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Dones VC, Serra MAB, Tangcuangco LPD, Orpilla VB. Superficial fascia displacement in cervical flexion: differentiating myofascial pain syndrome, a cross-sectional study. J Osteopath Med 2024; 124:353-363. [PMID: 38444081 DOI: 10.1515/jom-2023-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Abstract
CONTEXT Myofascial pain syndrome (MPS) is primarily characterized by myofascial trigger points related to fascial adhesions. MPS hinders fascial flexibility and mobility, leading to myofascial limitations, dysfunctional movement, and limitation of motion (LOM). OBJECTIVES This study determined the association of age, sex, type of work, symptom chronicity, symptom laterality, cervical LOM, altered direction of fascial displacement, and magnitude of superficial fascial displacement during active cervical flexion with the clinical diagnosis of MPS. METHODS A cross-sectional study selectively included MPS and non-MPS participants from different workplaces from January to October 2019. The MPS group exhibited clinical symptoms like tender spots, recognized pain patterns, and local twitch response upon palpation, often accompanied by cervical LOM. The non-MPS group lacked these symptoms, and those with certain pre-existing conditions or recent physiotherapy were not part of the study. Participants performed cervical active range of motion (AROM) while a sonographer recorded superficial fascial displacement utilizing ultrasound, which was later analyzed by three physiotherapists with the Tracker. Aiming for a multiple regression R-squared of 0.2, the target was 384 participants to account for a 20 % dropout, resulting in 307 participants after attrition. To explore the relationships between MPS and various factors, logistic regression models, rigorously tested for reliability and validity, were utilized. RESULTS In the study, there were 192 participants with MPS and 137 without MPS. The median ages were 33 years for the non-MPS group and 38 years for the MPS group. The adjusted model found significant links for sex (odds ratio [OR]=2.63, p<0.01), symptom chronicity (OR=8.28, p<0.01), and cervical LOM (OR=3.77, p=0.01). However, age and the presence of nodules/taut bands were not statistically significant (p>0.05). Also, the type of work, the direction of fascial displacement, and the difference in superficial fascial displacement during cervical flexion did not show a significant association with the clinical diagnosis of MPS (p>0.05). The adjusted model had a sensitivity of 73.80 % and a specificity of 81.34 %, correctly identifying 84.66 % of positive cases and 68.99 % of negative ones, resulting in an overall accuracy of 76.95 % in predicting MPS. CONCLUSIONS We provided an in-depth examination of MPS, identifying sex, duration of symptoms, and cervical LOM as significant predictive factors in its diagnosis. The study emphasizes the critical role of these variables in the accurate diagnosis of MPS, while delineating the comparatively minimal diagnostic value of other factors such as age, type of occupation, presence of nodules or taut bands, and variations in fascial displacement. This study underscores the imperative for further scholarly inquiry into the role of fascial involvement in musculoskeletal disorders, with the objective of enhancing both the theoretical understanding and diagnostic practices in this medical domain.
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Affiliation(s)
- Valentin C Dones
- Center for Health Research and Movement Science, 37572 University of Santo Tomas , Manila, Philippines
| | - Mark Angel B Serra
- Center for Health Research and Movement Science, 37572 University of Santo Tomas , Manila, Philippines
| | | | - Vergel B Orpilla
- College of Rehabilitation Sciences, 37572 University of Santo Tomas , Manila, Philippines
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Kamble SN, Gohil D, Pisudde PM, Telang-Chaudhari S, Baxi GD, Palekar TJ. Immediate Effect of Ultrasound-Guided Dry Needling on Soleus Muscle Spasticity in Stroke Survivors. Cureus 2024; 16:e62251. [PMID: 39006599 PMCID: PMC11244648 DOI: 10.7759/cureus.62251] [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: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Dry needling (DN) is commonly used to treat various neuromuscular syndromes. It is effective in reducing spasticity in stroke and other neurological conditions. The current study explores the immediate effect of ultrasound-guided dry needling on soleus muscle spasticity and thickness in individuals with stroke. METHODS Approval was obtained from the Institutional Sub-ethics Committee of Dr. D. Y. Patil College of Physiotherapy, Pune. The trial was registered with the Clinical Trials Registry of India. Thirty stroke survivors having soleus muscle spasticity ranging from grade 1 to 4 on the Modified Modified Ashworth Scale (MMAS) were selected. Spasticity was also assessed using the Modified Tardeau Scale (MTS) and H-reflex. Soleus muscle architecture was assessed by using ultrasonography (USG). Participants received a single session of DN for the spastic soleus muscle. Pre and immediate post-DN outcome measures were assessed. RESULTS Based on USG findings, the thickness of the soleus muscle significantly increased by 2.67 mm (p<0.001) after dry needling treatment. The MMAS showed decreased spasticity by 1.47 (p<0.001) for ankle plantar flexors. A significant reduction of H-reflex values by 1.4 mV (p<0.001) was noted. The MTS also showed a significant increase in the range of ankle motion by 2.7 (p<0.001). All these indicate an immediate reduction of spasticity following DN. CONCLUSION Based on the findings of the current study, we can conclude that a single session of USG-guided DN has an immediate beneficial effect on reducing soleus muscle spasticity and increased muscle thickness in individuals with stroke.
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Affiliation(s)
| | - Divya Gohil
- Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, IND
| | - Pravin M Pisudde
- Community Medicine, All India Institute of Medical Sciences, Bhatinda, IND
| | - Shweta Telang-Chaudhari
- Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy (AYUSH), Maharashtra University of Health Sciences, Nashik, IND
| | - Gaurang D Baxi
- Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, IND
| | - Tushar J Palekar
- Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, IND
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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).
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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
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Zhang HN, Chen JG, Wang XY, Fan S, Bao A, Li HN, Wang JG. Efficacy comparison between acupuncture and other modalities in the treatment of rotator cuff diseases: meta-analysis of randomized controlled trials. Am J Transl Res 2024; 16:599-616. [PMID: 38463603 PMCID: PMC10918137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE This study aimed to analyze the efficacy of acupuncture alone or combined with physical therapy compared to other treatment interventions for relieving pain and improving function in rotator cuff diseases. METHODS Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After PROSPERO (CRD42023396740) registration, all randomized controlled trials (RCTs) published from the inception of the databases to October 10, 2023, evaluating the efficacy of acupuncture either alone or in combination with physical therapy for treating rotator cuff diseases, were extracted from seven databases, including PubMed, Embase, the Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), and the Wanfang Date. Two independent researchers assessed the quality of the included studies and extracted relevant data. Furthermore, a meta-analysis was conducted using Stata 14 software. RESULTS We included 13 RCTs - 12 published in English and 1 in Chinese - that enrolled 1,371 patients. The meta-analysis results demonstrated that acupuncture alone or in combination with physical therapy was superior to other interventions for short-term shoulder joint function improvement (standardized mean difference [SMD] = -0.82, 95% confidence interval [95% CI]: -1.28 to -0.35, P = 0.001), medium-term shoulder joint function improvement (SMD = -1.00, 95% CI: -1.62 to -0.38, P = 0.002), short-term pain relief (weighted mean difference [WMD] = -1.37, 95% CI: -2.39 to -0.38, P = 0.006), medium-term pain relief (WMD = -1.66, 95% CI: -2.70 to -0.63, P = 0.002), and post-treatment shoulder joint abduction improvements (SMD = 0.68, 95% CI: 0.20 to 1.16, P = 0.005), external rotation (SMD = 0.62, 95% CI: 0.13 to 1.11, P = 0.012), and forward flexion (SMD = 0.71, 95% CI: 0.44 to 0.97, P < 0.001), with significant differences (P < 0.05). CONCLUSION Based on the current clinical data, meta-analysis showed that acupuncture alone or combined with physical therapy is efficacious for short- and medium-term (< 3 months) pain relief and functional improvements. However, compared to other interventions, the efficacy of the long-term (3 to 12 months) period did not significantly differ. After treatment, these modalities displayed advantages such as improved shoulder joint abduction, external rotation, and forward flexion movements. However, no significant difference was noted in internal rotation movement. Thus, future studies might further investigate whether different acupuncture methods affect the efficacy of treating rotator cuff diseases and improving long-term outcome.
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Affiliation(s)
- Hai-Ning Zhang
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - Jian-Ge Chen
- Orthopedics Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - Xiao-Yu Wang
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - Shun Fan
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - An Bao
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
- National Administration of Traditional Chinese Medicine Level Three Laboratory for Tuina Technique Biological EffectsTianjin, The People’s Republic of China
| | - Hua-Nan Li
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
- National Administration of Traditional Chinese Medicine Level Three Laboratory for Tuina Technique Biological EffectsTianjin, The People’s Republic of China
| | - Jin-Gui Wang
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
- National Administration of Traditional Chinese Medicine Level Three Laboratory for Tuina Technique Biological EffectsTianjin, The People’s Republic of China
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Zhang HN, Chen JG, Wang XY, Fan S, Bao A, Li HN, Wang JG. Efficacy comparison between acupuncture and other modalities in the treatment of rotator cuff diseases: meta-analysis of randomized controlled trials. Am J Transl Res 2024; 16:599-616. [PMID: 38463603 PMCID: PMC10918137 DOI: 10.62347/ncrj1270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/12/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE This study aimed to analyze the efficacy of acupuncture alone or combined with physical therapy compared to other treatment interventions for relieving pain and improving function in rotator cuff diseases. METHODS Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After PROSPERO (CRD42023396740) registration, all randomized controlled trials (RCTs) published from the inception of the databases to October 10, 2023, evaluating the efficacy of acupuncture either alone or in combination with physical therapy for treating rotator cuff diseases, were extracted from seven databases, including PubMed, Embase, the Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), and the Wanfang Date. Two independent researchers assessed the quality of the included studies and extracted relevant data. Furthermore, a meta-analysis was conducted using Stata 14 software. RESULTS We included 13 RCTs - 12 published in English and 1 in Chinese - that enrolled 1,371 patients. The meta-analysis results demonstrated that acupuncture alone or in combination with physical therapy was superior to other interventions for short-term shoulder joint function improvement (standardized mean difference [SMD] = -0.82, 95% confidence interval [95% CI]: -1.28 to -0.35, P = 0.001), medium-term shoulder joint function improvement (SMD = -1.00, 95% CI: -1.62 to -0.38, P = 0.002), short-term pain relief (weighted mean difference [WMD] = -1.37, 95% CI: -2.39 to -0.38, P = 0.006), medium-term pain relief (WMD = -1.66, 95% CI: -2.70 to -0.63, P = 0.002), and post-treatment shoulder joint abduction improvements (SMD = 0.68, 95% CI: 0.20 to 1.16, P = 0.005), external rotation (SMD = 0.62, 95% CI: 0.13 to 1.11, P = 0.012), and forward flexion (SMD = 0.71, 95% CI: 0.44 to 0.97, P < 0.001), with significant differences (P < 0.05). CONCLUSION Based on the current clinical data, meta-analysis showed that acupuncture alone or combined with physical therapy is efficacious for short- and medium-term (< 3 months) pain relief and functional improvements. However, compared to other interventions, the efficacy of the long-term (3 to 12 months) period did not significantly differ. After treatment, these modalities displayed advantages such as improved shoulder joint abduction, external rotation, and forward flexion movements. However, no significant difference was noted in internal rotation movement. Thus, future studies might further investigate whether different acupuncture methods affect the efficacy of treating rotator cuff diseases and improving long-term outcome.
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Affiliation(s)
- Hai-Ning Zhang
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - Jian-Ge Chen
- Orthopedics Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - Xiao-Yu Wang
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - Shun Fan
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
| | - An Bao
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
- National Administration of Traditional Chinese Medicine Level Three Laboratory for Tuina Technique Biological EffectsTianjin, The People’s Republic of China
| | - Hua-Nan Li
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
- National Administration of Traditional Chinese Medicine Level Three Laboratory for Tuina Technique Biological EffectsTianjin, The People’s Republic of China
| | - Jin-Gui Wang
- Tuina Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and MoxibustionTianjin, The People’s Republic of China
- National Administration of Traditional Chinese Medicine Level Three Laboratory for Tuina Technique Biological EffectsTianjin, The People’s Republic of China
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Fang X, Yin Y, Lun H, Liu Y, Zhu S. Assessment of the Effects of Sphingosine Kinase 1/Sphingosine-1-Phosphate on Microangiogenesis at Rat Myofascial Trigger Points Using Contrast-Enhanced Ultrasonography. J Pain Res 2024; 17:609-621. [PMID: 38371480 PMCID: PMC10871147 DOI: 10.2147/jpr.s437111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose Few studies have assessed the effects of sphingosine kinase 1/sphingosine-1-phosphate (SPHK1/S1P) on microangiogenesis at rat myofascial trigger points (MTrPs) using contrast-enhanced ultrasonography (CEUS). This study aimed to address these deficiencies. Here, we investigated the effects of SPHK1/S1P on MTrP microangiogenesis and the value of CEUS in evaluating these effects. Methods Forty Sprague‒Dawley rats were subdivided into two groups: control and MTrP groups. MTrPs were established by 8 weeks of the strike procedure combined with eccentric motion and 4 weeks of recovery. All rats were euthanized after having undergone CEUS with an overdose of pentobarbital sodium. MTrP and control tissue samples were removed for haematoxylin and eosin (H&E) staining and transmission electron microscopy (TEM) imaging. The tissue was dehydrated, cleared, and embedded before sectioning. The sections were then incubated overnight at 4°C, and immunohistochemistry was carried out with primary antibodies including rabbit anti-CD31, rabbit anti-SPHK1and rabbit anti-S1PR1. Results MTrP rats exhibited spontaneous electrical activity (SEA) and a local twitch response (LTR) during electromyography (EMG) examination. The CEUS time-intensity curves (TICs) showed that the perfusion intensity in the MTrPs and surrounding tissue area was increased, with faster perfusion than in normal sites, while the TICs in the control group slowly increased and then slowly decreased. The correlation coefficient between the microvessel density (MVD) and sphingosine 1-phosphate receptor 1 (S1PR1) was 0.716 (p <0.01). Spearman correlation analysis revealed that Spearman's rho (ρ) values between the MVD and peak intensity (PI), between the MVD and area under the curve (AUC), and between the MVD and SPHK1 were > 0.5 (p <0.05), > 0.7 (p <0.01), and > 0.7 (p <0.01), respectively. Conclusion CEUS is valuable for detecting microangiogenesis within MTrPs, and SPHK1/S1P plays an important role in promoting MTrP tissue microangiogenesis.
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Affiliation(s)
- Xin Fang
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yalong Yin
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Haimei Lun
- Department of Ultrasound, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People’s Republic of China
| | - Yaoli Liu
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Shangyong Zhu
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
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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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Wang JX, Fidimanantsoa OL, Ma LX. New insights into acupuncture techniques for poststroke spasticity. Front Public Health 2023; 11:1155372. [PMID: 37089473 PMCID: PMC10117862 DOI: 10.3389/fpubh.2023.1155372] [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] [Received: 02/01/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
With the trend of aging population getting more obvious, stroke has already been a major public health problem worldwide. As a main disabling motor impairment after stroke, spasticity has unexpected negative impacts on the quality of life and social participation in patients. Moreover, it brings heavy economic burden to the family and society. Previous researches indicated that abnormality of neural modulation and muscle property corelates with the pathogenesis of poststroke spasticity (PSS). So far, there still lacks golden standardized treatment regimen for PSS; furthermore, certain potential adverse-events of the mainstream therapy, for example, drug-induced generalized muscle weakness or high risk related surgery somehow decrease patient preference and compliance, which brings challenges to disease treatment and follow-up care. As an essential non-pharmacological therapy, acupuncture has long been used for PSS in China and shows favorable effects on improvements of spastic hypertonia and motor function. Notably, previous studies focused mainly on the research of antispastic acupoints. In comparison, few studies lay special stress on the other significant factor impacting on acupuncture efficacy, that is acupuncture technique. Based on current evidences from the clinic and laboratory, we will discuss certain new insights into acupuncture technique, in particular the antispastic needling technique, for PSS management in light of its potential effects on central modulations as well as peripheral adjustments, and attempt to provide some suggestions for future studies with respect to the intervention timing and course, application of acupuncture techniques, acupoint selection, predictive and aggravating factors of PSS, aiming at optimization of antispastic acupuncture regimen and improvement of quality of life in stroke patients. More innovations including rigorous study design, valid objective assessments for spasticity, and related experimental studies are worthy to be expected in the years ahead.
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Affiliation(s)
- Jun-Xiang Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jun-Xiang Wang,
| | | | - Liang-Xiao Ma
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- The Key Unit of State Administration of Traditional Chinese Medicine, Evaluation of Characteristic Acupuncture Therapy, Beijing, China
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Vas L, Phanse S, Pawar KS, Pai R, Pattnaik M. Ultrasound-guided dry needling of masticatory muscles in trigeminal neuralgia - A case series of 35 patients. J Postgrad Med 2023; 69:11-20. [PMID: 36453389 PMCID: PMC9997599 DOI: 10.4103/jpgm.jpgm_797_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Trigeminal neuralgia (TGN) is considered a sensory neuropathy. However, reports of pain on chewing/speaking suggest a masticatory myofascial involvement. Objective To examine the effect of ultrasound-guided dry needling (USGDN), which deactivates myofascial trigger points in masticatory, neck, and facial muscles on TGN symptoms. Methods Charts of 35 patients treated for TGN were retrospectively reviewed. Treatment was USGDN alone or combined with trigeminal ganglion/mandibular nerve pulsed radiofrequency (PRF), followed by yoga mudras to stretch masticatory and facial muscles. Patients were followed for 1-8 years. Outcome parameters were reduction of medications with reduction in neuralgic attack frequency and Numeric Rating Scale (NRS) score. Results 23 patients (65.7%) received USGDN alone, 12 patients (34.3%) received PRF treatment before USGDN. A significant reduction in the mean (SD) NRS (5.7 [1.2] vs 8.8 [1.6]; P < .001) and neuralgic attack frequency (47 [27] vs 118 [70] attacks/day; P < .001) was seen after PRF compared with baseline, respectively. Following USGDN, the mean (SD) NRS further decreased significantly to 1.0 (0.9) (P < .001). USGDN alone produced a similar improvement in the NRS (8.9 [1.5] at baseline reduced to 0.6 [0.7] post-USGDN; P < .001). Patients in both groups reported a cessation in neuralgic attacks after USGDN. Post-USGDN, 18/27 patients completely discontinued medication, with the mean (SD) carbamazepine dose significantly reducing from 716.7 (260.9) mg/day at baseline to 113.0 (250.2) mg/day post-USGDN (P < .001). Conclusion Decisive relief of TGN by USGDN suggests neuromyalgia involving masticatory muscles. Prospective, controlled studies could confirm these findings.
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Affiliation(s)
- L Vas
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
| | - S Phanse
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
| | - K S Pawar
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
| | - R Pai
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
| | - M Pattnaik
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
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10
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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.
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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
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11
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Dommerholt J, Gerwin RD. Contracture Knots vs. Trigger Points. Comment on Ball et al. Ultrasound Confirmation of the Multiple Loci Hypothesis of the Myofascial Trigger Point and the Diagnostic Importance of Specificity in the Elicitation of the Local Twitch Response. Diagnostics 2022, 12, 321. Diagnostics (Basel) 2022; 12:diagnostics12102365. [PMID: 36292054 PMCID: PMC9599994 DOI: 10.3390/diagnostics12102365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
A recent study published in Diagnostics attempted to visualize trigger points and contracture knots with high-definition ultrasound. Based on their findings, the authors reversed the commonly understood meaning of the two terms. However, they did so without providing any convincing evidence. The authors maintained that their sonography images represented trigger points within contracture knots, supporting the multiple loci hypothesis. On review of the paper, both conclusions seem premature and rather speculative.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD 20814, USA
- Myopain Seminars, Bethesda, MD 20814, USA
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
- Correspondence: ; Tel.: +1-301-656-5613
| | - Robert D. Gerwin
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21205, USA
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12
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Liu Q, Huang Q, Liu L, Nguyen TT. Efficacy of Dry Needling Under EMG Guidance for Myofascial Neck and Shoulder Pain: A Randomized Clinical Trial. J Pain Res 2022; 15:2293-2302. [PMID: 35967467 PMCID: PMC9374203 DOI: 10.2147/jpr.s372074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the difference in maintenance of improvement of pain and disability for dry needling (DN) under needle electromyography (EMG) guidance technique in myofascial neck and shoulder pain patients, compared with DN alone. Patients and Methods In this randomized single-blind clinical trial, 30 participants with myofascial pain in the neck and shoulder were randomly allocated to two groups: myofascial trigger points (MTrPs) DN with EMG guided (DN-EMG) group and MTrPs DN without EMG (DN) group. Needling treatment lasted for 2 weeks, twice a week. The primary outcome was pain intensity as assessed by visual analogue scale (VAS) and neck disability index (NDI). A number of mappings referred to pain and spontaneous muscle activity (SEA) were considered secondary outcomes. VAS and NDI were measured before treatment, after 2 weeks of intervention and at 4-, 6- and 12-week follow-up periods after the intervention. Secondary outcomes were assessed before each treatment (T1–T4). Data were analysed using mixed-model analyses of variance (ANOVA) with time as a within-subject variable and groups as between-subject variables followed by Bonferroni’s post-hoc test. Results Mixed-model ANOVA revealed significant time-by-group interaction effects (F = 3.49, P = 0.01) for VAS. Post-hoc analysis showed a significant decrease in VAS and NDI after 2 weeks of intervention and at all follow-up periods compared with baseline in both groups (p < 0.01). The DN-EMG group exhibited higher improvements in VAS at 6- and 12-week follow-up period than the DN group (p < 0.05). In the SEA of MTrPs, we found positive sharp waves, fibrillation and fascicular potentials. DN-EMG group exhibited lower amplitudes at T2–T4 and frequencies at T2 and T3. Conclusion DN under needle EMG guidance technique exhibited greater improvements in maintenance of improvement of pain and lower SEA value than the DN group due to sufficient MTrPs inactivation.
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Affiliation(s)
- Qingguang Liu
- International College of Football, Tongji University, Shanghai, People's Republic of China
| | - Qiangmin Huang
- Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China.,Shanghai Ciyuan Rehabilitation Hospital, Sinopharm Healthcare, Shanghai, People's Republic of China
| | - Lin Liu
- Department of Rehabilitation, School of Sport and Health, Nanjing Sport Institute, Nanjing, People's Republic of China
| | - Thi-Tham Nguyen
- Faculty of Sport Science, Ton Duc Thang University, Ho Chi Minh City, Vietnam
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13
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Rodríguez-Jiménez J, Ortega-Santiago R, Bonilla-Barba L, Falla D, Fernández-de-Las-Peñas C, Florencio LL. Immediate Effects of Dry Needing or Manual Pressure Release of Upper Trapezius Trigger Points on Muscle Activity during the Cranio-Cervical Flexion Test in People with Chronic Neck Pain: A Randomized Clinical Trial. PAIN MEDICINE 2022; 23:1717-1725. [PMID: 35179608 DOI: 10.1093/pm/pnac034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To compare the effects of dry needling or manual pressure release on an active trigger point in the upper trapezius on cranio-cervical flexion test performance, pressure pain thresholds, and cervical range of motion in chronic neck pain. DESIGN A parallel randomized clinical trial. SETTING Physical therapy service. SUBJECTS Individuals with chronic neck pain. METHODS Subjects were randomized to receive dry needling (n = 25) or manual trigger point pressure release (n = 25) on upper trapezius active trigger points. Surface electromyography from upper trapezius, splenius capitis, sternocleidomastoid, and scalene muscles during performance of the cranio-cervical flexion test was assessed before and immediately after the intervention as primary outcome. Neck pain intensity, range of motion and pressure pain thresholds were the secondary outcomes. RESULTS A decrease in sternocleidomastoid activity on all stages of the cranio-cervical flexion test (time effect, p < 0.001) was found in both groups after the interventions, with no significant between-group difference. Pressure pain thresholds measured over the cervical spine and second metacarpal increased after dry needling when compared to manual trigger point pressure release (p < 0.05). Pain intensity decreased immediately after both treatments with moderate to large effect sizes, whereas cervical range of motion increased for both groups but with small effect sizes. CONCLUSION A single session of dry needling or manual pressure release over upper trapezius active trigger points promotes limited effects on muscle performance during the cranio-cervical flexion test, pressure pain thresholds and cervical range of motion in patients with chronic neck pain.
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Affiliation(s)
- Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Laura Bonilla-Barba
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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14
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Evaluation of the Effectiveness of Dry Needling in the Treatment of Myogenous Temporomandibular Joint Disorders. Medicina (B Aires) 2022; 58:medicina58020256. [PMID: 35208580 PMCID: PMC8876889 DOI: 10.3390/medicina58020256] [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: 12/07/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points.
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15
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Ceballos-Laita L, Jiménez-Del-Barrio S, Marín-Zurdo J, Moreno-Calvo A, Marín-Boné J, Albarova-Corral MI, Estébanez-de-Miguel E. Effectiveness of Dry Needling Therapy on Pain, Hip Muscle Strength, and Physical Function in Patients With Hip Osteoarthritis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:959-966. [PMID: 33567336 DOI: 10.1016/j.apmr.2021.01.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/14/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the short-term effects of dry needling (DN) on physical function, pain, and hip muscle strength in patients with hip osteoarthritis (OA). DESIGN A double-blind, placebo-control, randomized controlled trial. SETTING Private practice physiotherapy clinic. PARTICIPANTS Patients with unilateral hip OA (N=45) were randomly allocated to a DN group, sham DN group, or control group. INTERVENTIONS Patients in the DN and sham groups received 3 treatment sessions. Three active myofascial trigger points (MTrPs) were treated in each session with DN or a sham needle procedure. The treatment was applied in active MTrPs of the iliopsoas, rectus femoris, tensor fasciae latae, and gluteus minimus muscles. MAIN OUTCOME MEASURES Physical function was assessed with the Western Ontario and McMaster Universities (WOMAC) physical function subscale, the timed Up and Go test, and the 40-meter self-paced walk test. Intensity of hip pain related to physical function was evaluated using the visual analog scale and WOMAC pain subscale. The maximal isometric force of hip muscles was recorded with a handheld dynamometer. RESULTS Significant group by time interactions were shown for physical function, pain, and hip muscle force variables. Post hoc tests revealed a significant reduction in hip pain and significant improvements in physical function and hip muscle strength in the DN group compared with the sham and control groups. The DN group showed within- and between-groups large effect sizes (d>0.8). CONCLUSIONS DN therapy in active MTrPs of the hip muscles reduced pain and improved hip muscle strength and physical function in patients with hip OA. DN in active MTrPs of the hip muscles should be considered for the management of hip OA.
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Affiliation(s)
- Luis Ceballos-Laita
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy. Faculty of Health Sciences, University of Valladolid, Soria.
| | - Sandra Jiménez-Del-Barrio
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy. Faculty of Health Sciences, University of Valladolid, Soria
| | - Javier Marín-Zurdo
- ID_ERGO Research Group, I3A, Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza
| | - Alejandro Moreno-Calvo
- ID_ERGO Research Group, I3A, Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza
| | - Javier Marín-Boné
- ID_ERGO Research Group, I3A, Department of Design and Manufacturing Engineering, University of Zaragoza, Zaragoza
| | | | - Elena Estébanez-de-Miguel
- Department of Physiatrist and Nursery, Faculty of Health Science, University of Zaragoza, Zaragoza, Spain
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16
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Núñez-Cortés R, Cruz-Montecinos C, Latorre-García R, Pérez-Alenda S, Torres-Castro R. Effectiveness of Dry Needling in the Management of Spasticity in Patients Post Stroke. J Stroke Cerebrovasc Dis 2020; 29:105236. [PMID: 33066920 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of the dry needling technique (DNT) in the treatment of spasticity for individuals with stroke. DESIGN We reviewed the Embase, Pubmed/MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We also performed a manual search of the references that are included in the selected articles. Studies included were: i) randomized clinical trials (RCTs); ii) involving patients with a diagnosis of stroke; and iii) using DNT alone or in a multimodal treatment. Muscular spasticity was the primary outcome of the study. The additional outcomes included were: pressure pain sensitivity, range of motion and perception of pain. The analysis of the certainty of the evidence was analyzed using GRADE. The risk of bias of the included studies was assessed with the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RESULTS A total of six RCTs with 221 patients were included in this systematic review, where a significant decrease in spasticity was observed in most of the muscles evaluated, though the certainty of the evidence was low. The effects were only evaluated in the short term in all included studies and the sample size was small. CONCLUSION These results should be taken with caution because the included studies are few in number and have different comparators. More RCTs are needed to cover aspects of biases found in the literature, in particular the blinding of participants and personnel.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.; Hospital Clínico La Florida, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile..
| | - Rodrigo Latorre-García
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
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17
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Valencia-Chulián R, Heredia-Rizo AM, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review. Complement Ther Med 2020; 52:102515. [PMID: 32951759 DOI: 10.1016/j.ctim.2020.102515] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To summarise the available evidence about the effectiveness of deep dry needling (DN) on spasticity, pain-related outcomes, and range-of-movement (ROM) in adults after stroke. DESIGN A computer search of Web of Science, Scopus, Medline, Cochrane Library, Cinahl, and Physiotherapy Evidence Database (PEDro) was conducted. A hand search of the reference lists of the selected studies and other relevant publications was also undertaken. Studies were assessed by two independent reviewers and included if they complied with the following criteria: (1) participants were adults after a stroke, (2) use of DN alone or within a multimodal approach, compared to no intervention or other treatments; (3) assessment of spasticity, pain, or joint ROM as a primary or secondary outcome. We included randomised controlled trials (RCTs), case series, and case reports. Data were extracted using a standardised protocol. The methodological quality of the studies was assessed with the Checklist for Measuring quality. RESULTS A total of sixteen studies, 7 of which were RCTs, were selected. All studies generally reported an improvement of spasticity level, pain intensity, and ROM after the use of DN, alone or combined with other interventions, in stroke survivors. CONCLUSION The management of adults after stroke with DN may impact positively on spasticity, pain, and ROM. However, there was significant heterogeneity across trials in terms of sample size, control groups, treated muscles, and outcome measures, and a meta-analysis was not feasible. Further research should include proper blinding, sham placebo DN as control intervention, and investigate long-term effects.
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Affiliation(s)
- Rafael Valencia-Chulián
- Department of Nursing and Physiotherapy Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
| | - Alberto M Heredia-Rizo
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain.
| | - Jose A Moral-Munoz
- Department of Nursing and Physiotherapy Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain; Institute of Research and Innovation in Biomedical Sciences of the Province of Cádiz (INiBICA), University of Cádiz, Cádiz, Spain
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
| | - Carlos Luque-Moreno
- Department of Nursing and Physiotherapy Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
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18
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Ma YT, Li LH, Han Q, Wang XL, Jia PY, Huang QM, Zheng YJ. Effects of Trigger Point Dry Needling on Neuromuscular Performance and Pain of Individuals Affected by Patellofemoral Pain: A Randomized Controlled Trial. J Pain Res 2020; 13:1677-1686. [PMID: 32753943 PMCID: PMC7354013 DOI: 10.2147/jpr.s240376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the effects of trigger point dry needling (TrP-DN) on exercise-induced patellofemoral pain syndrome (PFPS). Patients and Methods In this randomized, single-blind, parallel-group trial, 50 patients with PFPS were randomly allocated to the following two groups: the TrP-DN group (n = 25) and the Sham needling group (n = 25). Patients in both groups were asked to perform a stretching exercise of the quadriceps daily after needling. The needling group received a single session of TrP-DN to trigger points (TrPs) in the vastus medialis oblique (VMO), vastus lateralis (VL), and rectus femoris muscles (once a week for 6 weeks), and the Sham group received placebo needling. Visual analogue scale (VAS) for pain intensity and Kujala questionnaire for the functional status were assessed before treatment, 3 and 6 weeks after treatment, and at the 3-month follow-up. The ratio of the myoelectric amplitude of the vastus medialis oblique and vastus lateralis muscles (VMO/VL) was assessed before treatment and 6 weeks after treatment. Results There was no significant difference in the general data between the two groups. The VAS scores and Kujala scores in the TrP-DN group were significantly improved and increased at the 3-week treatment visit, 6-week treatment visit, and 3-month follow-up compared to the scores before treatment; and the scores in the Sham group were only significantly improved at the 3-week treatment visit, and 6-week treatment visit. VAS scores in the TrP-DN group were significantly lower and Kujala scores were significantly higher at the 6-week treatment visit and the 3-month follow-up compared to those in the Sham group. The VMO/VL ratio in the TrP-DN group was significantly increased at the 6-week treatment visit compared to that before treatment. Conclusion TrP-DN at the quadriceps combined with stretch can reduce the pain, and improves the clinical symptoms and function, the VMO/VL ratio, and the coordination of VMO and VL in patients with PFPS.
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Affiliation(s)
- Yan-Tao Ma
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China.,Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Li-Hui Li
- Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China.,School of Medicine, Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Qi Han
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Xiao-Lei Wang
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Pei-Yu Jia
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Qiang-Min Huang
- Department of Sport Rehabilitation, School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Yong-Jun Zheng
- Department of Pain Management, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
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19
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Acupotomy Alleviates Energy Crisis at Rat Myofascial Trigger Points. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:5129562. [PMID: 32190087 PMCID: PMC7064863 DOI: 10.1155/2020/5129562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/18/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the effects of acupotomy on energy crises in rat trigger points (TrPs) by measuring mechanical pain thresholds (MPTs) and levels of acetylcholinesterase (AChE), free sarcoplasmic calcium (Ca2+), adenosine 5'-triphosphate (ATP), adenosine 5'-monophosphate (AMP), substance P (SP), and calcitonin gene-related peptide (CGRP) in rat muscle TrP tissue. Male Sprague Dawley rats (n = 32) were randomly divided into four groups: control, TrP, acupotomy, and lidocaine injection. Enzyme-linked immunosorbent assays were used to measure AChE, and free sarcoplasmic Ca2+ concentrations were determined by fluorescent staining with Fura-2 AM; high-performance liquid chromatography was used to measure ATP and AMP, and SP and CGRP were evaluated by immunohistochemistry. Compared with the control group, free sarcoplasmic Ca2+, AMP, SP, and CGRP were higher in the model group, while MPT, AChE, and ATP were lower. Treatment with acupotomy or lidocaine injection reduced free sarcoplasmic Ca2+, SP, and CGRP and increased MPTs and AChE levels compared with the model group. However, only acupotomy also led to decreased AMP and increased ATP levels relative to the model group. We conclude that acupotomy can alleviate energy crises at TrPs.
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Lu Z, Briley A, Zhou P, Li S. Are There Trigger Points in the Spastic Muscles? Electromyographical Evidence of Dry Needling Effects on Spastic Finger Flexors in Chronic Stroke. Front Neurol 2020; 11:78. [PMID: 32153489 PMCID: PMC7047231 DOI: 10.3389/fneur.2020.00078] [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: 11/15/2019] [Accepted: 01/22/2020] [Indexed: 01/28/2023] Open
Abstract
The purpose was to examine the immediate effects of dry needling to spastic finger muscles in chronic stroke. Ten chronic stroke patients with spasticity in finger flexors participated in this experiment. Dry needling to the flexor digitorum superficialis (FDS) muscle was performed under ultrasound guidance for about 30 s (about 100 times). Clinical assessment and intramuscular needle EMG readings were made before and immediately after dry needling. Immediately after needling, the FDS muscle was felt less tight to palpation and the proximal phalangeal joint rested in a less flexed position (p = 0.036). The MAS score decreased for FDS (p = 0.017) and flexor digitorum profundus (FDP) (p = 0.029). Motor unit action potential (MUAP) spikes decreased from 41.6 ± 5.5 to 6.7 ± 2.2 spikes/s (p = 0.002), an 84% reduction after dry needling. However, the pre-needling spike frequency was not correlated to MAS or resting position of the FDS muscles. Dry needling to the spastic finger flexors leads to immediate spasticity reduction, increased active range of motion, and decreased frequency of motor unit spontaneous firing spikes. The results suggest that latent trigger points possibly exist in spastic muscles and they contribute partly to spastic hypertonia of finger flexors in chronic stroke.
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Affiliation(s)
- Zhiyuan Lu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Amy Briley
- TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,TIRR Memorial Hermann Hospital, Houston, TX, United States
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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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Zhang XF, Liu L, Wang BB, Liu X, Li P. Evidence for kinesio taping in management of myofascial pain syndrome: a systematic review and meta-analysis. Clin Rehabil 2019; 33:865-874. [PMID: 30712369 DOI: 10.1177/0269215519826267] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to evaluate the effectiveness of kinesio taping for managing myofascial pain syndrome in terms of pain intensity, pressure pain threshold, range of motion, muscle strength and disability. Data sources: PubMed, EBSCO, ScienceDirect, Web of Science, Cochrane Library and Physiotherapy Evidence Databases were searched from database inception to November 2018. Methods: Randomized controlled trials (RCTs) that used kinesio taping as the main treatment protocol for participants diagnosed with myofascial pain syndrome were included. Two reviewers independently screened articles, scored methodological quality using Cochrane risk-of-bias tool and extracted data. The primary outcomes were pain intensity, pressure pain threshold and range of motion at post-intervention and follow-up. The secondary outcomes were muscle strength and disability at post-intervention and follow-up. Data synthesis: Meta-analyses of 20 RCTs involving 959 patients showed that kinesio taping was more effective than other treatments in reducing pain intensity (mean difference (MD) = 1.06 cm, 95% confidence interval (CI): −1.66 to −0.46 cm, P = 0.006) and increasing range of motion (standardized mean difference (SMD) = 0.26, 95% CI: 0.09 to 0.43, P = 0.003) at post-intervention. Kinesio taping was also superior to other non-invasive techniques in relieving pain intensity at follow-up (MD = −0.68 cm, 95% CI: −1.22 to −0.13 cm, P = 0.02). However, there was no detectable effect on disability or function. Conclusion: Statistical evidence showed that kinesio taping could be recommended to relieve pain intensity and range of motion for patients with myofascial pain syndrome at post-intervention.
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Affiliation(s)
- Xue-Feng Zhang
- Department of Pain, Dongguan Third People’s Hospital, Affiliated Dongguan Shilong People’s Hospital of Southern Medical University, Dongguan, China
| | - Lin Liu
- Department of Sport Health Science, Nanjing Sport Institute, Nanjing, China
| | - Bin-Bin Wang
- Department of Pain, Dongguan Third People’s Hospital, Affiliated Dongguan Shilong People’s Hospital of Southern Medical University, Dongguan, China
| | - Xu Liu
- Department of Clinical Medicine, Hebei Medical University, Shijiazhuang, China
| | - Ping Li
- Department of Rehabilitation, Shanghai Hudong Zhonghua Shipbuilding Group Staff-worker Hospital, Shanghai, China
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Li L, Huang Q, Barbero M, Liu L, Nguyen T, Xu A, Ji L. Proteins and Signaling Pathways Response to Dry Needling Combined with Static Stretching Treatment for Chronic Myofascial Pain in a RAT Model: An Explorative Proteomic Study. Int J Mol Sci 2019; 20:ijms20030564. [PMID: 30699921 PMCID: PMC6387358 DOI: 10.3390/ijms20030564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/09/2023] Open
Abstract
A quantitative proteomic analysis of the response to dry needling combined with static stretching treatment was performed in a rat model of active myofascial trigger points (MTrPs). 36 rats were divided into a model group (MG), a stretching group (SG) and a dry needling combined with stretching group (SDG). We performed three biological replicates to compare large-scale differential protein expression between groups by tandem mass tag (TMT) labeling technology based on nanoscale liquid chromatography mass spectrometry analysis (LC–MS/MS). Hierarchical clustering, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment and protein-protein interaction network analyses were performed for the general characterization of overall enriched proteins. For validation of the results of TMT, the candidate proteins were verified by parallel reaction monitoring (PRM) analysis. 285 differentially expressed proteins between groups were identified and quantified. Tight junction pathway played a dominant role in dry needling combined with static stretching treatment for the rat model of active MTrPs. Three candidate proteins, namely actinin alpha 3, calsequestrin-1 and parvalbumin alpha, were further validated, consistent with the results of LC–MS/MS. This is the first proteomics-based study to report the therapeutic mechanism underlying dry needling and static stretching treatment for MTrPs. Further functional verification of the potential signaling pathways and the enriched proteins is warranted.
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Affiliation(s)
- Lihui Li
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai 200438, China.
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland.
| | - Qiangmin Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai 200438, China.
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland.
| | - Lin Liu
- Sport and Health Science Department, Nanjing Sport Institute, Nanjing 210014, China.
| | - Thitham Nguyen
- Faculty of Sport Science, Ton Duc Thang University, Ho Chi Minh City 71000, Viet Nam.
| | - Anle Xu
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai 200438, China.
| | - Lijuan Ji
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai 200438, China.
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Li LH, Huang QM, Barbero M, Liu L, Nguyen TT, Beretta-Piccoli M, Xu AL, Ji LJ. Quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of myofascial trigger points. J Pain Res 2019; 12:283-298. [PMID: 30662282 PMCID: PMC6327913 DOI: 10.2147/jpr.s185916] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Proteomics analysis may provide important information regarding the pathogenesis of chronic myofascial pain and the mechanisms underlying the treatment effects of dry needling. Materials and methods This study used a rat model of myofascial trigger points (MTrPs) to perform a proteomics analysis. Three biological replicate experiments were used to compare the proteomes of healthy control rats, a rat model of MTrP, MTrP model rats following dry needling of MTrPs, and MTrP model rats following dry needling of non-MTrPs. Tandem mass tag (TMT) labeling technology based on nanoscale liquid chromatography-tandem mass spectrometry was used. Hierarchical clustering, gene ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and protein–protein interaction network analysis were performed to characterize the proteins. To validate the TMT results, three candidate biomarker proteins were verified using parallel reaction monitoring and Western blot analysis. Results A total of 2,635 proteins were identified. GO and KEGG enrichment analyses showed that the glycolysis/gluconeogenesis pathways played dominant roles in the pathogenesis of chronic myofascial pain. The three candidate biomarker proteins were the pyruvate kinase muscle isozyme (encoded by the PKM gene), the muscle isoform of glycogen phosphorylase (encoded by the PYGM gene), and myozenin 2 (encoded by the MYOZ2 gene). The validation results were consistent with the TMT results. Conclusion This is the first proteomics study that has investigated the pathogenesis of chronic myofascial pain and the mechanisms underlying the treatment effects of dry needling in an in vivo rat model of MTrPs, which might promote our understanding of the molecular mechanisms underlying chronic myofascial pain.
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Affiliation(s)
- Li-Hui Li
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China, .,Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Qiang-Min Huang
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China,
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Lin Liu
- Nanjing Sport Institute, Sport and Health Science Department, Nanjing, China
| | - Thi-Tham Nguyen
- Faculty of Sport Science, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Matteo Beretta-Piccoli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - An-Le Xu
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China,
| | - Li-Juan Ji
- Department of Sport Medicine and Rehabilitation Center, Shanghai University of Sport, Shanghai, China,
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Vas L, Pai R. Ultrasound-Guided Dry Needling As a Treatment For Postmastectomy Pain Syndrome - A Case Series of Twenty Patients. Indian J Palliat Care 2019; 25:93-102. [PMID: 30820110 PMCID: PMC6388608 DOI: 10.4103/ijpc.ijpc_24_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Existing interventions for postmastectomy pain syndrome (PMPS) address the neural component while overlooking a possible myofascial component. AIM The aim of the study is to investigate the myofascial contribution to PMPS, by examining the effectiveness of myofascial trigger point release by ultrasound-guided dry needling (USGDN). PATIENTS AND METHODS This retrospective review assessed the efficacy of USGDN in addressing myofascial pain in twenty consecutive patients with treatment-refractory PMPS. Patients in Group 1 (n = 16) received USGDN after neural interventions (NIs) such as neuraxial blocks, intrathecal pump implant, or pulsed radiofrequency, while those in Group 2 (n = 4) received USGDN alone. Outcome measures were changes in Numerical Rating Scale (NRS), PainDETECT (PD), Disabilities of Arm, Shoulder, and Hand (DASH), Patient Health Questionnaire-9 (PHQ-9) scores, and opioid use. RESULTS In Group 1, the mean (standard deviation) NRS and PD scores (9.6 [0.9] and 28.3 [4.3], respectively, at baseline) reduced to 5.2 (1.1) and 16.1 (3.7) at 1-week post-NI. The post-NI DASH reduction was below the cutoff for clinical relevance (80.9 [10.5] at baseline vs. 71.1 [10.5] post-NI). The opioid dose remained unchanged. Following USGDN, NRS, PD, and DASH scores further reduced to 2.3 (0.8), 6.6 (1.2), and 34.6 (14.4), respectively. Patients receiving USGDN alone also showed reduction in NRS, PD, and DASH (7.8 [1.7], 20.0 [8.0], and 61.0 [14.4] at baseline vs. 1.3 [0.5], 6.0 [1.6], and 22.5 [10.4] post-USGDN, respectively). In all patients, opioid use and PHQ-9 scores reduced only post-USGDN. CONCLUSIONS USGDN reduced pain, disability, and opioid use, whereas NI reduced only pain. This suggests a myofascial contribution to pain and disability in PMPS.
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Affiliation(s)
- Lakshmi Vas
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
| | - Renuka Pai
- Ashirvad Institute for Pain Management and Research, Mumbai, Maharashtra, India
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