Shoulder and scapulothoracic impairments in women with breast cancer-related lymphedema in the upper limb: A cross-sectional study shoulder and breast cancer-related lymphedema.

INTRODUCTION: Lymphedema in the upper limb as a complication of breast cancer may lead to shoulder pain and dysfunctions. OBJECTIVE: To compare the scapular positioning, the shoulder range of motion, and muscle strength among women undergoing treatment for breast cancer with and without lymphedema and a control group. METHODS: This cross-sectional study evaluated women undergoing treatment for breast cancer (N = 25) and without lymphedema (N = 25), and a control group (N = 25). Static scapular positions and shoulder range of motion were measured by using an inclinometer. The shoulder and periscapular muscle strength were measured by using a hand-held dynamometer and the Disabilities of the Arm, Shoulder, and Hand Questionnaire was applied. Linear regression of the mixed effects model was used to compare the groups. RESULTS: Both groups of mastectomized women had reduced shoulder range of motion, scapular upward rotation, and muscle strength for shoulder and periscapular muscles compared to the control group. Also, women undergoing treatment for breast cancer with lymphedema had reduced shoulder range of motion, scapular upward rotation, increased anterior tilt, reduced muscle strength of the upper trapezius, and greater upper limb disability compared to women without lymphedema. CONCLUSION: Women undergoing treatment for breast cancer with lymphedema had even greater shoulder and scapulothoracic impairments when compared to the control group and women without lymphedema.

Electromyographic analysis of shoulder-complex muscles performing overhead presses with dumbbell, kettlebell, and bottom-up kettlebell.

INTRODUCTION: Kettlebell exercises, specifically the bottom-up grip, have become increasingly popular in training programs. The purpose of this research was to determine if a bottom-up kettlebell grip favorably alters the electromyography (EMG), activity in the medial deltoid (MD), serratus anterior (SA), and lower trapezius (LT), muscles compared to using a dumbbell or traditional kettlebell grip during overhead shoulder presses. METHODS: Twenty-eight healthy, male, Division III collegiate baseball players (mean age = 19.8 ± 1.28 years) performed five overhead presses of equal weight, 11.34 kg (25 lbs), using a dumbbell (DB), kettlebell w/traditional grip (KB), and kettlebell held with a bottom-up grip (KBU). RESULTS: For the MD, there was significantly greater EMG activity using the DB compared to KBU, but no significant differences between the DB and KB, or KB and KBU. For the SA, greater EMG activity was noted using the KBU compared to KB, and KBU compared to DB, but no differences between KB and DB. For the LT, greater EMG activity was noted using the DB compared to KB, but no differences between DB and KBU, or KB and KBU. CONCLUSION: The KBU press only elicited greater EMG activity in the SA. The DB elicited greater EMG activity in both the MD and LT. Shoulder-complex EMG activity varies with different types of overhead presses using equivalent loads.

Dry needling, trigger point electroacupuncture and motor point electroacupuncture for the treatment of myofascial pain syndrome involving the trapezius: a randomised clinical trial.

OBJECTIVE: The objective of this study was to compare trigger point (TrP) dry needling, TrP electroacupuncture and motor point electroacupuncture of the trapezius muscle for the treatment of myofascial pain syndrome (MPS). METHODS: This randomised clinical trial included 90 patients divided into three groups. Group 1 was treated with dry needling of TrPs, group 2 with intramuscular electrical stimulation of TrPs, and group 3 with electroacupuncture of motor points and/or the spinal accessory nerve. Each group received seven treatment sessions. The outcomes were the pain score measured by visual analogue scale (VAS) and quality of life evaluated by the 12-item short form (SF-12) health questionnaire. We compared the pain outcome over serial time points using growth curve analysis methods. RESULTS: Participants in the three groups experienced significant improvements in pain scores over time. The average pain level of participants in group 3 across the repeated assessments was 0.98 units lower than in group 1 (mean difference (95% confidence interval (CI) = 1.74-0.23)), p = 0.012). There were no significant differences in pain scores between participants in groups 1 and 2, and there were no significant differences in quality of life across the three groups at the end of the treatment period. CONCLUSION: Our results provide evidence that electrical stimulation of motor points and/or of the spinal accessory nerve may be superior in terms of pain relief (but not quality of life) to dry needling and possibly electrical stimulation of trigger points for the management of MPS involving the trapezius. TRIAL REGISTRATION NUMBER: TRIAL-RBR-43R7RF (Brazilian Clinical Trials Registry).

Standardised 25-Step Traditional Thai Massage (TTM) Protocol for Treating Office Syndrome (OS).

Traditional Thai massage (TTM) is a unique form of whole body massage practiced to promote health and well-being in Thailand since ancient times. The goal of the present study was to create a standardised TTM protocol to treat office syndrome (OS) diagnosed based on the identification of the palpation of at least one so-called myofascial trigger point (MTrP) in the upper trapezius muscle. The new 90 min TTM protocol, which was developed following appropriate review of the literature and in consultation with relevant experts, has 25 distinct steps (20 pressing steps, 2 artery occlusion steps, and 3 stretching steps). Eleven TTM therapists treated three patients each using the new 90 min TTM protocol. All of the therapists reported scores greater than 80% in respect to their satisfaction and confidence to deliver the protocol, and all of the patients gave the treatment a satisfaction score of greater than 80%. The treatment produced a significant reduction in pain intensity measured on a Visual Analogue Scale (VAS), with minimum and maximum values of 0 and 10 cm, of 2.33 cm (95% CI (1.76, 2.89 cm), p < 0.001) and significant increase in pain pressure threshold (PPT) of 0.37 kg/cm2 (95% CI (0.10, 0.64 kg/cm2), p < 0.05). The protocol was revised based on the feedback and the results obtained, and the new standardised TTM protocol will be applied in a randomised control trial (RCT) to compare the efficacy of TTM and conventional physical therapy (PT) for treating OS.

The effect of EMG biofeedback training on muscle activation in an impingement population.

Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p = 0.003) and 90° (p = 0.036), LT activity was increased at all measured humeral angles (p < 0.0005), and SA muscle activity was increased at 110° (p = 0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature.

Comparison of immediate and delayed effects of superficial and deep dry needling in patients with upper trapezius myofascial trigger points.

BACKGROUND: Dry needling is one of the most common treatments for this condition. In this study the immediate and delayed effects of superficial dry needling (SDN) and deep dry needling (DDN) on upper trapezius muscle function and patients' pain and disability was evaluated. METHODS: In this quasi-experimental study, 47 women with active MTrPs were randomly divided into SDN and DDN groups and received one session treatment. Pain and disability were assessed before and one week after intervention with visual analogue scale (VAS) and neck disability index (NDI) questionnaire. Muscle activity was assessed by surface electromyography (sEMG) before, immediately and one week after intervention. RESULTS: Both groups showed significant decrease in VAS (p < 0.001) and NDI (p < 0.001) after one week, however no significant difference were found between the groups (p > 0.05). A significant increase in sEMG activity was observed only in DDN group after one week (p < 0.007), but there were no significant differences in sEMG activity in SDN group after intervention and between the two groups (p > 0.05). CONCLUSION: Both SDN and DDN could be effective in reducing pain and disability in patients with active MTrPs of upper trapezius muscle. Regarding muscle function DDN seems to be more effective. So that based on evaluation of the therapist in some cases with not significant muscle dysfunction SDN as a gentle and less invasive method could be used but for long term effectiveness and in those with significant muscle dysfunction DDN could be used.

Changes in stiffness at active myofascial trigger points of the upper trapezius after dry needling in patients with chronic neck pain: a randomized controlled trial.

BACKGROUND/OBJECTIVE: Since, to our knowledge, the effects of dry needling (DN) on active myofascial trigger point (MTrP) stiffness have not been analyzed previously with shear wave elastography (SWE), our aim was to compare the effects of a single session of DN and sham DN applied to the most active MTrP located in the upper trapezius muscle on clinical outcomes. METHODS: A randomized, double-blinded sham-controlled trial was conducted; 60 patients were randomized into an experimental (DN) or sham (sham DN) group. Baseline data including sociodemographic and clinical characteristics were collected. SWE and pain pressure thresholds (PPTs) at the MTrP and a control point located 3 cm laterally were the main outcomes assessed before and 10 min after the interventions. RESULTS: Patients receiving DN interventions experienced greater increases in the control point PPTs immediately after receiving the intervention compared with sham DN (p < 0.05), but no differences were found for the MTrP (p > 0.05). Post-intervention PPT improvements were found at both locations for both groups (p < 0.01). No significant changes for either MTrP or control locations were found for SWE outcomes in either group (all ps > 0.05). No significant within-group SWE differences were found in the DN or sham DN groups (p > 0.05). CONCLUSION: A single session of DN or sham DN applied to active MTrPs located in the upper trapezius muscle produced no detectable changes in stiffness at the MTrP or control locations. Real DN induced an immediate analgesic response at both MTrP and control locations, while sham DN induced an immediate MTrP response. TRIAL REGISTRATION NUMBER: NCT04832074 (ClinicalTrials.gov).

Effectiveness of Photobiomodulation Therapy in the Treatment of Myofascial Pain Syndrome of the Upper Trapezius Muscle: A Systematic Review and Meta-Analysis.

Objective: This systematic review aimed to investigate the efficacy of photobiomodulation therapy (PBMT) on pain and pressure pain threshold (PPT) in patients with myofascial pain syndrome (MPS) of the upper trapezius muscle. Materials and methods: A total of 17 studies (944 patients) were included; data regarding participants, intervention parameters, outcome measures, time of measurement, and follow-up were extracted. Evaluation of the methodological quality was performed by Physiotherapy Evidence Database (PEDro) scale. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence. A meta-analysis was performed on 16 studies, and standardized mean difference (SMD), corresponding 95% confidence interval (CI), and overall effect size (ES) were calculated. Results: Meta-analysis using a random-effect model was performed to evaluate the effects of PBMT alone or PBMT plus exercise (EX) compared with placebo, medical treatment, physical therapy (PT) modality, manual therapy, or complementary PT. Assessment according to the PEDro scale revealed 12 high-quality, 3 fair-quality, and 2 low-quality studies. According to the GRADE system, studies exhibited low to medium quality of evidence, with medium ES [SMD -0.54 (95% CI -1.05 to -0.02)] for studies using PBMT alone and large ES [SMD -0.80 (95% CI -1.35 to -0.26)] for PBMT+EX. Conclusions: The present systemic review revealed that PBMT is an effective PT modality for reducing pain and increasing PPT in patients with MPS of the upper trapezius. PBMT, when combined with EX, had more significant effects in reducing pain and increasing PPT compared with controls. The low-quality studies with low to moderate quality of evidence limit the confidence in the effect estimate and recommend further high-quality studies for standardization of treatment protocols and irradiation parameters. PROSPERO registration number: CRD42021241155.

Changes in electromyographic activity of latent trigger points after a dry needling intervention: a randomised controlled trial.

OBJECTIVE: To analyse the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on pressure pain threshold (PPT) and surface electromyography (sEMG). DESIGN: Randomized, double-blind, placebo controlled clinical trial. SETTINGS: Sports Rehabilitation Laboratory, University of Castilla-La Mancha. PARTICIPANTS: Forty-six participants (18-35 years old) with LTrP in the upper trapezius were divided into two groups: DN-group and Sham-DN-group. INTERVENTIONS: In the DN-group, the needle was inserted 10-times through the skin, and it was manipulated up and down using a "fast in and out" technique. In the Sham-DN-group, non-penetrating needles were used. MAIN OUTCOME MEASURES: PPT, sEMG at rest, and sEMG in isometric contraction of the LTrP of the upper trapezius muscle were evaluated at baseline, 30 min after treatment, and after 24 h, and 72 h of follow-up. RESULTS: The mean change in sEMG at rest between baseline and 30 min was - 0.38 (0.38) %refRMS for the DN group and - 0.05 (0.31) %refRMS for the Sham-DN group (mean difference -0.34, 95% confidence interval (CI) of the difference: - 0.54 to - 0.13), and between baseline and 24 h was - 0.35 (0.35) %refRMS for the DN group and - 0.06 (0.58) %refRMS for the Sham-DN group (mean difference -0.29, 95% CI: -0.57 to -0.01). In addition, the DN-group showed higher values of PPT than the Sham-DN group at 72 h (5.22 (1.23) to 4.65 (1.03) kg/cm2; p < 0.05). CONCLUSIONS: A single session of DN intervention was effective in reducing the electromyographic activity, muscle fatigue and pain of the upper trapezius muscle in LTrP. CONTRIBUTION OF PAPER: In healthy volunteers dry needling is effective.

Cervical and scapula-focused resistance exercise program versus trapezius massage in patients with chronic neck pain: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to investigate the effects of resistance exercise in comparison with those of common exercise on chronic neck pain (CNP) to provide useful clinical guidelines for reducing pain or increasing cervical range of motion (ROM), upper trapezius tone, disability level, and quality of life (QOL). METHODS: The subjects were randomized into a cervical and scapula-focused resistance exercise group (CSREG, n = 21) or trapezius massage group (TMG, n = 20). All groups received a 4-week, five times per week CSRE or TM program for CNP. The visual analogue scale (VAS) score, cervical ROM, myotonometer measures (upper trapezius tone, stiffness, and elasticity), neck disability index (NDI), and short form-36 (SF-36) were identified as the primary outcomes. RESULTS: Within-group changes in VAS, cervical ROM, myotonometer measures, NDI, and SF-36 were significant in the CSREG and TMG (P < .05). The between-group changes in VAS, cervical rotation, myotonometer (upper trapezius tone and stiffness), NDI, and SF-36 after intervention showed significant differences between the CSREG and TMG (P < .05). CONCLUSION: These results suggest that the CSRE program is effective in improving pain, cervical ROM, upper trapezius tone, disability level, and QOL in patients with CNP. More comprehensive studies with longer follow-up durations are needed to better understand the potential effects of the CSRE program in patients with CNP.

Total autologous breast reconstruction with the Kiss Latissimus Dorsi Flap.

INTRODUCTION: Patients presenting breast actinic damage or implant-related complications require an autologous approach to breast reconstruction. However, when they are not good candidates for microsurgical procedures, alternative solutions must be sought. Latissimus dorsi (LD) is a workhorse flap in breast reconstruction, but often the amount of skin and volume achievable are insufficient. Taking inspiration from the Kiss flap concept, the authors hereby describe the "Kiss" LD flap to achieve totally autologous breast reconstruction. PATIENTS AND METHODS: A prospective service evaluation of all patients who underwent breast reconstruction with Kiss LD flap between 2018 and 2020 was performed. Patient demographics and operative variables were recorded, together with early and late complications. Patient satisfaction and quality of life were registered using the latest BREAST-Q reconstruction module, which includes specific LD scales. The questionnaire was administered to patients preoperatively and six months postoperatively. RESULTS: Thirty patients underwent total autologous breast reconstruction with Kiss LD flap. Breast cancer and breast sarcoma resection were followed by reconstruction. The timing of reconstruction was immediate in 3 cases and delayed in 27 cases. No major complications nor total flap loss were registered. BREAST-Q scores postoperatively were significantly higher than the preoperative ones in every domain (p<0.0001) except for the physical well-being of back and shoulder, where the scores differed slightly and non-significantly (p=0.05). CONCLUSIONS: The Kiss LD flap allows to harvest a large amount of skin to restore the breast envelope and a considerable volume to reconstruct the breast mound in a completely autologous procedure.

Effect of Myofascial Induction Therapy in Pterygoid Muscles of Woodwinds and String Musicians on Muscular Stiffness of the Upper Trapezius.

PURPOSE: Considering the fascial continuity and its biomechanical characteristics, the purpose of this study was to assess the change in muscular stiffness (Dm) of the upper trapezius muscles after the application of myofascial induction therapy (MIT) to the masticatory muscles of musicians. METHODS: This was a pre-posttest design involving one treatment. SUBJECTS: The total sample was 33 subjects (n = 33). The experimental group comprised 18 violin, viola, and woodwind players, and the control group was comprised of 15 non-musicians. The outcome measures included pre-posttest measurements with tensiomyography of the upper trapezius (muscle stiffness, Dm), and baseline neck disability (Neck Disability Index), and pain (SF-36 questionnaire). The experimental group received MIT for 5 minutes on each side of the lateral pterygoid muscle. The control group assumed a supine position for 10 minutes. RESULTS: After the intervention, there was a significant difference in Time per Group (F = 2.896, p = 0.034, ƞ2p = 0.367, and w = 0.755). There were statistically significant differences in pre-post and side-by-side analyses for the Dm of the upper trapezius in the experimental group as well as between the two groups. CONCLUSION: MIT of the lateral pterygoids is effective in decreasing upper trapezius stiffness as measured by an increase in the Dm measured by tensiomyography. The greatest change occurred in musicians with a lower percentage of Neck Disability Index at baseline.

Correlation between thoracic kyphosis and dry needle length required to reach the pleural space needling the upper trapezius: A cadaveric fluoroscopic assessment.

BACKGROUND: It is unknown whether greater prone thoracic kyphosis increases pneumothorax risk during upper trapezius dry needling. OBJECTIVES: To fluoroscopically assess for a correlation between prone thoracic kyphosis and needle length required to reach the pleural space dry needling the upper trapezius in prone. DESIGN: Cadaveric study. METHODS: Prone thoracic kyphosis was assessed using dual bubble inclinometers. A 30 mm dry needle was inserted into the midsubstance of the upper trapezius perpendicular to the thoracic kyphosis. A single C-arm fluoroscopic image was obtained. This procedure was repeated with 40, 50, and 60 mm needles. Images were independently viewed by a radiologist to make a binary decision (yes vs. no) whether the needle had potentially broached the pleural space. RESULTS: Fifteen cadaveric specimens with a mean age of 74.9 ± 9.7 and mean kyphosis of 21.5° ±7.7 were used. A 30 mm needle never reached the pleural space. The pleural space was potentially broached on one, four and six occasions by the 40, 50, and 60 mm needle respectively. The correlation between needle depth penetration and kyphosis was not significant (r = 0.03, p = 0.93). Longer needles (50 and 60 mm) were significantly (p = 0.0049) more likely to reach the pleural space than shorter needles (30 and 40 mm). CONCLUSION: Thoracic kyphosis was not correlated with needle length required to reach the pleural space. Clinicians may consider selecting shorter needles (<40 mm) to mitigate potential risk while dry needling the upper trapezius in prone.

Physiotherapeutic approach in seamstresses with neck pain: A single-blind, randomized clinical trial.

PURPOSE: To investigate and compare the effects of therapeutic exercise, therapeutic ultrasound and photobiomodulation on pain, functionality and recruitment pattern of motor units, after a rehabilitation protocol for seamstresses with neck pain. MATERIALS AND METHODS: All 36 female, randomly divided into three groups; i)exercise control group, ii)exercise and photobiomodulation group, iii)exercise and ultrasound group. The groups were composed of sewing machine operators with complaints neck pain. Clinical evaluations: Visual analog pain scale, questionnaires Nordic Musculoskeletal Questionnaire and the International Physical Activity Questionnaire, and electromyographic evaluations of the sternocleidomastoid and upper trapezius muscles. All variables were compared before and after the protocol. For statistical analysis, the values of mean, standard deviation and standard error of the mean were used. The values obtained were compared using the One-Way ANOVA with post-hoc Tukey, and Cohen's-d, with a significance coefficient of p < 0.05. RESULTS: In the Ultrasound and laser groups there was a greater tendency to improve pain (p < 0.0001) and size of the effect on pain reduction (ultrasound = d:1.99; photobiomodulation = d:1.81). Between groups, there was a significant difference in post-treatment for the onset of right trapezius (p = 0.024) in the exercise and photobiomodulation groups (p = 0.0347). The photobiomodulation group showed pre and post-intervention differences in the left trapezius maximum onset (p = 0.010). CONCLUSION: Interventions with photobiomodulation, ultrasound, and exercise assist to pain, function, and muscular activation in seamstresses with neck pain.

Comparison of the effectiveness between dry needling with and without needle retention in myofascial trigger points in upper trapezius muscle: A randomized comparative trial.

BACKGROUND: Dry needling (DN) is commonly used to treat myofascial trigger points (MTrPs). OBJECTIVE: To compare the effect between DN with and without needle retention in the treatment of MTrPs in the upper trapezius muscle. METHODS: Fifty-four patients who had active MTrPs in the upper trapezius muscle were randomly allocated into the DN group or the DN with retention group. The DN group received DN only, while the DN with retention group received DN with needle retention for 30 minutes. The visual analogue scale (VAS) and pressure pain threshold (PPT) were recorded both before and after 7 and 14 days of the treatment sessions. RESULTS: Both groups showed a significant decrease of the VAS at 7 and 14 days (mean difference DN group -53.0, DN with retention group -57.0, p< 0.001). The PPT was also significantly improved in both groups (mean difference DN group 109.8 kPa, DN with retention group 132.3 kPa, p< 0.001). However, there were no significant differences in the VAS or PPT between the groups. CONCLUSIONS: Both DN and DN with retention had significant improvement of pain intensity in the treatment of MTrPs in the upper trapezius muscle at 14 days. However, pain reduction was not significantly different between the interventions.

Using biofeedback to optimize scapular muscle activation ratios during a seated resisted scaption exercise.

Impairments in muscle activation have been linked to increased risk of developing shoulder pathologies such as subacromial impingement syndrome (SIS) and associated rotator cuff injuries. Individuals with SIS have demonstrated increased upper trapezius (UT) muscle activation and reduced serratus anterior (SA) and lower trapezius (LT) muscle activation, which can be collectively represented as ratios (UT/SA and UT/LT). Targeted exercise is an important component of shoulder rehabilitation programs to re-establish optimal muscle activation and ratios. Electromyography (EMG) biofeedback during exercise has been shown to reduce UT activation and favorably alter scapular muscle activation ratios, however, a literature gap exists regarding the efficacy of other types of biofeedback. Therefore, we compared the effects of three types of biofeedback (visual EMG, auditory, verbal cues) on UT/SA and UT/LT ratios during a seated resisted scaption exercise in fifteen subjects without shoulder pain. Baseline muscle activation was recorded and compared to real-time muscle activation during each randomized biofeedback trial. All biofeedback types showed improvements in the UT/SA and UT/LT ratios, with visual EMG demonstrating a significant change in UT/LT ratio (p < 0.05). These results suggest that biofeedback could be utilized as a component of rehabilitation programs to prevent or treat shoulder pain.

Acute effects of myofascial reorganization on trapezius muscle oxygenation in individuals with nonspecific neck pain.

BACKGROUND AND PURPOSE: Nonspecific neck pain (NNP) is a common idiopathic disorder in the general population that affects the trapezius muscle (TM) and blood supply, thereby compromising the fascial system. Myofascial reorganization (MR) is a physical therapy technique that can influence the dynamics of local fluids reducing excessive muscle tension and capillary constriction, and increasing local blood flow. This study aimed to investigate whether MR improves peripheral muscle oxygenation. METHODS: This was a quasi-experimental study with an intentional non-probability sample. Fifty participants (women: 36, men: 14) with and without NNP were assigned to either the experimental group (EG: n = 25, with NNP, subjected to MR) or the control group (CG: without NNP, no MR intervention). TM oxygenation was measured using near-infrared spectroscopy (NIRS) before and after a single intervention. All participants were evaluated and reassessed after 10 min. RESULTS: The results revealed that immediately after 10 min of MR, the EG exhibited an increase in the oxyhemoglobin level of the medium fibers of the TM (0.72 ± 1.47 vs. -0.14 ± 1.33 mmol/dL, p = 0.01). In addition, functional disability (CG: 5.48 ± 5.58%/EG: 21.12 ± 7.73%) and neck pain were measured using the neck disability index. The pain pressure threshold (CG: 70.49 ± 32.29 kgf/EG: 51.08 ± 27.65 kgf) and pain intensity (CG: 0.76 ± 1.56/EG: 3.28 ± 2.35) were also measured. CONCLUSION: The findings indicate that application of MR for 10 min increases the tissue oxyhemoglobin level in the TM of the group with NNP compared to the CG without NNP.

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.