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.

A comparison of lower limb muscle activation pattern using voluntary response index between pronated and normal foot structures during forward jump landing.

BACKGROUND: Pronated of the foot is one of the important factors contributing to musculoskeletal problems affecting the lower extremities. It is known that in a pronated foot, excessive mechanical load is applied to the lower limb structures which may result in altered biomechanics and muscle activation patterns. The aim of this study was to determine changes in the muscle activation pattern of the lower extremities in individuals with pronated, compared to normal, feet, using the voluntary response index (VRI). METHODS: In this cross sectional study, 15 asymptomatic pronated foot individuals (mean age 23.27 ± 3.28 years) and 15 normal subjects (mean age 23.40 ± 3.11 years) were recruited by simple non-random sampling. Electrical activities of gluteus medius (GM), vastus lateralis (VL), vastus medialis (VM), biceps femoris, semitendinosus (ST), and medial gastrocnemius (MG) muscles were recorded during a forward jump landing task. Voluntary response index (VRI) variables, included similarity index (SI) and magnitude (Mag) were also evaluated. RESULTS: Muscle activity of VM (p < 0.001) and ST (p = 0.010) were significantly higher but VL (p = 0.039) and MG (p = 0.001) were significantly lower in pronated foot, compared to normal subjects. Similarity index was found to be different (p < 0.001) between pronated foot and healthy individuals. No significant difference was found in terms of Mag between the two groups (p = 0.576). CONCLUSION: The altered pattern of lower limb muscle activation identified in the pronated foot during landing may be attributed to the different activation involving VL, VM, MG and ST muscles. Adaptations to the biomechanical effects, due to the pronated foot causing altered activation of VL, VM, MG, and ST muscles, results in an altered pattern of muscle activation. This change in activation pattern may harm the effectiveness of movement control processes; and might also predispose individuals with pronated feet, to injuries. It seems that an altered motor strategy with the aim of minimizing biomechanical changes, predisposes individuals to injuries. However, further large scale studies are needed to support the findings of the present study.

Quantification of dry needling on myofascial trigger points using a novel ultrasound method: A study protocol.

INTRODUCTION: Myofascial pain syndrome (MPS) is a neuromuscular dysfunction consisting of both motor and sensory abnormalities. Considering the high prevalence of MPS and its related disabilities and costs, this study was designed to determine the reliability of new ultrasonographic indexes of the upper trapezius muscle as well as the sensitivity and specificity of 2D ultrasound imaging for diagnostic purposes. Furthermore, we sought to evaluate the effectiveness of dry needling (DN) on studied ultrasonographic indexes. MATERIALS AND METHODS: This study will be performed in two steps with two different designs. The first is a pilot study and was designed as a semi-experimental study to determine the sensitivity and specificity of ultrasonography for the diagnosis of MPS and the reliability of ultrasonographic measurements like muscle thickness, area of myofascial trigger points (MTrPs) in longitudinal view, echogenicity of MTrPs in longitudinal view, echogenicity of muscle with MTrPs in longitudinal and transverse views, and pennation angle of upper trapezius muscle. The second study is an interventional study which was designed to investigate the effectiveness of DN on ultrasonographic measurements, for which the reliability was determined in the first study. CONCLUSION: we will quantify the effectiveness of DN on MTrPs and muscle tissue by using novel ultrasonographic indexes. The results of the current study will provide baseline information to design more interventional studies to improve the evaluation of other treatments of MPS.