Efficacy of Deep Dry Needling versus Percutaneous Electrolysis in Ultrasound-Guided Treatment of Active Myofascial Trigger Points of the Levator Scapulae in Short-Term: A Randomized Controlled Trial.

Deep dry needling (DDN) and percutaneous electrolysis (PE) provide the benefit of the mechanical effect of the needle, and PE adds the potential advantages of the galvanic current it incorporates in myofascial trigger points (MTrPs) therapy. The aim of this study was to compare the short-term efficacy between PE and DDN on active MTrPs of the levator scapulae by considering pain intensity. A simple-blind randomized controlled trial was carried out, recruiting patients suffering from non-specific neck pain lasting more than 3 months and with active MTrPs in the levator scapulae muscle (n = 52). Patients were divided into intervention (PE; n = 26) and control (DDN; n = 26) groups and received one treatment session on the active MTrPs of the levator scapulae. Patients were assessed for pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), neck disability and post-needling soreness, immediately after treatment, at 72 h and at 14 days. In addition, pain during treatment was recorded after the procedure. There were no significant differences for pain intensity, post-needling soreness and PPT. We found significant differences in CROM, immediately after treatment (p = 0.043), and at 72 h (p = 0.045), in favor of the PE group. Significant differences were found for neck disability (p < 0.047), immediately post-treatment, in favor of the DDN group. Moreover, there were significant differences for pain during the intervention (p < 0.002), in favor of the DDN group (4.54 ± 2.21) versus the PE group (6.54 ± 2.27). PE and DDN appear to have similar short-term effects. PE proved to be a more painful treatment than DDN. Clinical trial registry: NCT04157426.

Immediate Effects of Whole-Body versus Local Dynamic Electrostimulation of the Abdominal Muscles in Healthy People Assessed by Ultrasound: A Randomized Controlled Trial.

Dynamic electrostimulation consists of the application of local or global electrostimulation together with physical exercise. This study aimed to investigate the immediate effects of a dynamic electrostimulation session on the thickness of the abdominal musculature, inter-rectus distance, heart rate, blood pressure, and body temperature, and to identify possible differences in its form of application. A total of 120 healthy participants were divided into three groups: the whole-body electrostimulation group, the local electrostimulation group, and the control group without electrical stimulation. All groups performed a single session with the same dynamic exercise protocol. Muscle thickness and inter-rectus distance were evaluated ultrasonographically using the Rehabilitative Ultrasound Imaging technique both at rest and in muscle contraction (the active straight leg raise test) to find the post-intervention differences. The results showed significant differences in immediate post-intervention heart rate, with a smaller increase in the local electrostimulation group compared to the control and whole-body electrostimulation groups. No significant differences were identified between the groups after the interventions in the rest of the variables analyzed. Therefore, a local application, with the same effects as a global application on the abdominal musculature, has fewer contraindications, which makes its use more advisable, especially in populations with cardiorespiratory disorders, for which more research is needed.

Dry needling of the flexor digitorum brevis muscle reduces postural control in standing: A pre-post stabilometric study.

There are studies that show the better balance after dry needling in lumbar pain. However, the postural control effects after foot dry needling are unknown. Our objective was to check if dry needling reduces postural control. Eighteen subjects with flexor digitorum brevis (FDB) muscle Myofascial trigger point were evaluated pre- and post-deep dry needling. We measured stabilometric variables in a pre-post study. We have found significant differences in three stabilometric variables: surface with eyes closed (29.36-53.21 mm2 ) (p = 0.000), medium speed of the laterolateral displacement with eyes closed (1.42-1.64 mm/s) (p = 0.004), and medium speed of the anteroposterior displacement with eyes closed (1.30-1.53 mm/s) (p = 0.025). Dry needling therapy application in FDB muscle reduces standing postural control with eyes closed.

Dry needling in active or latent trigger point in patients with neck pain: a randomized clinical trial.

The purpose was to determine the efficacy of deep dry needling (DDN) applied on an active myofascial trigger point (MTrP) versus a latent-MTrP versus a non-MTrP location, on pain reduction and cervical disability, in patients with chronic neck pain. A randomized, double-blind clinical trial design was used. A sample of 65 patients was divided into non-MTrP-DDN, active-MTrP-DDN and latent-MTrP-DDN groups. The visual analog scale (VAS), reproduction of the patient's pain, number of local twitch responses, pressure pain threshold (PPT) and Neck Disability Index (NDI) were assessed before, during and after the intervention and up to 1 month post-intervention. The active-MTrP-DDN-group reduced pain intensity more than non-MTrP-DDN-group after a week and a month (P < 0.01), as well as showing the greatest improvement in tibialis muscle PPT. The treatment of both Active and Latent MTrPs was associated with the reproduction of the patient's pain. The application of DDN on an active-MTrP in the upper trapezius muscle shows greater improvements in pain intensity after 1 week and 1 month post-intervention, compared to DDN applied in latent-MTrPs or outside of MTrPs in patients with neck pain.

Current advances and novel research on minimal invasive techniques for musculoskeletal disorders.

The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.

Electromyographic Assessment of the Efficacy of Deep Dry Needling versus the Ischemic Compression Technique in Gastrocnemius of Medium-Distance Triathletes.

Several studies have shown that gastrocnemius is frequently injured in triathletes. The causes of these injuries are similar to those that cause the appearance of the myofascial pain syndrome (MPS). The ischemic compression technique (ICT) and deep dry needling (DDN) are considered two of the main MPS treatment methods in latent myofascial trigger points (MTrPs). In this study superficial electromyographic (EMG) activity in lateral and medial gastrocnemius of triathletes with latent MTrPs was measured before and immediately after either DDN or ICT treatment. Taking into account superficial EMG activity of lateral and medial gastrocnemius, the immediate effectiveness in latent MTrPs of both DDN and ICT was compared. A total of 34 triathletes was randomly divided in two groups. The first and second groups (n = 17 in each group) underwent only one session of DDN and ICT, respectively. EMG measurement of gastrocnemius was assessed before and immediately after treatment. Statistically significant differences (p = 0.037) were shown for a reduction of superficial EMG measurements differences (%) of the experimental group (DDN) with respect to the intervention group (ICT) at a speed of 1 m/s immediately after both interventions, although not at speeds of 1.5 m/s or 2.5 m/s. A statistically significant linear regression prediction model was shown for EMG outcome measurement differences at V1 (speed of 1 m/s) which was only predicted for the treatment group (R2 = 0.129; ß = 8.054; F = 4.734; p = 0.037) showing a reduction of this difference under DDN treatment. DDN administration requires experience and excellent anatomical knowledge. According to our findings immediately after treatment of latent MTrPs, DDN could be advisable for triathletes who train at a speed lower than 1 m/s, while ICT could be a more advisable technique than DDN for training or competitions at speeds greater than 1.5 m/s.

Effectiveness of Dry Needling with Percutaneous Electrical Nerve Stimulation of High Frequency Versus Low Frequency in Patients with Myofascial Neck Pain.

BACKGROUND: Percutaneous nerve electrical stimulation is a novel treatment modality for the management of acute and chronic myofascial pain syndrome. OBJECTIVES: To compare the effectiveness of dry needling combined with percutaneous electrical nerve stimulation  of low frequency versus high frequency, in patients with chronic myofascial neck pain. STUDY DESIGN: Randomized, single-blind trial. SETTING: Laboratory in an academic institution. METHODS: A total of 40 volunteer patients with chronic neck pain were randomly divided into 2 groups. All patients initially received deep dry needling in a myofascial trigger point of the upper trapezius. Then, one group received high frequency percutaneous electrical nerve stimulation while the other group received low frequency percutaneous electrical nerve stimulation. The primary outcomes were the visual analog scale  and the pressure pain threshold, while Neck Disability Index and Kinesiophobia were secondary outcomes. RESULTS: We detected significant improvements in the visual analog scale score in both groups without differences between them. We did not observe significantly different statistics in either group during the evaluation of data on pressure pain threshold. LIMITATIONS: Limitations of the study include (1) heterogeneity of the sample in relation to gender, with more women, (2) the small sample size (40 patients), (3) the absence of placebo group, and (4) the fact that the treatment is focused exclusively on the upper trapezium myofascial trigger point. . CONCLUSIONS: Low and high frequency percutaneous electrical nerve stimulation combined with deep dry needling showed similar effects, since no differences between groups were observed on any of the outcome measures. High and low frequency of percutaneous electrical nerve stimulation generates changes on pain intensity and disability, but not on pressure pain threshold or fear of movement.

Biomarkers and Nutrients in Musculoskeletal Disorders.

Worldwide, the burden of musculoskeletal disorders is increasing with great variations between-countries, which makes it difficult for policymakers to provide resources and adequate interventions in order to provide for their appropriate management [...].

Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study.

BACKGROUND: The effects of the dry needling technique and pain reduction have been demonstrated in numerous quality studies. However, the mechanical effects of dry needling are largely unknown. METHODS: A total of 18 subjects with flexor digitorum brevis muscle myofascial trigger point were evaluated pre- and post-deep dry needling. We measured static footprint variables in a pre-post study. MAIN FINDINGS: We found differences in rearfoot maximum pressure (119.22-111.63 KPa; p = 0.025), midfoot maximum pressure (13.68-17.26 KPa; p = 0.077), midfoot medium pressure (4.75-6.24 KPa; p = 0.035) and forefoot surface (86.58-81.75 cm2; p = 0.020). All variables with significant differences decrease, with the exception of forefoot surface which showed an increase. CONCLUSIONS: After flexor digitorum brevis muscle dry needling, midfoot plantar pressures (maximum and medium) and forefoot surface were increased, and rearfoot maximum pressure was decreased.

Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: a randomized clinical trial.

OBJECTIVES: The aim of this study was to observe the medium-term effects on pain, disability, and psychological factors of a combination of myofascial trigger point (MTrP) dry needling (DN) with pain neuroscience education (PNE) versus DN alone versus control care as usual (CUC) in patients with chronic neck pain. METHODS: A total of 60 patients were randomly selected in a Spanish National Health Service Public Hospital and divided into three groups: 6 sessions of DN with 3 sessions of PNE (TrPDN + PNE group, n = 21), 6 sessions of DN alone (TrPDN group, n = 20), or 10 sessions of usual care (CUC group, n = 19). The primary outcome was neck pain intensity, while neck disability, medication intake, and psychological factors were secondary outcomes. These variables were measured at baseline, post-treatment, and at 1 month and 3 months after treatment. RESULTS: TrPDN + PNE and DN alone were associated with greater reductions in pain intensity and disability compared to CUC (p < 0.01). TrPDN + PNE resulted in greater improvements in kinesiophobia, pain anxiety, and pain-related beliefs than DN alone and CUC (p < 0.01). No differences between groups were observed in medication intake, quality of life, catastrophizing, depression, or fear of pain (p > 0.05). DISCUSSION: Provision of PNE and DN in the management of chronic neck pain in a Spanish National Health Service Public Hospital was associated with greater improvements in psychological factors than DN therapy only. CONCLUSION: DN alone was more effective at reducing chronic non-specific neck pain and disability than CUC at 3-month follow-up. However, the inclusion of PNE combined with DN resulted in greater improvements in kinesiophobia, pain anxiety, and pain-related beliefs. TRIAL REGISTRATION NUMBER: NCT03095365 (ClinicalTrials.gov).

Hip-Joint Posture and Movement Alterations Are Associated With High Interference of Pain in the Life of Patients With Greater Trochanteric Pain Syndrome.

OBJECTIVE: Greater trochanteric pain syndrome (GTPS) is a common condition that can cause lateral hip pain. The single-leg-squat test (SLST) may be used by physicians in primary care environments to evaluate patients' dynamic stability. The aim of this study was to evaluate the dynamic stability and strength of lateral abduction hip movements in primary care patients with GTPS in relation to their perceived pain interference in life. METHODS: A descriptive observational study was carried out in a primary health care center. Fifty-four participants with GTPS were included in this study and divided into lower- and higher-interference groups (n = 30 and 19, respectively) according to the Graded Chronic Pain Scale. Participants were evaluated for their lateral abduction hip strength and the SLST. RESULTS: The SLST showed a statistically significant difference between groups with respect to hip-joint posture and movement level (P = .043) but not for other SLST domains or lateral abduction hip strength (P > .05). CONCLUSION: Patients with GTPS with more pain interference in their lives had poorer dynamic stability with respect to hip-joint posture and movements based on the SLST but did not present impaired lateral hip abduction strength in comparison with those who perceived lower pain interference in life.

Effectiveness of manual lymphatic drainage vs. perineal massage in secundigravida women with gestational oedema: A randomised clinical trial.

Perineal trauma (PT) may be considered as a very common injury during the childbirth. The incidence of PT was estimated in 30% to 85%, with 60% to 70% requiring suture. The present study was a prospective, single-blinded, randomised, clinical trial carried out from January 2015 to January 2016. For this study, 49 secundigravida women diagnosed with gestational oedema were recruited and randomly divided into two groups (A and B). Group A (n = 30) received the conventional treatment plus perineal massage and group B (n = 19) the conventional treatment plus manual lymphatic drainage (MLD). Visual analogue scale (VAS) and King Health's Questionnaire (KHQ) were performed to assess pain intensity and quality of life-related with urinary incontinence (UI). Pain intensity measurements showed statistically significant differences for a decrease after 30-weeks (P = .037), after 36-weeks (P = .000), and at the end of puerperium (P = .014) for MLD with respect to perineal massage group. Moreover, inter-groups repeated measures ANOVA for the values related statistically significant differences to the interaction of each applied treatment (perineal massage and MLD group, separately) over the pain intensity variable. MLD treatment reduced pain intensity with respect to perineal massage in secundigravida women with gestational oedema from 25-weeks of gestation to the end of puerperium.

Efficacy of dry needling as an adjunct to manual therapy for patients with chronic mechanical neck pain: a randomised clinical trial.

OBJECTIVE: Chronic mechanical neck pain is associated with musculoskeletal tissue alterations. Active trigger points in the trapezius and levator scapulae muscles are common in patients with chronic mechanical neck pain. In this study, we compared the effect of dry needling (DN) combined with manual therapy (MT) to sham dry needling (SDN) combined with MT on pain, pain pressure threshold, cervical range of motion and neck disability in patients with chronic mechanical neck pain. METHODS: A randomised, single-blind clinical trial was carried out involving 101 participants with chronic mechanical neck pain, divided into an intervention group (DN+MT, n=47) and a control group (SDN+MT, n=54). Participants received two treatment sessions. The intervention group received MT in conjunction with DN of the most mechano-sensitive myofascial trigger point (MTrP). The control group received MT plus SDN. Outcomes measures were: pain intensity (numeric pain rating scale, NPRS), pressure pain threshold (PPT), cervical range of motion (ROM) and neck disability (neck disability index, NDI). RESULTS: This study found that between-group differences in pain intensity were statistically significant (P<0.01). Pain decreased after the first intervention in the DN+MT group (3.47±0.25 points on the NPRS) and even more so after the second intervention (4.76±0.24 points on the NPRS). After 4 weeks, pain intensity differed from baseline by 4.89±0.27 points on the NPRS. Statistically significant differences (P<0.001) in PPT were also found between the intervention group and the control group. After the first intervention, a significant increase in PPT within the DN+MT group (3.09±0.8 kg/cm2) was observed. Cervical ROM also showed highly statistically significant differences. After 4 weeks, a statistically significant reduction (P<0.001) in NDI was observed between the two groups. CONCLUSION: Our results show that DN+MT is efficacious and significantly better than SDN+MT at reducing pain intensity, PPT, neck disability and cervical ROM in patients with chronic mechanical neck pain. LEVEL OF EVIDENCE: 1b.

Pressure and Traction Technique Improves Postural Control More Than Tactile Stimulation in Foot Plantar Fascia: A Randomized Single-Blind Trial.

OBJECTIVE: To check the acute effects of manual pressure and traction technique on balance and plantar footprint variables. DESIGN: A single-blind clinical study with 2 groups. SETTING: Private practice. PARTICIPANTS: Healthy participants (N=40; 28 female and 12 male) were recruited to carry out a single-blind study. INTERVENTIONS: Experimental group performed a bilateral plantar fascia manual pressure and traction technique. Control group performed a tactile stimulation. The position of the participant, the therapist, and the time of application of the techniques (5min) were the same for both interventions. MAIN OUTCOME MEASURES: We measured stabilometry variables and static footprint. The footprint variables were divided in rear, middle, and front foot areas. RESULTS: Significant differences were found in stabilometry variables. There was an improvement in experimental group at X displacement with eyes open (P=.014) and surface eyes closed (P=.046) variables. CONCLUSIONS: After technique the experimental group improved the stabilometry variables, specifically surface with eyes closed and X displacement with eyes open. The static footprint variables have not shown differences after the technique compared with the control group.

Immediate Effects of Intermittent Bilateral Ankle Plantar Flexors Static Stretching on Balance and Plantar Pressures.

OBJECTIVE: The purpose of this study was to analyze the immediate effects of an intermittent plantar flexion static-stretching protocol on balance and plantar pressures. METHODS: The study included a sample size of 24 healthy participants (21 female and 3 male). Participants were 32.20 ± 8.08 years, 166.20 ± 8.43 cm, and 62.77 ± 9.52 kg. All participants performed an intermittent plantar flexion static-stretching protocol. Five sets (60 seconds intermittent stretch; 15 seconds for the rest time) of a passive plantar flexor stretching (70% to 90% of the point of discomfort) were performed. Static footprint analysis and a stabilometry analysis were performed before and after stretching. A P value < .05 with a CI of 95% was considered statistically significant for all tests. RESULTS: Intermittent ankle plantar static stretching resulted in a significantly greater forefoot surface contact area and lower rear foot medium and maximum plantar pressures. In addition, static stretching caused a lower displacement of the center of pressure for both eyes open and eyes closed conditions. CONCLUSION: An intermittent plantar flexor static-stretching protocol improved balance and reduced rear foot plantar pressures (maximum and medium pressures).

Is a Combination of Exercise and Dry Needling Effective for Knee OA?

OBJECTIVE: To assess the effectiveness of adding dry needling (DN) to an exercise program on pain intensity and disability in patients with knee osteoarthritis. DESIGN: Double-blind randomized clinical trial with one-year follow-up. SETTING: Older adults in a multicenter study. SUBJECTS: Sixty-two patients with knee osteoarthritis were randomly allocated into one of two groups: exercise plus DN (exercise + DN; N = 31) or exercise plus sham DN (exercise + sham DN; N = 31). METHODS: Participants received six sessions of either DN or sham DN over the leg muscles related to knee pain from osteoarthritis plus a supervised exercise program. We evaluated between-group differences in terms of the numerical pain rating scale (NPRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. We used the EuroQol Group 5-Dimension Self-Report Questionnaire, Barthel Index, Timed Up & Go Test, and Global Rating of Change Scale to examine between-group differences for health-related quality of life, functional status evaluation, balance assessment, and clinical progress, respectively. RESULTS: The groups were not different in terms of pain intensity (0.32 points, 95% confidence interval [CI] = -1.12 to 1.18, P = 0.92) or WOMAC score (0.29 points, 95% CI = -6.16 to 6.74, P = 0.92) at one year. Both groups presented within-group differences at all follow-up periods (F = 28.349, P < 0.0001, ηp2 = 0.32) on secondary outcomes. Nevertheless, 90.3% of the DN group had reduced medication consumption vs only 26.3% in the sham DN group. CONCLUSIONS: The inclusion of DN to an exercise program does not reduce pain or disability in patients with knee osteoarthritis.

Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial.

BACKGROUND: Deep dry needling (DDN) and ischemic compression technic (ICT) may be considered as interventions used for the treatment of Myofascial Pain Syndrome (MPS) in latent myofascial trigger points (MTrPs). The immediate effectiveness of both DDN and ICT on pressure pain threshold (PPT) and skin temperature of the latent MTrPs of the triceps surae has not yet been determined, especially in athletes due to their treatment requirements during training and competition. OBJECTIVE: To compare the immediate efficacy between DDN and ICT in the latent MTrPs of triathletes considering PPT and thermography measurements. METHOD: A total sample of 34 triathletes was divided into two groups: DDN and ICT. The triathletes only received a treatment session of DDN (n = 17) or ICT (n = 17). PPT and skin temperature of the selected latent MTrPs were assessed before and after treatment. RESULTS: Statistically significant differences between both groups were shown after treatment, showing a PPT reduction (p < 0.05) in the DDN group, while PPT values were maintained in the ICT group. There were not statistically significant differences (p > 0.05) for thermographic values before and treatment for both interventions. CONCLUSIONS: Findings of this study suggested that ICT could be more advisable than DDN regarding latent MTrPs local mechanosensitivity immediately after treatment due to the requirements of training and competition in athletes' population. Nevertheless, further studies comparing both interventions in the long term should be carried out in this specific population due to the possible influence of delayed onset muscle soreness and muscle damage on PPT and thermography values secondary to the high level of training and competition.

Prediction Model for Choosing Needle Length to Minimize Risk of Median Nerve Puncture With Dry Needling of the Pronator Teres.

OBJECTIVE: The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling. METHODS: We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness. RESULTS: For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%. CONCLUSION: Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.

Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial.

OBJECTIVE: Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae. METHODS: In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T30s; n=17), 60s (T60s; n=22) or 90s (T90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment. RESULTS: Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta2=0.103), comparing T60s versus T30s (P=0.009; Cohen's d=1.044) and T90s versus T30s groups (P=0.001; Cohen's d=1.253), and for left side bending strength (P=0.043; partial Eta2=0.105), comparing T90s versus T30s (P=0.023; Cohen's d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05). CONCLUSIONS: The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term. TRIAL REGISTRATION NUMBER: NCT03006822.