Analysis and comparison of pain pressure threshold and active cervical range of motion after superficial and deep dry needling techniques of the upper trapezius muscle

Abstract

Objectives:

To evaluate the changes in pain pressure threshold (PPT) and active cervical range of motion (ACROM) after the application of superficial dry needling (DN) or deep DN in myofascial trigger point (MTrP) 1 of the upper trapezius versus a simulated DN technique in the gastrocnemius muscle (control group).

Design:

Double-blind, randomized controlled trial with 7-day follow-up.

Participants:

Asymptomatic volunteers (n = 180; 76 men, 104 women) with a latent MTrP 1 in the upper trapezius were randomly divided into three groups: G1, receiving superficial DN in the upper trapezius; G2, receiving deep DN in the upper trapezius; and G3, control group, receiving simulated DN technique in the gastrocnemius muscle.

Main outcome measures:

While sitting in a chair, each subject underwent measurements of PPT and ACROM (ipsilateral and contralateral side flexion and rotation, flexion and extension) preintervention, (immediately) postintervention, and at 24 h, 72 h and 7 days.

Results:

Superficial and deep DN produced an increase in PPT at 7 days with respect to preintervention levels. Furthermore, superficial and deep DN produced a decrease in cervical flexion at 24 h and an increase in ipsilateral rotation until 72 h, increasing to 7 days in the case of deep DN. On the contrary, superficial DN produced an increase in ipsilateral and contralateral side flexion after intervention, unlike deep DN that produced a decrease at 24 h. Furthermore, superficial DN produced an increase in contralateral rotation at 24 h and deep DN decreased extension at 72 h.

Conclusion:

A single intervention of superficial or deep DN did not produce statistically significant changes in PPT or goniometry measurements.

Trial registration number: NCT03719352 (ClinicalTrials.gov)

Keywords

myofascial trigger point needles pain pressure threshold range of motion rehabilitation

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References

Lucas

Polus

Rich

Latent myofascial trigger points: their effects on muscle activation and movement efficiency. J Bodyw Mov Ther 2004; 8: 160–166.

Simons

Travell

JG.

Myofascial origins of low back pain: 1—principles of diagnosis and treatment. Postgrad Med 1983; 73: 66, 68–70, 73 passim.

Kannan

Management of myofascial pain of upper trapezius: a three group comparison study. Glob J Health Sci 2012; 4: 46–52.

Gerwin

RD.

Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep 2001; 5(5): 412–420.

Simons

Travell

Simons

LS.

Travell y Simons dolor y disfunción miofascial: el manual de los puntos gatillo. Madrid: Médica Panamericana, 2002.

Ruiz Illán

Sánchez Ayuso

Cubero Climent

, et al. Tratamiento del punto gatillo miofascial 1del músculo trapecio superior con punción seca superficial. FIsioterapia y calidad de vida 2010; 13: 5–16.

Doraisamy

Anshul . Effect of latent myofascial trigger points on strength measurements of the upper trapezius: a case-controlled trial. Physiother Can 2011; 63(4): 405–409.

Del Moral

. Dry needling treatments for myofascial trigger points. J Musculoskelet Pain 2010; 18: 411–416.

Domingo

Mayoral

Monterde

, et al. Neuromuscular damage and repair after dry needling in mice. Evid Based Complement Alternat Med 2013; 2013: 260806.

10.

Hong

CZ.

Treatment of myofascial pain syndrome. Curr Pain Headache Rep 2006; 10: 345–349.

11.

Baldry

Superficial versus deep dry needling. Acupunct Med J Br Med Acupunct Soc 2002; 20: 78–81.

12.

Hong

Torigoe

Electrophysiological characteristics of localized twitch responses in responsive taut bands of rabbit skeletal muscle fibers. J Musculoskelet Pain 1994; 2: 17–43.

13.

Lewit

The needle effect in the relief of myofascial pain. Pain 1979; 6(1): 83–90.

14.

Hong

CZ.

New trends in myofascial pain syndrome. Zhonghua Yi Xue Za Zhi Chin Med J Free China Ed 2002; 65: 501–512.

15.

Hong

CZ.

Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994; 73(4): 256–263.

16.

Bennett

Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol 2007; 21: 427–445.

17.

Travell

Rinzler

SH.

The myofascial genesis of pain. Postgrad Med 1952; 11(5): 425–434.

18.

Hong

CZ.

Considerations and recommendations regarding myofascial trigger point injection. J Musculoskelet Pain 1994; 2: 29–59.

19.

Gerwin

Dommerholt

Shah

JP.

An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep 2004; 8(6): 468–475.

20.

Dommerholt

Dry needling in orthopedic physical therapy practice. Orthop Phys Ther Pract 2004; 16: 15–20.

21.

Le Bars

Dickenson

Besson

. Diffuse noxious inhibitory controls (DNIC): II—lack of effect on non-convergent neurones, supraspinal involvement and theoretical implications. Pain 1979; 6(3): 305–327.

22.

Chen

Kuan

, et al. Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. Arch Phys Med Rehabil 1998; 79(7): 790–794.

23.

Hubbard

DR.

Chronic and recurrent muscle pain. J Musculoskelet Pain 1996; 4: 123–144.

24.

Olausson

Lamarre

Backlund

, et al. Unmyelinated tactile afferents signal touch and project to insular cortex. Nat Neurosci 2002; 5(9): 900–904.

25.

Mohr

Binkofski

Erdmann

, et al. The anterior cingulate cortex contains distinct areas dissociating external from self-administered painful stimulation: a parametric fMRI study. Pain 2005; 114(3): 347–357.

26.

Lund

Lundeberg

Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?

Acupunct Med 2006; 24: 13–15.

27.

Zwarenstein

Treweek

Gagnier

, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008; 337: a2390.

28.

Fischer

Application of pressure algometry in manual medicine. J Man Med 1990; 5: 145–150.

29.

Fischer

AA.

Documentation of myofascial trigger points. Arch Phys Med Rehabil 1988; 69: 286–291.

30.

White

Lewith

Hopwood

, et al. The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial. Pain 2003; 106: 401–409.

31.

Chesterton

Sim

Wright

, et al. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 2007; 23(9): 760–766.

32.

Vanderweeen

Oostendorp

Vaes

, et al. Pressure algometry in manual therapy. Man Ther 1996; 1(5): 258–265.

33.

Kapandji

Saillant

Torres Lacomba

Fisiología articular: dibujos comentados de mecánica humana. Madrid: Editorial Médica Panamericana, 2015.

34.

Taboadela

CH.

Goniometría: una herramienta para la evaluación de las incapacidades laborales. 1st ed. Buenos Aires: Asociart ART, 2007.

35.

Enderlein

Fleiss

JL.

The design and analysis of clinical experiments. New York; Chichester; Brisbane, QLD, Australia; Toronto, ON, Canada; Singapore: Wiley, 1986; (Biom J 1988; 30: 304–304).

36.

Cagnie

Barbe

De Ridder

, et al. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. J Manipulative Physiol Ther 2012; 35(9): 685–691.

37.

Sandberg

Larsson

Lindberg

L-G

, et al. Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia. Eur J Pain 2005; 9(5): 497–510.

38.

Mejuto-Vázquez

Salom-Moreno

Ortega-Santiago

, et al. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44(4): 252–260.

39.

Shah

Phillips

Danoff

, et al. A novel microanalytical technique for assaying soft tissue demonstrates significant quantitative biochemical differences in 3 clinically distinct groups: normal, latent, and active – 11 disclosure: none. Arch Phys Med Rehabil 2003; 84: E4.

40.

Shah

Phillips

Danoff

, et al. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol Bethesda Md 2005; 99: 1977–1984.

41.

Arendt-Nielsen

Graven-Nielsen

Translational musculoskeletal pain research. Best Pract Res Clin Rheumatol 2011; 25(2): 209–226.

42.

Choi

J-H

Park

C-H

, et al. Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients: a randomised trial. Acupunct Med 2007; 25(4): 130–136.

43.

Martín-Pintado Zugasti

Rodríguez-Fernández

ÁL

García-Muro

, et al. Effects of spray and stretch on postneedling soreness and sensitivity after dry needling of a latent myofascial trigger point. Arch Phys Med Rehabil 2014; 95(10): 1925–1932.

44.

Torres

Mayoral

Díez

Pain and tenderness after deep dry needling. J Musculoske Pain 2004; 12: 40.

45.

Martín-Pintado-Zugasti

Pecos-Martin

Rodríguez-Fernández

ÁL

, et al. Ischemic compression after dry needling of a latent myofascial trigger point reduces postneedling soreness intensity and duration. PM R 2015; 7(10): 1026–1034.

46.

Choi

J-H

Park

C-H

, et al. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. J Altern Complement Med 2007; 13(6): 617–624.

47.

Martín-Pintado-Zugasti

López-López

González Gutiérrez

, et al. The role of psychological factors in the perception of postneedling soreness and the influence of postneedling intervention. PM R 2017; 9(4): 348–355.

48.

Llamas-Ramos

Pecos-Martín

Gallego-Izquierdo

, et al. Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther 2014; 44(11): 852–861.

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