Journal of Clinical Medicine

Editorial

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2 pages, 195 KiB

Open AccessEditorial

Needling Interventions for the Management of Musculoskeletal Pain Syndromes

by César Fernández-de-las-Peñas

J. Clin. Med. 2021, 10(19), 4603; https://doi.org/10.3390/jcm10194603 - 7 Oct 2021

Viewed by 1727

Abstract

Needling interventions consist of the use of filiform needles for the management of different conditions of the neuromusculoskeletal system [...] Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

Research

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15 pages, 2744 KiB

Open AccessArticle

Effects of Dry Needling of Latent Trigger Points on Viscoelastic and Muscular Contractile Properties: Preliminary Results of a Randomized Within-Participant Clinical Trial

by Albert Pérez-Bellmunt, Oriol Casasayas-Cos, Carlos López-de-Celis, Jacobo Rodríguez-Sanz, Jorge Rodríguez-Jiménez, Sara Ortiz-Miguel, Toni Meca-Rivera and César Fernández-de-las-Peñas

J. Clin. Med. 2021, 10(17), 3848; https://doi.org/10.3390/jcm10173848 - 27 Aug 2021

Cited by 9 | Viewed by 2970

Abstract

This study aimed to evaluate changes in neuromuscular function and pain perception in latent trigger points (TrPs) in the gastrocnemius muscle after a single session of dry needling. A randomized within-participant clinical trial was conducted. Fifty volunteers with latent TrPs in the gastrocnemius [...] Read more.

This study aimed to evaluate changes in neuromuscular function and pain perception in latent trigger points (TrPs) in the gastrocnemius muscle after a single session of dry needling. A randomized within-participant clinical trial was conducted. Fifty volunteers with latent TrPs in the gastrocnemius muscles were explored. Each extremity was randomly assigned to a control or experimental (dry needling) group. Viscoelastic parameters and contractile properties were analyzed by tensiomyography. Ankle dorsiflexion range of motion was assessed with the lunge test. Pressure pain thresholds (PPT) and pain perceived were also analyzed. The results observed that three viscoelastic proprieties (myotonometry) showed significant differences in favor of the experimental extremity in the lateral gastrocnemius: stiffness (p = 0.02), relaxation (p = 0.045), and creep (p = 0.03), but not in the medial gastrocnemius. No changes in tensiomyography outcomes were found. The control extremity showed a higher increase in PPTs (i.e., decrease in pressure pain sensitivity) than the experimental extremity (p = 0.03). No significant effects for range of motion or strength were observed. In general, gender did not influence the effects of dry needling over latent TrPs in the gastrocnemius muscle. In conclusion, a single session of dry needling was able to change some parameters of neuromuscular function, such as muscle tone, relaxation, pressure pain sensitivity, and creep in the lateral (but not medial) gastrocnemius but did not improve strength or range of motion. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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16 pages, 764 KiB

Open AccessArticle

Effects of Physiotherapy vs. Acupuncture in Quality of Life, Pain, Stiffness, Difficulty to Work and Depression of Women with Fibromyalgia: A Randomized Controlled Trial

by Elisa María Garrido-Ardila, María Victoria González-López-Arza, María Jiménez-Palomares, Agustín García-Nogales and Juan Rodríguez-Mansilla

J. Clin. Med. 2021, 10(17), 3765; https://doi.org/10.3390/jcm10173765 - 24 Aug 2021

Cited by 16 | Viewed by 4592

Abstract

Background: Fibromyalgia is a chronic clinical condition characterized by pain and other associated symptoms that have a negative impact on the quality of life of the affected person. The objective of this study was to assess the effectiveness of a core stability training [...] Read more.

Background: Fibromyalgia is a chronic clinical condition characterized by pain and other associated symptoms that have a negative impact on the quality of life of the affected person. The objective of this study was to assess the effectiveness of a core stability training physiotherapy program compared to an acupuncture treatment on quality of life, pain, joint stiffness, difficulty to work and depression of women with fibromyalgia. Methods: This was a single-blind, randomized clinical controlled trial. Women with fibromyalgia were randomized to a core stability physiotherapy program group (n = 45), an acupuncture treatment group (n = 45) and a control group (n = 45) for 13 weeks. Measurements were taken at baseline (week 0), post-intervention (week 6) and at follow-up (week 13). The primary outcome measure was quality of life (Spanish Fibromyalgia Impact Questionnaire). The secondary outcome measures were pain, joint stiffness, difficulty to work and depression (Visual Analogue Scale). Results: In total, 103 participants completed the study. The results, from a descriptive perspective, showed improvements in all the outcome measures in both intervention groups (physiotherapy and acupuncture) at weeks 6 and 13 in relation to week 0 and in comparison to the control group. Only the difficulty to work measure in the acupuncture group showed a slight decrease at week 13. In particular, mean (±SD) Spanish Fibromyalgia Impact Questionnaire score at 6 weeks was 62.89 ± 16.91 for the physiotherapy group, 62.5 ± 18.09 for the acupuncture group and 67.45 ± 17.07 for the control group. However, these improvements were not statistically significant. Conclusion: Core stability-based physiotherapy and acupuncture showed non-significant improvements in quality of life, pain, joint stiffness, difficulty to work and depression in women with fibromyalgia. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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14 pages, 2320 KiB

Open AccessArticle

Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial

by Gracia María Gallego-Sendarrubias, José Luis Arias-Buría, Edurne Úbeda-D’Ocasar, Juan Pablo Hervás-Pérez, Manuel Antonio Rubio-Palomino, César Fernández-de-las-Peñas and Juan Antonio Valera-Calero

J. Clin. Med. 2021, 10(4), 690; https://doi.org/10.3390/jcm10040690 - 10 Feb 2021

Cited by 9 | Viewed by 3372

Abstract

It has been suggested that Percutaneous Electrical Nerve Stimulation (PENS) can increase muscle strength. No previous study has investigated changes in performance in semiprofessional soccer players. This study compares the effects of adding two sessions of PENS to a training program versus the [...] Read more.

It has been suggested that Percutaneous Electrical Nerve Stimulation (PENS) can increase muscle strength. No previous study has investigated changes in performance in semiprofessional soccer players. This study compares the effects of adding two sessions of PENS to a training program versus the single training program over sport performance attributes (e.g., jump height and squat speed) in healthy soccer players. A cluster-randomized controlled trial was conducted on twenty-three semiprofessional soccer players who were randomized into an experimental (PENS + training program) or control (single training program) group. The training program consisted of endurance and strength exercises separated by 15-min recovery period, three times/week. The experimental group received two single sessions of PENS one-week apart. Flight time and vertical jump height during the countermovement jump and squat performance speed were assessed before and after each session, and 30 days after the last session. Male soccer players receiving the PENS intervention before the training session experienced greater increases in the flight time, and therefore, in vertical jump height, after both sessions, but not one month after than those who did not receive the PENS intervention (F = 4.289, p = 0.003, η 2 p: 0.170). Similarly, soccer players receiving the PENS intervention experienced a greater increase in the squat performance speed after the second session, but not after the first session or one month after (F = 7.947, p < 0.001, η 2 p: 0.275). Adding two sessions of ultrasound-guided PENS before a training strength program improves countermovement jump and squat performance speed in soccer players. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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10 pages, 1064 KiB

Open AccessArticle

Short-Term Morphological Changes in Asymptomatic Perimandibular Muscles after Dry Needling Assessed with Rehabilitative Ultrasound Imaging: A Proof-of-Concept Study

by Alice Botticchio, Firas Mourad, Samuel Fernández-Carnero, José Luis Arias-Buría, Alejandro Santodomingo Bueno, Juan Mesa Jiménez and Massimiliano Gobbo

J. Clin. Med. 2021, 10(2), 209; https://doi.org/10.3390/jcm10020209 - 8 Jan 2021

Cited by 3 | Viewed by 3750

Abstract

Facial anatomical structures are not easily accessible to manual palpation. The aim of our study is to objectively assess temporomandibular joint and perimandibular muscles dimensions by means of sonographic measurements before and after dry needling (DN) in asymptomatic subjects. Seventeen subjects participated in [...] Read more.

Facial anatomical structures are not easily accessible to manual palpation. The aim of our study is to objectively assess temporomandibular joint and perimandibular muscles dimensions by means of sonographic measurements before and after dry needling (DN) in asymptomatic subjects. Seventeen subjects participated in this before-after study with a within-subject control. After random allocation, one side of the face was used for the intervention and the contralateral as control. DN was performed on the temporal, masseter, and sternocleidomastoid muscles. Each subject was examined bilaterally before, immediately after, and one month after the intervention through Rehabilitative Ultrasound Imaging (RUSI) of the temporomandibular articular disc and the three target muscles. Maximum mouth opening was measured at baseline and at one month. After a single DN session, articular disc thickness significantly decreased; muscles’ thicknesses (except for temporal thickness) significantly decreased immediately and at follow-up on the treated side; no significant changes resulted for the control side. The maximum mouth opening increased from 4.77 mm to 4.86 mm. RUSI may be useful to assess the dimensions and thickness of the temporomandibular disc and muscles before and after an intervention. DN influences muscle morphology, and it has a positive influence on mouth opening in the short term. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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18 pages, 5477 KiB

Open AccessArticle

Changes in Gene Expression Associated with Collagen Regeneration and Remodeling of Extracellular Matrix after Percutaneous Electrolysis on Collagenase-Induced Achilles Tendinopathy in an Experimental Animal Model: A Pilot Study

by José Luis Sánchez-Sánchez, Laura Calderón-Díez, Javier Herrero-Turrión, Roberto Méndez-Sánchez, José L. Arias-Buría and César Fernández-de-las-Peñas

J. Clin. Med. 2020, 9(10), 3316; https://doi.org/10.3390/jcm9103316 - 15 Oct 2020

Cited by 21 | Viewed by 3989

Abstract

Percutaneous electrolysis is an emerging intervention proposed for the management of tendinopathies. Tendon pathology is characterized by a significant cell response to injury and gene expression. No study investigating changes in expression of those genes associated with collagen regeneration and remodeling of extracellular [...] Read more.

Percutaneous electrolysis is an emerging intervention proposed for the management of tendinopathies. Tendon pathology is characterized by a significant cell response to injury and gene expression. No study investigating changes in expression of those genes associated with collagen regeneration and remodeling of extracellular matrix has been conducted. The aim of this pilot study was to investigate gene expression changes after the application of percutaneous electrolysis on experimentally induced Achilles tendinopathy with collagenase injection in an animal model. Fifteen Sprague Dawley male rats were randomly divided into three different groups (no treatment vs. percutaneous electrolysis vs. needling). Achilles tendinopathy was experimentally induced with a single bolus of collagenase injection. Interventions consisted of 3 sessions (one per week) of percutaneous electrolysis or just needling. The rats were euthanized, and molecular expression of genes involved in tendon repair and remodeling, e.g., Cox2, Mmp2, Mmp9, Col1a1, Col3a1, Vegf and Scx, was examined at 28 days after injury. Histological tissue changes were determined with hematoxylin–eosin and safranin O analyses. The images of hematoxylin–eosin and Safranin O tissue images revealed that collagenase injection induced histological changes compatible with a tendinopathy. No further histological changes were observed after the application of percutaneous electrolysis or needling. A significant increase in molecular expression of Cox2, Mmp9 and Vegf genes was observed in Achilles tendons treated with percutaneous electrolysis to a greater extent than after just needling. The expression of Mmp2, Col1a1, Col3a1, or Scx genes also increased, but did not reach statistical significance. This animal study demonstrated that percutaneous electrolysis applied on an experimentally induced Achilles tendinopathy model could increase the expression of some genes associated with collagen regeneration and remodeling of extracellular matrix. The observed gene overexpression was higher with percutaneous electrolysis than with just needling. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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11 pages, 3103 KiB

Open AccessArticle

Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial

by Manuel Rodríguez-Huguet, Jorge Góngora-Rodríguez, Rafael Lomas-Vega, Rocío Martín-Valero, Ángeles Díaz-Fernández, Esteban Obrero-Gaitán, Alfonso Javier Ibáñez-Vera and Daniel Rodríguez-Almagro

J. Clin. Med. 2020, 9(7), 2068; https://doi.org/10.3390/jcm9072068 - 1 Jul 2020

Cited by 29 | Viewed by 5598

Abstract

Few studies have considered the effects of percutaneous electrolysis (PE) in the treatment of lateral epicondylalgia (LE). For this reason, the objective of this study was to compare the effects of PE with an evidence-based approach—trigger point dry needling (TDN)—in patients with LE. [...] Read more.

Few studies have considered the effects of percutaneous electrolysis (PE) in the treatment of lateral epicondylalgia (LE). For this reason, the objective of this study was to compare the effects of PE with an evidence-based approach—trigger point dry needling (TDN)—in patients with LE. A randomized controlled trial was conducted in which 32 participants with LE were randomly assigned to two treatment groups, the PE group (n = 16) and the TDN group (n = 16). Both groups received four therapy sessions and an eccentric exercise program to be performed daily. The numerical pain rating scale (NPRS), pressure pain thresholds (PPT), quality of life, and range of motion were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. Significant between-group mean differences were found after treatment for NPRS (p < 0.001) and flexion movement (p = 0.006). At one-month follow-up, significant mean differences between groups were found for NPRS (p < 0.001), PPT (p = 0.021), and flexion (p = 0.036). At three-months follow-up, significant mean differences between groups were found for NPRS (p < 0.001), PPT (p = 0.004), and flexion (p = 0.003). This study provides evidence that PE could be more effective than TDN for short- and medium-term improvement of pain and PPTs in LE when added to an eccentric exercise program. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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10 pages, 2255 KiB

Open AccessArticle

Enhancing Trigger Point Dry Needling Safety by Ultrasound Skin-to-Rib Measurement: An inter-Rater Reliability Study

by Anna Folli, Alessandro Schneebeli, Simone Ballerini, Francesca Mena, Emiliano Soldini, César Fernández-de-las-Peñas and Marco Barbero

J. Clin. Med. 2020, 9(6), 1958; https://doi.org/10.3390/jcm9061958 - 23 Jun 2020

Cited by 7 | Viewed by 3739

Abstract

Dry needling (DN) is a minimally invasive treatment technique widely used by physical therapists to treat myofascial trigger points (MTrP). Even if its safety has been commonly declared and the majority of adverse events are considered mild, serious adverse events cannot be excluded [...] Read more.

Dry needling (DN) is a minimally invasive treatment technique widely used by physical therapists to treat myofascial trigger points (MTrP). Even if its safety has been commonly declared and the majority of adverse events are considered mild, serious adverse events cannot be excluded and DN treatments of several trunk muscles can potentially result in pneumothorax. Ultrasound imaging (US) skin-to-rib measurement could ensure the safety of this treatment procedure. Therefore, the aim of this study was to determine the inter-rater reliability of depth measurement of different trunk muscles (i.e., rhomboid, lower trapezius, iliocostalis, and pectoralis major) between an expert and two novice physiotherapists. Skin-to-rib distance of 26 asymptomatic and normal weights subjects was consecutively, independently, and randomly measured for each muscle by the three examiners (1 expert and 2 novice physical therapists) with a handheld US wireless probe. Intraclass correlation coefficient (ICC_3,k) and standard error of measurement (SEM) were used to assess inter-rater reliability. Inter-rater reliability of skin-to-rib measurements between the three examiners was good to excellent or excellent for every muscle, with an ICC_3,k ranging from 0.92 and 0.98 (95% CI 0.86–0.99). The SEM never exceeded 10% of the skin-to-rib distance. In conclusion, skin-to-rib US measurements of the trunk muscles can be reliably performed by novice physical therapists using a handheld US device. These measures could be used as an innovative and reliable technique to improve the safety of some potential dangerous DN treatments. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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13 pages, 1709 KiB

Open AccessArticle

Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial

by Manuel Rodríguez-Huguet, Jorge Góngora-Rodríguez, Pablo Rodríguez-Huguet, Alfonso Javier Ibañez-Vera, Daniel Rodríguez-Almagro, Rocío Martín-Valero, Ángeles Díaz-Fernández and Rafael Lomas-Vega

J. Clin. Med. 2020, 9(6), 1837; https://doi.org/10.3390/jcm9061837 - 12 Jun 2020

Cited by 23 | Viewed by 6746

Abstract

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder [...] Read more.

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n = 18) or a TDN group (n = 18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p = 0.002). The improvement achieved in the PE group was greater in the NPRS (p < 0.001), proximal PPT, middle PPT, distal PPT (all p < 0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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16 pages, 1621 KiB

Open AccessArticle

Short-Term Effects of PENS versus Dry Needling in Subjects with Unilateral Mechanical Neck Pain and Active Myofascial Trigger Points in Levator Scapulae Muscle: A Randomized Controlled Trial

by Santiago Garcia-de-Miguel, Daniel Pecos-Martin, Tamara Larroca-Sanz, Beatriz Sanz-de-Vicente, Laura Garcia-Montes, Ruben Fernandez-Matias and Tomas Gallego-Izquierdo

J. Clin. Med. 2020, 9(6), 1665; https://doi.org/10.3390/jcm9061665 - 1 Jun 2020

Cited by 17 | Viewed by 5441

Abstract

Procedures such as dry needling (DN) or percutaneous electrical nerve stimulation (PENS) are commonly proposed for the treatment of myofascial trigger points (MTrP). The aim of the present study is to investigate if PENS is more effective than DN in the short term [...] Read more.

Procedures such as dry needling (DN) or percutaneous electrical nerve stimulation (PENS) are commonly proposed for the treatment of myofascial trigger points (MTrP). The aim of the present study is to investigate if PENS is more effective than DN in the short term in subjects with mechanical neck pain. This was an evaluator-blinded randomized controlled trial. Subjects were recruited through announcements and randomly allocated into DN or PENS groups. Pain intensity, disability, pressure pain threshold (PPT), range of motion (ROM), and side-bending strength were measured. The analyses included mixed-model analyses of variance and pairwise comparisons with Bonferroni correction. The final sample was composed of 44 subjects (22 per group). Both groups showed improvements in pain intensity (η_p² = 0.62; p < 0.01), disability (η_p² = 0.74; p < 0.01), PPT (η_p² = 0.79; p < 0.01), and strength (η_p² = 0.37; p < 0.01). The PENS group showed greater improvements in disability (mean difference, 3.27; 95% CI, 0.27–6.27) and PPT (mean difference, 0.88–1.35; p < 0.01). Mixed results were obtained for ROM. PENS seems to produce greater improvements in PPT and disability in the short term. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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Review

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22 pages, 1476 KiB

Open AccessReview

Needling Interventions for Sciatica: Choosing Methods Based on Neuropathic Pain Mechanisms—A Scoping Review

by Thomas Perreault, César Fernández-de-las-Peñas, Mike Cummings and Barry C. Gendron

J. Clin. Med. 2021, 10(10), 2189; https://doi.org/10.3390/jcm10102189 - 19 May 2021

Cited by 9 | Viewed by 9749

Abstract

Sciatica is a condition often accompanied by neuropathic pain (NP). Acupuncture and dry needling are common treatments for pain, and the current literature supports acupuncture as an effective treatment for sciatica. However, it is unknown if the mechanisms of NP are considered in [...] Read more.

Sciatica is a condition often accompanied by neuropathic pain (NP). Acupuncture and dry needling are common treatments for pain, and the current literature supports acupuncture as an effective treatment for sciatica. However, it is unknown if the mechanisms of NP are considered in the delivery of needling interventions for sciatica. Our objective was to assess the efficacy and the effectiveness of needling therapies, to identify common needling practices and to investigate if NP mechanisms are considered in the treatment of sciatica. A scoping review of the literature on needling interventions for sciatica and a review of the literature on mechanisms related to NP and needling interventions were performed. Electronic literature searches were conducted on PubMed, MEDLINE, CINAHL and Cochrane Database of Systematic Reviews from inception to August, 2020 to identify relevant papers. Reference lists of included papers were also manually screened and a related-articles search through PubMed was performed on all included articles. Mapping of the results included description of included studies, summary of results, and identification of gaps in the existing literature. Ten articles were included. All studies used acupuncture for the treatment of sciatica, no studies on dry needling were identified. Current evidence supports the efficacy and effectiveness of acupuncture for sciatica, however, no studies considered underlying NP mechanisms in the acupuncture approach for sciatica and the rationale for using acupuncture was inconsistent among trials. This review reveals that neuropathic pain mechanisms are not routinely considered in needling approaches for patients with sciatica. Studies showed acupuncture to be an effective treatment for sciatic pain, however, further research is warranted to explore if needling interventions for sciatica and NP would be more effective if NP mechanisms are considered. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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35 pages, 11877 KiB

Open AccessReview

Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck Pain Symptoms: An Updated Systematic Review and Meta-Analysis

by Marcos J. Navarro-Santana, Jorge Sanchez-Infante, César Fernández-de-las-Peñas, Joshua A. Cleland, Patricia Martín-Casas and Gustavo Plaza-Manzano

J. Clin. Med. 2020, 9(10), 3300; https://doi.org/10.3390/jcm9103300 - 14 Oct 2020

Cited by 52 | Viewed by 15844

Abstract

Our aim was to evaluate the effect of dry needling alone as compared to sham needling, no intervention, or other physical interventions applied over trigger points (TrPs) related with neck pain symptoms. Randomized controlled trials including one group receiving dry needling for TrPs [...] Read more.

Our aim was to evaluate the effect of dry needling alone as compared to sham needling, no intervention, or other physical interventions applied over trigger points (TrPs) related with neck pain symptoms. Randomized controlled trials including one group receiving dry needling for TrPs associated with neck pain were identified in electronic databases. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The Cochrane risk of bias tool and the Physiotherapy Evidence Database (PEDro) score were used to assessed risk of bias (RoB) and methodological quality of the trials. The quality of evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated (3) Twenty-eight trials were finally included. Dry needling reduced pain immediately after (MD −1.53, 95% CI −2.29 to −0.76) and at short-term (MD −2.31, 95% CI −3.64 to −0.99) when compared with sham/placebo/waiting list/other form of dry needling and, also, at short-term (MD −0.51, 95% CI −0.95 to −0.06) compared with manual therapy. No differences in comparison with other physical therapy interventions were observed. An effect on pain-related disability at the short-term was found when comparing dry needing with sham/placebo/waiting list/other form of dry needling (SMD −0.87, 95% CI −1.60 to −0.14) but not with manual therapy or other interventions. Dry needling was effective for improving pressure pain thresholds immediately after the intervention (MD 55.48 kPa, 95% CI 27.03 to 83.93). No effect on cervical range of motion of dry needling against either comparative group was found. No between-treatment effect was observed in any outcome at mid-term. Low to moderate evidence suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms associated with TrPs at the short-term. No significant effects on pressure pain sensitivity or cervical range of motion were observed. Full article

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32 pages, 1897 KiB

Open AccessReview

Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

by Youssef Rahou-El-Bachiri, Marcos J. Navarro-Santana, Guido F Gómez-Chiguano, Joshua A Cleland, Ibai López-de-Uralde-Villanueva, César Fernández-de-las-Peñas, Ricardo Ortega-Santiago and Gustavo Plaza-Manzano

J. Clin. Med. 2020, 9(7), 2044; https://doi.org/10.3390/jcm9072044 - 29 Jun 2020

Cited by 31 | Viewed by 10915

Abstract

Background: To evaluate the effect of trigger point dry needling alone or as an adjunct with other interventions on pain and related disability in people with knee pain. Methods: Several electronic databases were searched for randomized controlled trials where at least one group [...] Read more.

Background: To evaluate the effect of trigger point dry needling alone or as an adjunct with other interventions on pain and related disability in people with knee pain. Methods: Several electronic databases were searched for randomized controlled trials where at least one group received dry needling for knee pain. Studies had to include human subjects and collect outcomes on pain and pain-related disability in musculoskeletal knee pain. Data were extracted by two reviewers. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the quality of evidence by using the GRADE approach. Standardized mean differences (SMD) were calculated. Results: Ten studies (six patellofemoral pain, two knee osteoarthritis, two post-surgery knee pain) were included. The meta-analysis found moderate effect sizes of dry needling for reducing pain (SMD −0.53, 95% CI −0.87 to −0.19) and improving related disability (SMD −0.58, 95% CI −1.08 to −0.09) as compared to a comparison group at short-term. The main effect was observed for patellofemoral pain (SMD −0.64, 95% CI −1.17 to −0.11). No significant effects were observed at mid- or long-term follow-ups. The risk of bias was generally low, but the heterogenicity and the imprecision of the results downgraded the level of evidence. Conclusion: Low to moderate evidence suggests a positive effect of trigger point dry needling on pain and related disability in patellofemoral pain, but not knee osteoarthritis or post-surgery knee pain, at short-term. More high-quality trials investigating long-term effects are clearly needed. Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

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