Trigger point dry needling versus strain-counterstrain technique for upper trapezius myofascial trigger points: a randomised controlled trial.

BACKGROUND: Treatment of active myofascial trigger points includes both invasive and non-invasive techniques. OBJECTIVES: To compare the effects of upper trapezius trigger point dry needling (DN) and strain-counterstrain (SCS) techniques versus sham SCS. STUDY DESIGN: Randomised controlled trial. METHOD: 34 study subjects with active trigger points were randomly assigned to one of three treatment groups, and received either three sessions of DN (n=12), six sessions of SCS (n=10), or sham SCS (n=12) over a 3-week period. Subjective pain response and subjects' own ratings of perceived disability were measured. RESULTS: The analysis of variance mixed model showed a significant time effect for pain (p<0.001), elicited pain (p<0.001), pain pressure threshold (p<0.01), and neck disability index (p=0.016). Pain at rest decreased in all groups, as follows: DN 18.5 mm (95% CI 4.3 to 32.7 mm); SCS 28.3 mm (95% CI 12.4 to 44.1 mm); sham SCS 21.9 mm (95% CI 3.5 to 40.1 mm). Reductions in disability score (points) were significant in the SCS group (5.5, 95% CI 1.6 to 9.4) but not in the DN (1.4, 95% CI -4.9 to 2.1) or sham SCS (1.8, 95% CI -6.4 to 2.7) groups. There was no significant group×time interaction effect for any variables studied. CONCLUSIONS: There were no differences between the sham SCS, SCS, and DN groups in any of the outcome measures. DN relieved pain after fewer sessions than SCS and sham SCS, and thus may be a more efficient technique. Future studies should include a larger sample size. TRIAL REGISTRATION NUMBER: NCT01290653.

Efectividad de la punción seca de un punto gatillo miofascial versus manipulación de codo sobre el dolor y fuerza máxima de prensión de la mano / Effectiveness of a myofascial trigger point dry needling versus elbow manipulation on pain and maximum hand grip strength

Objetivo Comparar el efecto provocado por la aplicación de manipulación de codo, punción seca o punción seca placebo sobre el umbral de dolor a la presión (UDP), la intensidad subjetiva de dolor y la fuerza de agarre en sujetos con punto gatillo miofascial (PGM) latente en la musculatura epicondílea. Material y métodos Se seleccionó a 52 participantes (26,9±7,6 años) con PGM latente en la musculatura epicondílea; 50 sujetos se integraron en el estudio controlado, doble ciego y aleatorizado. Se utilizó un algómetro para la medición de UDP, una escala analógica visual (EAV) para la intensidad subjetiva de dolor y un dinamómetro de mano para la fuerza máxima de prensión. Todo ello en 3 momentos de medición: preintervención, post-intervención y transcurridos 10 min. El análisis estadístico se realizó mediante un ANOVA mixto, p ≤ 0,05.ResultadosLos datos obtenidos mostraron un efecto significativo de la interacción grupo y tiempo para el UDP (p=0,01). Se produjo una disminución del UDP significativa (p=0,02) a los 10 min de la intervención comparado con el valor obtenido inmediatamente tras la intervención en el grupo manipulación. Para la variable del dolor medido mediante la EAV se observó un efecto significativo del factor tiempo (p=0,004).Conclusiones No se ha podido demostrar que la manipulación o la punción seca resulten superiores a la punción placebo en beneficios sobre el dolor, el UDP y la respuesta de fuerza de agarre en mano(AU)

Objective To compare the effect caused by a single application of elbow manipulation, dry needling and sham dry needling on pain and grip strength threshold (PPT) on subjects with latent myofascial trigger point (MTP) in the lateral epicondyle musculature. Material and methods A total of 52 participants (26.9±7.6 age) with latent MTP in the epicondyle musculature were enrolled. Fifty subjects were integrated in the double blind, randomized and controlled study. An algometer was used to measure PPT, Visual Analogue Scale (VAS) to measure the subjective intensity of pain and hand dynamometer to measure maximum grip strength. Three different points in time were measured: pre-intervention, post-intervention and 10minutes following the intervention. The statistical analysis was performed by a mixed ANOVA using P≤.05.ResultsStatistical analysis showed a significant effect for group per time interaction for the PPT (P=.01). Post-hoc tests showed a significant decrease of the PPT (P=.02) 10 minutes after the intervention compared to the post-intervention value for the manipulation group. Subjective pain measured by the VAS showed a significant effect for the time factor (P=.004).Conclusions It was not possible to demonstrate that manipulation or dry needling is superior to placebo puncture in benefits on pain, PPT and handgrip strength (AU)