Mulligan's Mobilization with Movement and Muscle Trigger Point Dry Needling for the Management of Chronic Lateral Epicondylalgia: A Case Report

Therapeutic Effects of Dry Needling on Lateral Epicondylitis: An Updated Systematic Review and Meta-analysis

OBJECTIVE

To investigate the therapeutic effects of dry needling on lateral epicondylitis and identify a relatively more effective needling technique.

DATA SOURCES

English databases (Pubmed, Web of Science, Scopus, EBSCO, ScienceDirect, Taylor & Francis, ProQuest, Cochrane, Ovid, and Embase) and Chinese databases (China National Knowledge Infrastructure, Wanfang, and VIP) were searched.

STUDY SELECTION

This study included randomized controlled trials for comparing the effectiveness of dry needling with other treatment methods for lateral epicondylitis. The primary outcome measures were pain intensity and elbow disability, while the secondary outcome measures included grip strength and upper limb function.

DATA EXTRACTION

Data extraction was performed by 2 researchers who used the Cochrane risk of bias analysis tool and the Physiotherapy Evidence Database checklist to assess the risk of bias and methodological quality of the included studies. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the quality of evidence.

DATA SYNTHESIS

A total of 17 studies that involved 979 subjects were included in this research. Dry needling exhibited a significant advantage in improving pain intensity among patients with lateral epicondylitis within 1 week after treatment (mean difference [MD]=-0.95, 95% confidence interval [CI], -1.88 to -0.02). Within 1 week and in the follow-ups that exceeded 1 week, dry needling also demonstrated better improvement in elbow disability (<1 week: standardized mean difference [SMD]=-1.37, 95% CI, -1.88 to -0.86; ≥1 week: SMD=-1.32, 95% CI, -2.23 to -0.4) and grip strength (<1 week: SMD=0.27, 95% CI, 0.01 to 0.53; ≥1 week: SMD=0.45, 95% CI, 0.02 to 0.88). Trigger point dry needling with local twitch response exhibited more significant improvement in pain intensity within 1 week (MD=-1.09, 95% CI, -1.75 to -0.44).

CONCLUSIONS

Dry needling demonstrates good therapeutic effects on pain intensity (within 1 week), function, and grip strength among patients with lateral epicondylitis. Local twitch response is necessary in treatment that targets trigger points.

Dry needling strategies for musculoskeletal conditions: Do the number of needles and needle retention time matter? A narrative literature review

Acupuncture and dry needling are both minimally invasive procedures that use thin, filiform needles without injectate for the management of a variety of neuromusculoskeletal pain conditions. While the theoretical constructs underlying the use of acupuncture and dry needling are unique, both appear to have the ability to elicit biochemical, biomechanical, endocrinological and neurovascular changes associated with reductions in pain and disability. However, optimal treatment dosage has yet to be determined, and there is a lack of consistency in the literature on the number of needles that should be inserted and the needle retention time. Therefore, the purpose of this narrative review is to further explore the importance of these two variables. While trigger point dry needling advocates single needle insertions via repetitive, quick in-and-out pistoning, most acupuncture and dry needling clinical trials have incorporated multiple needles for five to 40 min. Notably and to date, using a single needle to repeatedly prick trigger points one at a time with fast-in and fast-out pistoning maneuvers has not yet been shown to produce significant and clinically meaningful long term improvements in pain and disability in a wide array of musculoskeletal conditions. Insertion of multiple needles for typically 20-30 min durations has been shown to produce larger treatment effect sizes and longer-lasting outcomes than brief, single-needle strategies. Moreover, the number of needles and needle retention time are two variables associated with treatment dosage and must be carefully matched with specific musculoskeletal conditions and the patient's goals.

The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females

AIM

The purpose of this clinical trial experiment was to compare the effects of the combination of dry needling (DN) and the muscle energy technique (MET) on the upper trapezius latent myofascial trigger point.

METHOD

Sixty female patients, aged 18-30 with latent myofascial trigger points in the upper trapezius muscle were randomly divided into three groups: group 1 (n = 20) received DN and MET, group 2 (n = 20) received only MET, and group 3 (n = 20) received only DN. The visual analogue scale (VAS), pressure pain threshold (PPT), and range of active contra lateral flexion (CLF) were measured before each treatment. The patients were treated for three sessions in a one-week period with at least a two-day break between each session, and in session four, an assessment of primary outcomes was conducted without any treatment.

RESULTS

All three treatment groups showed decreases in pain (p = 0.001) and increases in PPT levels (p = 0.001) as well as increases in CLF (p = 0.001). But the group receiving trigger point DN together with MET showed more significant improvement than the other two groups in VAS, PPT and ROM. No significant differences were found between the MET-only group and the DN-only group.

CONCLUSION

Our results indicate that all three treatments used in this study were effective for treating MTP. According to this study, DN and MET is suggested as a new method for the treatment of MTP.

Dry needling - peripheral and central considerations

Dry needling is a common treatment technique in orthopedic manual physical therapy. Although various dry needling approaches exist, the more common and best supported approach targets myofascial trigger points. This article aims to place trigger point dry needling within the context of pain sciences. From a pain science perspective, trigger points are constant sources of peripheral nociceptive input leading to peripheral and central sensitization. Dry needling cannot only reverse some aspects of central sensitization, it reduces local and referred pain, improves range of motion and muscle activation pattern, and alters the chemical environment of trigger points. Trigger point dry needling should be based on a thorough understanding of the scientific background of trigger points, the differences and similarities between active and latent trigger points, motor adaptation, and central sensitize application. Several outcome studies are included, as well as comments on dry needling and acupuncture.