11.048). Patients treated with DNES with or without CPT (n=118) had a frequency-weighted mean decrease in disability of 34.7 ± 9.1 points. In contrast, patients treated with CPT alone (n=115) had a frequency-weighted decrease in disability of 20.1 ± 5.0 points. For meta-analysis of disability outcomes (n=233 total patients), DNES with or without CPT did not have a significant improvement in disability as compared to CPT alone (p=0.282; Cohen's d ES: 0.543; 95% CI: -0.446, 1.532). No serious adverse effects were reported for patients treated with DNES with or without CPT or CPT alone. DNES with or without CPT may significantly improve pain and disability in patients with MSP. However, DNES with or without CPT does not provide statistically significant improvements in pain or disability compared to CPT alone. Furthermore, DNES appears to be a safe intervention for MSP.
Collapse
Affiliation(s)
- Anthony N Baumann
- Department of Rehabilitation Services, University Hospitals, Cleveland, USA
| | - Andrew Fiorentino
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | - Caleb J Oleson
- College of Medicine, Northeast Ohio Medical University, Rootstown, USA
| | | |
Collapse
|
4
|
Benito-de-Pedro AI, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C, Benito-de-Pedro M. Efficacy of Deep Dry Needling versus Percutaneous Electrolysis in Ultrasound-Guided Treatment of Active Myofascial Trigger Points of the Levator Scapulae in Short-Term: A Randomized Controlled Trial. Life (Basel) 2023; 13:life13040939. [PMID: 37109468 PMCID: PMC10143630 DOI: 10.3390/life13040939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/28/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
Deep dry needling (DDN) and percutaneous electrolysis (PE) provide the benefit of the mechanical effect of the needle, and PE adds the potential advantages of the galvanic current it incorporates in myofascial trigger points (MTrPs) therapy. The aim of this study was to compare the short-term efficacy between PE and DDN on active MTrPs of the levator scapulae by considering pain intensity. A simple-blind randomized controlled trial was carried out, recruiting patients suffering from non-specific neck pain lasting more than 3 months and with active MTrPs in the levator scapulae muscle (n = 52). Patients were divided into intervention (PE; n = 26) and control (DDN; n = 26) groups and received one treatment session on the active MTrPs of the levator scapulae. Patients were assessed for pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), neck disability and post-needling soreness, immediately after treatment, at 72 h and at 14 days. In addition, pain during treatment was recorded after the procedure. There were no significant differences for pain intensity, post-needling soreness and PPT. We found significant differences in CROM, immediately after treatment (p = 0.043), and at 72 h (p = 0.045), in favor of the PE group. Significant differences were found for neck disability (p < 0.047), immediately post-treatment, in favor of the DDN group. Moreover, there were significant differences for pain during the intervention (p < 0.002), in favor of the DDN group (4.54 ± 2.21) versus the PE group (6.54 ± 2.27). PE and DDN appear to have similar short-term effects. PE proved to be a more painful treatment than DDN. Clinical trial registry: NCT04157426.
Collapse
Affiliation(s)
- Ana Isabel Benito-de-Pedro
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | | | | | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - María Benito-de-Pedro
- Facultad HM Hospitales de Ciencias de la Salud Universidad Camilo José Cela, 28692 Madrid, Spain
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Fernández-de-las-Peñas C, Nijs J, Cagnie B, Gerwin RD, Plaza-Manzano G, Valera-Calero JA, Arendt-Nielsen L. Myofascial Pain Syndrome: A Nociceptive Condition Comorbid with Neuropathic or Nociplastic Pain. Life (Basel) 2023; 13:life13030694. [PMID: 36983849 PMCID: PMC10059732 DOI: 10.3390/life13030694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Myofascial pain syndrome is featured by the presence of myofascial trigger points (TrPs). Whether TrPs are primary or secondary phenomena or if they relate to central or peripheral nervous system disorders is controversial. Referred pain, a cardinal sign of TrPs, is a central phenomenon driven by peripheral input. In 2021, the International Association for the Study of Pain (IASP) proposed a clinical criteria and grading system for classifying patients with pain on nociceptive, neuropathic, or nociplastic phenotypes. Myofascial TrP pain has been traditionally categorized as a nociceptive phenotype; however, increasing evidence supports that this condition could be present in patients with predominantly nociplastic pain, particularly when it is associated with an underlying medical condition. The clinical response of some therapeutic approaches for managing TrPs remains unclear. Accordingly, the ability to classify myofascial TrP pain into one of these phenotypes would likely be critical for producing more successful clinical treatment outcomes by a precision medicine approach. This consensus paper presents evidence supporting the possibility of subgrouping individuals with myofascial TrP pain into nociceptive, nociplastic, or mixed-type phenotype. It is concluded that myofascial pain caused by TrPs is primarily a nociceptive pain condition, is unlikely to be classified as neuropathic or nociplastic, but can be present in patients with predominantly neuropathic or nociplastic pain. In the latter cases, management of the predominant central pain problem should be a major treatment goal, but the peripheral drive from TrPs should not be ignored, since TrP treatment has been shown to reduce sensitization-associated symptomatology in nociplastic pain conditions, e.g., fibromyalgia.
Collapse
Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Madrid, Spain
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Correspondence:
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Jette, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Robert D. Gerwin
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan A. Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Sensory Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Fakontis C, Iakovidis P, Lytras D, Kasimis K, Koutras G, Ntinou SR, Kottaras A, Chatziprodromidou IP, Chatzikonstantinou P, Apostolou T. Efficacy of percutaneous needle electrolysis versus dry needling in musculoskeletal pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2023; 36:1033-1046. [PMID: 37458028 DOI: 10.3233/bmr-220408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Physical therapists use dry needling (DN) and percutaneous needle electrolysis (PNE) to treat musculoskeletal pain. OBJECTIVE To investigate the efficacy of PNE vs. DN in the treatment of musculoskeletal pain. METHODS This systematic review and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, Cochrane Library, SCOPUS, and Google Scholar databases were searched for randomized clinical trials measuring pain intensity in various musculoskeletal syndromes using PNE and DN. Pain outcome measures were the visual analog scale or the numerical pain rating scale. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE). Standardized mean differences were calculated using random effects models. RESULTS The meta-analysis of the six included studies showed that the overall effect of PNE vs. DN for pain reduction was statistically significant at -0.74 (95% confidence interval [CI], -1.34 to -0.14) with a large effect size (SMD =-0.41; 95% CI, -0.75 to -0.08), albeit clinically insignificant in the short, medium, and long term. Risk of bias was generally low with moderate-level evidence due to the overall effect heterogeneity and the small sample. CONCLUSIONS Moderate-quality evidence showed that PNE is slightly more effective than DN in reducing pain. However, because the results were not clinically significant, we cannot recommend the application of PNE over DN. More high-quality studies comparing the two interventions are needed to draw firm conclusions.
Collapse
|
9
|
Pressure Pain Threshold of the Upper Trapezius Trigger Point: A Systematic Review with Meta-Analysis of Baseline Values and Their Modification after Physical Therapy. J Clin Med 2022; 11:jcm11237243. [PMID: 36498817 PMCID: PMC9739431 DOI: 10.3390/jcm11237243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Myofascial trigger points (TrP) are diagnosed upon the presence of clinical signs among which hypersensitivity is considered one of the most important. The detection of the pressure pain threshold (PPT) is used to quantify the degree of hypersensitivity. However, there is a lack of normative data about how hypersensitive a TrP is. Therefore, the objective was to quantify the PPT for myofascial TrP in the upper trapezius muscle and its modification after manual or instrumental physical therapy interventions. METHODS A systematic review and meta-analysis were conducted among three databases (MEDLINE, Cochrane Library, and PEDro). Two independent reviewers conducted the electronic search and assessed the methodological quality of the included studies. RESULTS Eleven studies with a high-risk bias indicated that the PPT at TrP sites was 105.11 kPa lower (95% CI: -148.93; -61.28) at active TrP sites (Chi-squared = 1.07, df = 1 (p = 0.30), I2 = 7%) compared to the PPT of the upper trapezius muscles of healthy subjects. In addition, the PPT of TrP was also lower than the reference values coming from the pain-free population. Moreover, the PPT increased after both manual and instrumental treatment by 28.36 kPa (95% CI: 10.75; 45.96) and 75.49 kPa (95% CI: 18.02; 132.95), respectively. CONCLUSIONS The results of the present study show that TrP has a decreased PPT when compared to healthy muscles and that physical therapy may increase the PPT. However, the clinical relevance of this decreased PPT needs to be further elucidated. Further, the high risk of bias in all the retrieved studies undermines the validity of the results.
Collapse
|
10
|
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.
Collapse
|
11
|
Perreault T, Ball A, Dommerholt J, Theiss R, Fernández-de-las-Peñas C, Butts R. Intramuscular Electrical Stimulation to Trigger Points: Insights into Mechanisms and Clinical Applications—A Scoping Review. J Clin Med 2022; 11:jcm11206039. [PMID: 36294360 PMCID: PMC9605351 DOI: 10.3390/jcm11206039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Abstract
Intramuscular electrical stimulation (IMES) is a modality used by clinicians to treat myofascial pain. Recent studies have shown positive results for the use of IMES on pain outcomes, yet studies investigating the potential mechanisms of IMES directly to trigger points (TrPs) are lacking. We performed a scoping review of the literature to summarize the current evidence from human and animal studies on the mechanisms of IMES to the TrP location, and to identify gaps in the existing literature. Electronic literature searches were conducted across five databases from inception to 15 August 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), Scopus and Cochrane Register of Controlled Trials. Four studies met our full criteria for inclusion in this review. Three studies assessed the effects of IMES to TrPs on human subjects with MPS, and only one study used an animal model with experimentally generated TrPs. Based on the results of the included studies, IMES within a TrP region was reported to normalize muscle blood flow, decrease endplate noise of the TrP and elicit antinociceptive effects, at least partially, through engaging supraspinal descending pain inhibitory systems. At present, no clinical implications can be determined on the use of IMES to TrPs due to the limited amount and quality of the available evidence. Further studies investigating the clinical effectiveness and also underlying mechanisms of IMES to TrPs are clearly needed.
Collapse
Affiliation(s)
- Thomas Perreault
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA
- Correspondence: ; Tel.: +1-603-740-2101
| | - Andrew Ball
- Atrium Health, Carolinas Rehabilitation, Charlotte, NC 28216, USA
- Myopain Seminars, Bethesda, MD 20814, USA
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Robert Theiss
- Department of Physical Medicine and Rehabilitation, Atrium Health, Carolinas Rehabilitation, Charlotte, NC 28203, USA
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Raymond Butts
- Department of Rehabilitative Sciences, Gannon University, Ruskin, FL 33573, USA
| |
Collapse
|
12
|
Jiménez-del-Barrio S, Medrano-de-la-Fuente R, Hernando-Garijo I, Mingo-Gómez MT, Estébanez-de-Miguel E, Ceballos-Laita L. The Effectiveness of Dry Needling in Patients with Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101575. [PMID: 36295010 PMCID: PMC9605049 DOI: 10.3390/life12101575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Osteoarthritis is one of the most common degenerative joint diseases. The main symptoms of the osteoarthritis have been linked to the presence of myofascial trigger points in the soft tissues. Dry needing (DN) is the most investigated technique for the treatment of myofascial trigger points. Thus, the aim of this study was to evaluate the effectiveness of DN in pain and physical function in patients with osteoarthritis in the short-, medium- and long-term. METHODS PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in September 2022. Randomized controlled trials involving DN compared to non-pharmacological interventions, sham techniques or no additional treatment were selected. Quality of the studies was assessed with PEDro scale and risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using fixed or random effects models according to the Cochrane handbook for systematic reviews of interventions. RESULTS Seven studies were included in the meta-analysis involving 291 patients with osteoarthritis. The methodological quality of the included studies ranged from fair to high. DN showed significant improvements in pain intensity (SMD = -0.76; 95% CI: -1.24, -0.29; I2: 74%) and physical function (SMD = -0.98; 95% CI: -1.54, -0.42; I2: 75%) in the short-term. No differences were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence to very low. CONCLUSIONS Very low-quality evidence suggests a positive effect of DN for reducing pain intensity and improving physical function in the short term in patients with osteoarthritis. Further investigation is needed to determine a medium- and long-term effects.
Collapse
Affiliation(s)
- Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, Calle Universidad s/N, 42004 Soria, Spain
| | - Ricardo Medrano-de-la-Fuente
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, Calle Universidad s/N, 42004 Soria, Spain
| | - Ignacio Hernando-Garijo
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, Calle Universidad s/N, 42004 Soria, Spain
| | - María Teresa Mingo-Gómez
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, Calle Universidad s/N, 42004 Soria, Spain
| | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Health Sciences, University of Zaragoza, Calle Domingo Miral s/N, 50009 Zaragoza, Spain
| | - Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, Calle Universidad s/N, 42004 Soria, Spain
- Correspondence:
| |
Collapse
|
13
|
Lucena-Anton D, Luque-Moreno C, Valencia-Medero J, Garcia-Munoz C, Moral-Munoz JA. Effectiveness of Dry Needling of Myofascial Trigger Points in the Triceps Surae Muscles: Systematic Review. Healthcare (Basel) 2022; 10:healthcare10101862. [PMID: 36292308 PMCID: PMC9602116 DOI: 10.3390/healthcare10101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
This study aims to analyze the effects of Dry Needling (DN) for the release of myofascial trigger points (MTrPs) in the triceps surae muscles (TSM). A systematic review was performed up to February 2022 in PubMed, PEDro, Scopus, CENTRAL, and Web of Science. Selection criteria were studies involving subjects older than 18 years presenting MTrPs in the TSM, without any concomitant acute or chronic musculoskeletal conditions; DN interventions applied to the MTrPs of the TSM; and results on pain, range of motion (ROM), muscle strength, muscle stiffness, and functional outcomes. The PEDro scale was used to assess the methodological quality of the studies, and the Risk of Bias Tool 2.0 to assess risk of bias. A total of 12 studies were included in the systematic review, involving 426 participants. These results suggest that DN of MTrPs in TSM could have a positive impact on muscle stiffness and functional outcomes. There are inconclusive findings on musculoskeletal pain, ROM, and muscle strength. Significant results were obtained in favor of the control groups on pressure pain thresholds. Despite the benefits obtained on muscle stiffness and functional performance, the evidence for the use of DN of MTrPs in the TSM remains inconclusive.
Collapse
Affiliation(s)
- David Lucena-Anton
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Carlos Luque-Moreno
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
- Correspondence:
| | - Jesus Valencia-Medero
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Cristina Garcia-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
| | - Jose A. Moral-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, 11009 Cadiz, Spain
| |
Collapse
|
14
|
Comparison of dry needling and self-stretching in muscle extensibility, pain, stiffness, and physical function in hip osteoarthritis: A randomized controlled trial. Complement Ther Clin Pract 2022; 49:101667. [PMID: 36152527 DOI: 10.1016/j.ctcp.2022.101667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Patients with hip osteoarthritis (OA) present myofascial trigger points in the hip muscles that may reduce muscle extensibility, provoke pain and stiffness, and decrease physical function. The purpose of the study was to compare the effects of dry needling (DN) intervention with a self-stretching protocol on muscle extensibility, pain, stiffness, and physical function in patients with hip OA. MATERIALS AND METHODS A single-blinded randomised controlled trial was designed. Thirty-eight participants with hip OA were randomly assigned to the DN group (n = 19) or the stretching group (n = 19). The DN group received three sessions of DN, and the stretching group followed a 3-week protocol. Hip muscle extensibility was the primary outcome and was measured using the Ely test, the modified Ober test, and the Active Knee Extension test. Pain, stiffness, and physical function were the secondary outcomes measured with the WOMAC questionnaire. The variables were assessed before and after treatment by blinded examiners. RESULTS DN was more effective than self-stretching for improving hip flexor and abductor muscles extensibility (p < 0.05). DN and self-stretching techniques improved hip extensor muscles extensibility, pain, stiffness, and physical function in patients with hip OA (<0.05). The DN group showed large effect sizes in all the variables (d > 0.8). CONCLUSION Three sessions of DN were more effective than three weeks of self-stretching to improve hip muscle extensibility in patients with hip OA. DN and self-stretching techniques decreased pain and stiffness and improved physical function in patients with hip OA.
Collapse
|
15
|
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).
Collapse
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
| |
Collapse
|
16
|
Sánchez-Infante J, Bravo-Sánchez A, Esteban-García P, Jiménez F, Abián-Vicen J. Changes in electromyographic activity of latent trigger points after a dry needling intervention: a randomised controlled trial. Physiotherapy 2022; 117:72-80. [DOI: 10.1016/j.physio.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/20/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
|
17
|
Tang CT, Song B. Acupuncture and Dry Needling for Sports Performance and Recovery. Curr Sports Med Rep 2022; 21:213-218. [PMID: 35703748 DOI: 10.1249/jsr.0000000000000968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Acupuncture and dry needling share many similarities in their proposed mechanisms of action and their sports medicine-related applications. Pain is the most common indication for these needling treatments, but there also are some limited studies on their use for ergogenic purposes. Needling can likely improve muscular strength and power, including increasing jump height, and it also can increase flexibility. In terms of sports recovery, acupuncture can not only be used for pain relief after injury, but also can help with routine recovery, such as in delayed onset muscle soreness. There are numerous case reports of acupuncture and dry needling being used to treat athletes for various diagnoses and conditions, however more high quality studies are needed in order to make more specific evidence-based recommendations. Given the high degree of safety and limited adverse events associated with needling treatments, it can likely be promoted in athletes.
Collapse
Affiliation(s)
- Chi-Tsai Tang
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | | |
Collapse
|
18
|
Vervullens S, Meert L, Baert I, Delrue N, Heusdens CHW, Hallemans A, Van Criekinge T, Smeets RJEM, De Meulemeester K. The effect of one dry needling session on pain, central pain processing, muscle co-contraction and gait characteristics in patients with knee osteoarthritis: a randomized controlled trial. Scand J Pain 2022; 22:396-409. [PMID: 34821140 DOI: 10.1515/sjpain-2021-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the immediate and three days postintervention effect of one dry needling session compared to one sham needling session on pain, central pain processing, muscle co-contraction and spatiotemporal parameters during gait in knee osteoarthritis patients. METHODS A double-blind randomized controlled trial was conducted. Sixty-one knee osteoarthritis patients were randomly assigned to the dry needling or sham needling group. Primary outcomes were pain and central pain processing. Secondary outcomes included muscle co-contraction and spatiotemporal parameters during gait. Patients were assessed at baseline and 15 min after the intervention, and pain also three days after the intervention. Linear mixed models were used to examine between- and within-group differences. RESULTS No significant between-group differences for pain were found, but within-group scores showed a significant decrease 15 min after sham needling and three days after dry needling. The mean conditioned pain modulation effect measured at the m. Trapezius worsened significantly 15 min after sham needling compared to after dry needling (between-group difference). However, individual conditioned pain modulation percentage scores remained stable over time. Various significant within-group differences were found 15 min after sham needling: a decrease of conditioned pain modulation measured at m. Quadriceps and m. Trapezius and stride- and step-time scores, and an increase in step length and widespread pain pressure threshold. A significant decrease in muscle co-contraction index of the m. Vastus Medialis and Semitendinosus was found as within-group difference 15 min after dry needling. CONCLUSIONS Dry needling has no larger effect on pain, central pain processing, muscle co-contraction and gait pattern 15 min and three days postintervention compared to sham needling. Mean conditioned pain modulation scores worsened after sham needling compared to after dry needling. Further research remains necessary.
Collapse
Affiliation(s)
- Sophie Vervullens
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), www.paininmotion.be, Antwerp, Belgium
| | - Lotte Meert
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), www.paininmotion.be, Antwerp, Belgium
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), www.paininmotion.be, Antwerp, Belgium
| | | | | | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
| | - Tamaya Van Criekinge
- Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Research Group MOVANT, University of Antwerp, Wilrijk, Belgium
- Department of Rehabilitation Sciences, Catholic University of Leuven, Campus Bruges, Bruges, Belgium
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- CIR Revalidatie, Eindhoven, The Netherlands
| | - Kayleigh De Meulemeester
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group (PiM), www.paininmotion.be, Antwerp, Belgium
| |
Collapse
|
19
|
Effects of dry needling on mechanical and contractile properties of the upper trapezius with latent myofascial trigger points: A randomized controlled trial. Musculoskelet Sci Pract 2021; 56:102456. [PMID: 34507046 DOI: 10.1016/j.msksp.2021.102456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Latent trigger point (LTrP) can cause motor dysfunction and disturb normal patterns of motor recruitment. OBJECTIVE To analyze the effects of DN in the upper trapezius (UT) LTrP on pain and the mechanical and contractile properties of the muscle. DESIGN A randomized, double-blinded, parallel-group-trial. METHODS Fifty healthy volunteers with LTrPs in the UT were randomly divided into a DN-group (n = 26) and a Sham-DN-group (n = 24) and received one session of DN or placebo treatment. Mechanical and contractile properties of the muscle and pressure pain perception (PPP) were evaluated before treatment and in a 30min, 24 h and 72 h follow-up after treatment. RESULTS In the mechanical properties, the DN-group showed lower values than the Sham-DN-group for dynamic stiffness at 72 h (p = 0.04). The DN-group showed lower values for dynamic stiffness at 72 h from baseline (278.74 ± 38.40 to 261.54 ± 33.64 N/m; p = 0.01) and for tone at 72 h from 30min (16.62 ± 1.27 to 15.88 ± 1.31 Hz; p = 0.01). In the contractile properties, the DN-group showed higher values for maximal radial displacement (Dm) of the muscle belly at 72 h from baseline (5.38 ± 1.67 to 6.13 ± 1.70 mm; p = 0.04), higher values for contraction time at 30min (28.53 ± 8.80 s; p = 0.03) and lower ones at 72 h (24.74 ± 4.36 s; p = 0.04) from baseline (26.97 ± 6.63 s). The DN-group showed a decrease of PPP from baseline to 72 h after treatment (5.16 ± 1.33 to 4.02 ± 0.97 mm; p < 0.01). CONCLUSION The application of DN in healthy volunteers over LTrPs in the UT decreased dynamic stiffness, tone and contraction time and increased Dm at 72 h after treatment. Additionally, the PPP showed a decrease at 72 h after needling. CLINICALTRIALS.GOV: NCT04466813.
Collapse
|
20
|
Ijaz N, Welsh S, Boon H. A mixed-methods survey of physiotherapists who practice acupuncture and dry needling in Ontario, Canada: practice characteristics, motivations, and professional outcomes. BMC Complement Med Ther 2021; 21:264. [PMID: 34666749 PMCID: PMC8524909 DOI: 10.1186/s12906-021-03440-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background Physiotherapists (PTs) across the globe are increasingly incorporating filiform needling techniques (e.g., acupuncture, dry needling) into their clinical toolkits; and, the evidence base for these complementary therapies is becoming progressively more robust. However, to date, little is known about needling PTs themselves. Methods Using a cross-sectional survey design, PTs authorized to perform needling therapies in Ontario, Canada were recruited for anonymous participation (n = 2061) in an online survey. The survey asked providers about their demographics and practice characteristics, rationale for and views about therapeutic needling, and their related clinical and professional outcomes. The response rate was 20.7% (n = 426), and 22.3% (n = 95) of respondents provided textual responses to an open-ended qualitative question. Results While study respondents’ demographic features appear similar to their broader professional population, Ontario’s needling PTs are less likely to work in public sector settings. Most completed training in medical acupuncture rather than dry needling, and typically used needling in over one-third of patient visits. Almost all endorsed needling as an effective musculoskeletal treatment, the primary factor informing their adoption of the practice. While many viewed traditional Chinese medical theories as a useful explanatory framework, most relied on biomedical epistemology to drive their needling work. A majority of respondents reported that the inclusion of needling within their clinical toolkits had improved their likelihood of achieving excellent clinical results, helped support patient recruitment and retention, and heightened their professional satisfaction. While a few reported earning a higher income as a result, most reported that their clinical use of needling in addition to other PT modalities reduced their physical fatigue after a day’s work. Conclusions This study represents a first scholarly investigation into the motivations, training backgrounds and practice patterns of PTs who use acupuncture or dry needling. Additional research from other jurisdictions is needed to evaluate the transferability of study findings.
Collapse
Affiliation(s)
- Nadine Ijaz
- Department of Law and Legal Studies, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Sandy Welsh
- Department of Sociology, University of Toronto, 725 Spadina Ave, Toronto, ON, M5S 2J4, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada
| |
Collapse
|
21
|
Bazzaz-Yamchi M, Naghdi S, Nakhostin-Ansari A, Hadizadeh M, Ansari NN, Moghimi E, Hasson S. Acute and Short-Term Effects of Dry Needling in Patients with Chronic Nonspecific Low Back Pain and Hamstring Tightness: A Pilot Study. ScientificWorldJournal 2021; 2021:7259956. [PMID: 34845408 PMCID: PMC8627360 DOI: 10.1155/2021/7259956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic nonspecific low back pain (LBP) is one of the common health issues. Hamstring tightness contributes to the development of LBP. This study aimed to investigate the acute and short-term effects of deep dry needling (DN) in patients with chronic nonspecific LBP and hamstring muscle tightness. METHODS A single-group pretest-posttest clinical study design was followed. The outcome measures were the visual analog scale (VAS), passive knee extension (PKE) test, finger-floor distance (FFD) test, and functional rating index (FRI). Patients underwent one session of deep DN of three points on both hamstring muscles, each point for one minute. Patients were assessed before (T0), immediately after (T1), and one week after DN (T2). The FRI was assessed at T0 and T2. RESULTS Ten women with a mean age of 21.1 years (SD = 1.6) participated in the study. Significant large effect sizes in VAS pain reduction (d = 1.25) and PKE hamstring tightness were obtained (hamstring: right, d = 0.82; left, d = 0.88) at T2. Medium effect sizes were obtained for FFD (d = 0.45) and FRI (d = 0.72) at T2. CONCLUSION A single session of deep DN improved pain and function and increased hamstring flexibility. This pilot study supports the use of DN in patients with LBP and hamstring tightness; however, future research with a rigorous study design of randomized controlled trial is required to confirm the findings. This trial is registered with IRCT20180511039612N1.
Collapse
Affiliation(s)
- Mahnaz Bazzaz-Yamchi
- 1Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- 1Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- 2Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Nakhostin-Ansari
- 3Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Monavar Hadizadeh
- 4Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- 1Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- 2Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Moghimi
- 2Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- 5Department of Physical Therapy, Augusta University, Augusta, Georgia, USA
| |
Collapse
|