dry needling

This study investigates the impact of dry needling on myofascial trigger points in the soleus muscles among soccer players with medial tibial stress syndrome (MTSS).

Soccer players diagnosed with MTSS were enlisted and randomly divided into two groups (11 participants in the experimental group [Group 1] and 11 participants in the control group [Group 2]). Pre-intervention measurements included repeated shuttle sprint ability, MTSS score, and pain pressure threshold (PPT) for both groups. In the experimental group, dry needling was performed on the soleus muscle, followed by active stretching and cryotherapy. The control group underwent active stretching of the soleus muscle and cryotherapy exclusively. Post-intervention measurements of repeated shuttle sprint ability, MTSS score, and PPT were taken for both groups after 2 days.

The experimental group exhibited a statistically significant improvement in PPT, MTSS score, and repeated shuttle sprint ability. Conversely, within the control group, statistically significant changes were observed only in PPT values through paired t-test assessment. Between-group analysis using an independent t-test revealed significant enhancement in PPT (P=0.000) and MTSS score (P=0.01) within the experimental group compared to the control group.

Addressing myofascial trigger points in the soleus muscle through dry needling offers a more effective approach to treating MTSS than relying solely on muscle stretching.

Flexibility or the ability of a muscle to increase in length is an integral part of musculoskeletal characteristics and is essential in preventing musculoskeletal injuries and increasing functional levels. Hamstring muscles rupture is a common injury. One of the important factors in the occurrence of this injury is poor hamstring muscle flexibility, which because of its stiffened structure, has less ability to quickly increase in length. Some researchers have recently suggested that the dry needling technique could reduce the number of treatment sessions for hamstring muscle tightness and bring faster and more effective results. Accordingly, this study aims to investigate the effect of the application of dry needling through an acupuncture technique on hamstring muscle flexibility.

The present study is a single-blinded randomized controlled trial in which 16 individuals with bilateral hamstring muscle shortness were randomly allocated into dry-needling and sham-needling groups. The sampling method was non-probability convenience. The outcome measures were the right and left active knee extension range of motion, assessed before and after the first, third, and fifth sessions of intervention. A 2-factor mixed analysis of variance was applied to determine the differences between and within the two groups.

Except for the group main effect, time main effect and interaction effect were statistically significant for the right and left active knee extension range of motion (P<0.001). There were differences in behavioral patterns in groups; accordingly, in the real dry-needling group, a significant difference was detected across times. However, in the sham dry-needling group, no significant difference was observed.

The application of dry needling into motor points of hamstring muscles in individuals with bilateral hamstring muscles shortness could improve flexibility and increase the range of knee extension after 3 and 5 sessions of intervention because of the therapeutic effects of the dry needling technique in improving the muscle flexibility.

 In this case report of a 31-year-old female, we describe the effects of dry needling on scar tissue following total hip arthroplasty.

   Case report: 

A 31-year-old woman underwent an elective bilateral total hip replacement due to a motor vehicle accident. Based on physical examination, the patient had burning pain at the incision site at the time of menstruation and limited hip range of motion worse on the right side. The treatment program consisted of six sessions of dry needling over a three-week period alongside infrared radiation for 20 minutes during each session. The needles were spaced along the entire length of the scar tissue and rotation was performed back and forth across the scar region to release the adhesion between the scar line and the underlying tissue, focusing more on the painful-to-touch spots and adhesive points. Following the completion of the dry needling treatments hip range of motion and the patient’s functional outcome improved. Dry needling may be an effective and rapid treatment for scar tissue adhesion after surgical procedures. High-quality randomized-controlled studies are needed to verify the efficacy of this method.

Osteoarthritis is one of the most common rheumatological diseases and is also considered as one of the causes of myofascial trigger points (MtrPs). Dry needling (DN) is one of the methods used for the treatment of the MtrPs. The aim of the current study was to investigate the effects of DN on pain in participants with knee osteoarthritis (KOA).

In this before and after preliminary clinical trial study, patients with mild to moderate KOA were enrolled. In one session, after determining the location of trigger points in quadriceps and gastrocnemius muscles, the patients underwent DN. The pain was evaluated at baseline, by passing 4 days and 1 month from the intervention using the Visual Analog Scale (VAS).

Sixteen patients with a mean age of 56.5 (4.53) years old have completed the study and follow‑up period. According to the ANOVA analysis, VAS values indicated a significant decrease in pain score at the 4th and 1 month after the intervention compared to baseline (P < 0.001). There was no significant difference between VAS at the 4th day of intervention and also 1 month later of intervention (P = 0.087).

The application of one session DN can lead to improvement in pain intensity in participants with mild to moderate KOA.

Peyronie’s disease (PD) is a connective tissue disorder resulting from abnormal development of fibrotic and non-expandible thickened scar tissue in the penis. Surgical intervention might lead to other complications, including decreased sensation in the penis, persistent pain after surgery, and less-rigid erections. This study presents the physiotherapeutic assessment and management of a 33-year-old man with erectile dysfunction and impaired penile sensation following reconstructive surgeries of the penis. The patient was given physiotherapeutic interventions including dry needling (DN) and subcision of the scar and stretching exercise of the penis. After the 5th visit, the patient reported improvement in symptoms. This case report suggests that dry-needling and subcision techniques can improve pain and sexual well-being in patients with post-plication surgery problems.

This study aimed to evaluate the effect of conventional physiotherapy plus Dry Needling (DN) technique in patients with chronic nonspecific neck pain with Sternocleidomastoid (SCM) and Upper Trapezius (UT) muscles involvement.

This study was designed as a single-blind randomized clinical trial. A total of 39 patients (19 men and 21 women) with chronic non-specific neck pain with a Mean±SD age of 38.13±5.68 years, a Mean±SD height of 168.28±8.34 cm, and a Mean±SD weight of 75.78±9.02 kg participated in this study. They were randomly divided into conventional physiotherapy (control group: n=19) and conventional physiotherapy plus DN (intervention group: n=20). SCM and UT muscle pain, neck disability, and thickness were assessed for all participants in the pre-test, post-test, and follow-up periods. This study was reviewed and approved by the Faculty of Physical Education and Sport Science, University of Kharazmi, Tehran, Iran. Repeated measures analysis of variance and Bonferroni post hoc tests were used for data analysis using SPSS v. 22.

The results of 1-way analysis of variance showed that pain, neck disability, and SCM and UT muscle thickness in the intervention group had a significant decrease compared to the control group in the post-test and follow-up period (P<0.05). Also, according to the results of the corrected Bonferroni post hoc test, the intervention group showed a greater effect size than the control group in the post-test and the follow-up periods in the above variables.

The present study results show that adding DN to conventional physiotherapy for neck pain can increase the effectiveness of intervention in relieving pain, disability, and SCM and UT muscle thickness in people with chronic neck pain.

Myofascial pain syndrome is one of the most common complaints in patients referring to orthopedic treatment centers. The present study aimed to examine the effects of instrument-assisted soft tissue mobilization (IASTM) and dry needling (DN) on active myofascial trigger points (AMTrP) of the upper trapezius muscle (UTM).

The current study was designed as a randomized clinical trial and a total of 81 patients, aged 18-40 years, with active myofascial trigger points in the upper trapezius muscle were randomly divided into 3 groups: group 1 (n = 30) received DN treatment, group 2 (n = 26) received IASTM treatment, and group 3 (n = 25) was considered as the control group (no intervention). The numeric pain scale (NPS), pain pressure threshold (PPT), active cervical contra-lateral flexion (ACLF), neck disability index (NDI), and muscle thickness (MT), according to rehabilitative ultrasonic imaging (RUSI), were measured at baseline, immediately after the last session (session 4 in week 2), and 1 month after the last session. The statistical analysis was conducted at a 95% confidence level. The P values less than .05 were considered as statistically significant.

Both techniques were effective in treating active trigger point of the upper trapezius (p<0.05), but there was no significant difference between the treatment groups in terms of any of the above variables except for ACLF (p>0.05)

Both IASTM and DN were determined to improve NPS, PPT, ROM, and NDI in participants with active trigger points in the upper trapezius, although IASTM was more effective in increasing ACLF in these patients.

Myofascial pain syndrome is one of the most common disorders of the musculoskeletal system with skeletal muscle origin. It is characterized by the presence of trigger points, which are very sensitive points in the muscle and are often found in the tight band of skeletal muscle; they are sensitive to stimulation (pressure or use of dry needles) and create a referral pain in an area far from that points. The prevalence of trigger points is higher in the postural muscles of the upper quarter, especially the trapezius muscle. The aim of this study was to compare the short-term effects of transcutaneous electrical nerve stimulation (TENS) with dry needling on pain, disability, and pressure pain threshold in subjects with trigger points in upper trapezius muscle.

In this clinical trial, 45 patients with upper trapezius muscle trigger points were randomly divided into three groups: TENS and stretching exercise (group A), dry needling and stretching exercise (group B), and stretching exercise alone (group C, control). The joint program between the three groups was to perform trapezius muscle stretching exercises at home for two weeks. In addition to stretching exercise training, group A was treated with TENS for ten sessions during two weeks (5 days a week). Group B, besides stretching exercise training, was treated with three sessions of dry needling for two weeks. Group C was the control group and was trained only in stretching exercises. The outcomes were pain intensity, disability, and pressure pain threshold that were measured using Visual Analog Scale (VAS), Neck Disability Index (NDI), and digital algometer. Paired t-test was used to compare before and after treatment in each group and one-way analysis of variance (ANOVA) test was used to compare mean changes between the three groups.

After treatment, significant improvement was seen in pain intensity and NDI in all three groups (P < 0.001), but there was no significant difference in pressure pain threshold in any of the three groups before and after the intervention (P > 0.05). Moreover, there was no significant difference between the three groups in mean changes of pain, pressure pain threshold, and NDI scores after the intervention compared to before the intervention (P > 0.05).

Although the use of TENS and dry needling along with stretching exercises in subjects with upper trapezius muscle trigger points helps to reduce pain and disability, but it has no additional effect and only stretching exercise in these patients helps to reduce pain and disability to the same extent.

Cervicogenic headache (CGH) is a secondary headache with a cervical source that radiates pain to the head or face. Accordingly, one reason of CGH is myofascial trigger points. The purpose of this study was to investigate the effect of one session dry needling (DN) of myofascial trigger points of the sternocleidomastoid (SCM) muscle in patients with CGH.

In this before‑and‑after clinical trial, 16 females aged 18–60 years with a clinical diagnosis of CGH were enrolled. All of the patients received one session DN into the myofascial trigger points of the SCM muscle. Headache index (HI), headache duration, headache frequency, and headache disability index (HDI) were assessed at 2 weeks before and 2 weeks after the intervention. This study was registered in Clinical Trials as IRCT20181109041599N1.

One session DN into myofascial trigger points of the SCM muscle showed a significant improvement in HI (P < 0.001). Duration and frequency of headache as well as HDI significantly reduced after intervention (P < 0.001).

One session DN into myofascial trigger points of the SCM muscle was effective on improvement of HI, headache duration, headache frequency, and HDI in patients with CGH.

 Tension type headache is the most common type of headache that is associated with myofascial pain syndrome and trigger points. The aim of this study was to evaluate the efficacy of deep dry needling into trigger points of temporalis, sternocleidomastoid and upper trapezius muscles of females with episodic tension type headache.

 The study was a clinical randomized, single-blind, parallel-group trial in which 24 participants were allocated into two groups. The first group received dry needling with passive stretching treatment and the second group (control group) received only passive stretching. Subjects were asked to record headache indices (headache intensity and frequency) for 4 weeks before treatment. Headache intensity and frequency and quality of life (SF-36) were measured at baseline and 4 weeks after the intervention.

 In the dry needling group, the intensity and frequency of headache and physical functioning scores of quality of life questionnaire were significantly improved after treatment (p <0.05).

 Due to the positive effects of deep dry needling and passive stretching in females with episodic tension type headache, the use of deep dry needling into trigger points of head and neck musculature is recommended in the presence of episodic tension type headache.

Myofascial pain syndrome (MPS) is one of the most frequent causes of chronic musculoskeletal pain which is characterized by myofascial trigger points (MTrPs). Hence, it is of crucial importance to identify practical approaches for the treatment of these points. Upper trapezius muscle (UT) is highly susceptible to the development of MTrPs that are commonly resulted from overuse and micro-trauma.

The present study aimed to compare the effects of dry needling (DN) and low-level laser therapy (LLLT) regarding the reduction of pain and muscle thickness and improvement of the range of motion (ROM) and pressure pain threshold (PPT) in patients with latent MTrPs (LTrPs) in their UT muscles.

In total, 60 patients with LTrPs in UT muscle participated in this randomized clinical trial. The subjects were randomly divided into two treatment groups of DN and LLLT. The PPT was evaluatedby visual analog scale (VAS) and algometer while ROM and muscle thickness were assessed using goniometer and ultrasonography, respectively. It should be noted that the variables were evaluated before the first and after the sixth sessions. Finally, the collected data were analyzed using independent and paired t-tests.

Based on the results, the VAS and muscle thickness significantly reduced, while the PPT and cervical ROM increased in both groups after treatment (P<0.001). The independent t-test revealed a statistically significant improvement in the DN group in terms of PPT (9.9-14.17, P=0.009) and ROM (37.33-42.67, p=0.005), compared to the LLLTgroup. Nevertheless, no significant difference was found between the two groups regarding VAS and muscle thickness variables (P>0.05).

The DN and LLLT effectively improved symptoms in the UT muscles of patients with LTrPs. However, the DN was more effective in the improvement of ROM and PPT variables

The purpose of the present study was to examine the effectiveness of dry needling as local treatment of upper trapezius trigger points related to chronic neck pain on pain and pain pressure threshold in women with chronic nonspecific neck pain.

Thirty females with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the intervention for three weeks. The outcomes were pain intensity and pain pressure threshold. Every outcome was recorded at baseline and 2 days after the fifth session. 

Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. The results of the independent t-test showed a significant difference in measurements between the dry needling and passive stretch groups (P<0.05). 

Dry needling with passive stretch can be more effective on pain and pain pressure threshold than passive stretching alone in short term in women with nonspecific neck pain.