Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Combinação de terapia por ondas de choque extracorpórea e agulhamento seco no tratamento de lombalgia crônica incapacitante: um relato de caso / Combination of extracorporeal shockwave therapy and dry needling as treatment of disabling chronic low back pain: a case report

Paciente do sexo masculino, 55 anos, apresentava antecedente clínico de radiculopatia lombar abordado cirurgicamente (discectomia e artrodese L5-S1) em dezembro de 2021, com resolução completa da dor associada. Iniciou com quadro de dor pós-operatória de características distintas. A primeira sessão de tratamento iniciou-se com terapia por ondas de choque extracorpóreas focal direcionada ao quadrado lombar, glúteo médio, glúteo mínimo e região peritrocantérica à direita. Posteriormente, associou-se agulhamento seco em pontos-gatilho presentes nesses mesmos 3 músculos e também no ligamento sacrotuberal direito, junto à inserção do glúteo máximo direito. Numa reavaliação uma semana depois, o paciente referiu uma redução de 70% da intensidade da dor inicial. O mesmo tratamento foi repetido, com resolução completa dos sintomas no final da sessão. Três meses depois, o doente manteve o controle álgico e recuperou totalmente a sua funcionalidade e qualidade de vida anteriores. Neste caso de limitação funcional a longo prazo devido a dor lombar crônica, a combinação da terapia por ondas de choque extracorporais e do agulhamento seco resultou num método eficaz e rápido para obter o alívio da dor e restaurar a funcionalidade anterior. No entanto, são necessários mais estudos para investigar o impacto desta combinação de terapias no controle da dor e na perda de funcionalidade devido à dor lombar crônica.

Male patient, 55 years old, had a clinical background of lumbar radiculopathy and a surgical approach (L5-S1 discectomy and arthrodesis) in December of 2021, with complete resolution of associated pain. One year later, the patient seeks medical treatment, referring a new, different pattern of low back pain, which initiated post-surgery. The first treatment session began with focused extracorporeal shockwave therapy directed at the right quadratus lumborum, gluteus medius, gluteus minimus and peritrochanteric region. Afterwards, dry needling was associated in trigger-points present in those same 3 muscles and also in the right sacrotuberal ligament, close to the insertion of the right gluteus maximus. In a reevaluation one week later, the patient reported a reduction of 70% of initial pain intensity. The same treatment was repeated, with complete resolution of symptoms at the end of the session. Three months later, the patient-maintained symptom control and fully recovered his previous functionality and quality of life. In this case of long-term functional limitation due to chronic low back pain, the combination of extracorporeal shock wave therapy and dry needling resulted in an effective and quick method to achieve pain relief and restore previous functionality. However, more studies are needed to investigate the impact of this combination of therapies in pain management and functionality loss due to chronic low back pain.

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain / Tratamento da dor miofascial com agulhamento a seco: uma revisão sistemática para as melhores práticas baseadas em evidências em lombalgia

Abstract Background Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling. Objective The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain. Methods A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023. Results A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability. Conclusion Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

Resumo Antecedentes A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco. Objetivo O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar. Métodos Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023. Resultados Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco "sham", terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor. Conclusão O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.

Dry needling in the treatment of myofascial trigger points and painful shoulder dysfunctions: narrative review of the literature / Agulhamento a seco no tratamento de pontos-gatilho miofasciais e disfunções dolorosas do ombro: revisão narrativa da literatura

ABSTRACT BACKGROUND AND OBJECTIVES: Shoulder painful dysfunctions comprises one of the most common musculoskeletal disorders that requires specialized assistance. Dry Needling (DN) became an adjuvant approach with increased use in clinical practice to treat this type of condition. The present study discusses the literature related to DN in the treatment of myofascial trigger points (MTPs), shoulder dysfunctions and associated pain. METHODS: A narrative review through search of articles from 2010 to 2022 written in Portuguese, English or Spanish was performed in Latin American and Caribbean Literature on Health Sciences (LILACS), Health Information from the National Library of Medicine (Medline), Web of Science and the Scientific Electronic Library Online (Scielo) databases using the keywords: <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <"Shoulder Dysfunctions">; <"Disfunções do ombro">. The qualitative analysis was performed determining the level of evidence for DN treatment of MTPs, shoulder dysfunctions and pain. RESULTS: A total of 45 citations were found, 22 citations were excluded because they did not meet the selection criteria. The 23 remaining citations were examined for titles and abstracts and duplicate studies were removed. Finally, 10 articles met the selection criteria and were included in the present review. No articles were excluded after full-text screening. The analysis showed poor advances and knowledge regarding the application of DN for the treatment of pain, painful and general shoulder dysfunctions and MTPs, with few evidence regarding treatment effectiveness, patient's pain scores data, mechanisms of action and statistical analysis. CONCLUSION: There is still a lack of concrete scientific evidence to assess DN effectiveness in modulating pain in patients with MTPs shoulder. More systematic reviews and meta-analyses together with experimental and clinical searches must be conducted to provide stronger evidence of this modality to relief painful symptoms in the shoulder, as well as a treatment of MTPs and general shoulder disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: As disfunções dolorosas de ombro constituem uma das disfunções musculoesqueléticas mais comuns que requerem assistência especializada. O agulhamento a seco (AS) tornou-se uma abordagem adjuvante com uso crescente na prática clínica para tratar esse tipo de condição. O objetivo deste estudo foi rever na literatura aspectos relacionados ao AS no tratamento de pontos-gatilho miofasciais (PGMs), disfunções do ombro e dores associadas. MÉTODOS: Foi realizada uma revisão narrativa através da busca de artigos de 2010 a 2022 escritos em português, inglês ou espanhol, na Literatura Latino-Americana e do Caribe nos bancos de dado Ciências da Saúde (LILACS), Informações em Saúde da Biblioteca Nacional de Medicina (Medline), Web of Science e Scientific Electronic Library Online (Scielo) utilizando as palavras-chave <"Dry Needling">; <"Agulhamento a Seco">; <"Myofascial Trigger Points">; <"Pontos-Gatilhos Miofasciais">; <" Disfunções do ombro">. A análise qualitativa foi realizada determinando o nível de evidência para tratamento de AS para o tratamento de PGMs, disfunções do ombro e dor. RESULTADOS: Um total de 45 citações foram encontradas, 22 citações foram excluídas porque não atenderam aos critérios de seleção. As 23 citações restantes foram examinadas para títulos e resumos e estudos duplicados foram removidos. Finalmente, 10 artigos atenderam aos critérios de seleção e foram incluídos na presente revisão. Nenhum artigo foi excluído após a triagem de texto completo. A análise mostrou poucos avanço e conhecimento sobre a aplicação de AS para o tratamento da dor, disfunções dolorosas e gerais do ombro e PGMs, com poucas evidências sobre a eficácia do tratamento, dados dos escores de dor do paciente, mecanismos de ação e análise estatística. CONCLUSÃO: Ainda faltam evidências científicas concretas para avaliar a eficácia do AS na modulação da dor em pacientes com PGMs no ombro. Mais revisões sistemáticas e meta-análises associadas a pesquisas experimentais e clínicas devem ser realizadas para fornecer evidências dessa modalidade promissora para alívio de sintomas dolorosos no ombro, bem como tratamento de PGMs e distúrbios gerais do ombro.

Evolution of acupuncture techniques for jin diseases and the rise and fall of jingjin doctrine / 中国针灸

It has the important enlightenment and reference significance for the inheritance and innovation of jin (sinew/fascia) diseases and its theoretic basis, jingjin (muscle region of meridian) doctrine by sorting out the origin of the acupuncture techniques for jin diseases and exploring the root of its rise and fall. Using context analysis, overall investigation and practice test, the paper elaborates the basic concepts, e.g. needling techniques for jin, jingjin, jinji (muscular contracture) and jiejin (knotted tendon), and jingjin doctrine. In particular, the three key concepts, i.e. fanzhen jieci (heating after needling), yizhi weishu (feelings from patients and acupuncture operators) and yitong weishu (the worst painful sites of muscle spasm) are deeply investigated. These three concepts, involved in the treatment of jingjin disorders, treatment principles and methods, are of a great controversy in the current academic circle. The author clarified the category of needling for jin disease and main needling techniques, investigated specially the origin of fanzhen jieci and guancifa (repeated needling directly on the foci), and explored the evolution of the needling methods that had been controversial or neglected for a long time, i.e. neire cifa (technique for inducing heat inside for cold obstruction), guancifa, tiaocifa (inserting the needles around the foci), fencifa (intramuscular needling) and mucifa (deep puncturing to the peritoneum or on front-mu points). Finally, from the relationship between jin and mai (meridian), and the differences between dry needling and acupuncture technique for jin diseases, the author explored the crucial problems and countermeasures urgently required in the future development of jingjin doctrine so as to provide the references for the theoretical innovation of acupuncture- moxibustion science.

Trigger point dry needling increases masseter muscle oxygenation in patients with temporomandibular disorder

Abstract Background: Temporomandibular disorder (TMD) is an umbrella term encompassing various clinical complaints involving the temporomandibular joints, masticatory muscles, and/or associated orofacial structures. Myogenous TMDs are the most frequent cause of chronic orofacial pain. Musculoskeletal pain is commonly associated with myofascial trigger points (MTPs), for which dry needling (DN) is a routine treatment. Objective: To investigate muscle oxygenation and pain immediately after DN application on an MTP in the masseter muscle of patients with myogenous TMDs. Methodology: Masseter muscle oxygen tissue saturation indices (TSI%) were assessed by near-infrared spectroscopy (NIRS) pre- and post-interventions by a randomized, controlled, double-blind, crossover DN/Sham clinical trial (primary outcome). Pain was investigated by the visual analog scale (VAS). In total, 32 individuals aged from 18 to 37 years who were diagnosed with myogenous TMD and myofascial trigger points in their masseter muscles participated in this study. Relative deltas for the studied variables were calculated. Data normality was tested using the Shapiro-Wilk test. According to their distribution, data were analyzed by two-way ANOVA and the Student's t-, and Mann-Whitney tests. Statistical analyses were performed using Prism® 5.0 (GraphPad, USA). Results: We found a significant difference (2,108% vs. 0,142%) between masseter muscle TSI% deltas after the DN and Sham interventions, respectively (n=24). We only evaluated women since men refused to follow NIRS procedures. Pain increased immediately after DN (n=32, 8 men), in comparison to Sham delta VAS. Conclusion: These findings show an increase in tissue oxygen saturation in the evaluated sample immediately after the DN intervention on the MTP of patients' masseter muscle. Pain may have increased immediately after DN due to the needling procedure.

La electrólisis percutánea intratisular: una revisión sistemática / Percutaneous intratissue electrolysis: a systematic review

La electrólisis percutánea intratisular es un procedimiento terapéutico tecnológico mínimamente invasivo para el tratamiento de lesiones en el sistema musculoesquelético mediante inflamación controlada y fagocitosis para recuperar el tejido afectado. Acerca de esta, se realizó un análisis de la producción científica publicada de 2014 a 2021. El estudio se realizó por medio de una revi-sión bibliográfica sistémica siguiendo la metodología PRISMA, que incluyó el uso de fuentes de información en las bases científicas: PubMed, SciencieDirect, EuropePMC, ResearchGate, Sage Journal, Thiem Connect y PHysiotherapy evidence database (PEdro). Previamente al procesa-miento de los datos, los documentos encontrados fueron sometidos diversos criterios de selec-ción. Los investigadores concluyeron que la electrólisis percutánea intratisular resulta un trata-miento efectivo para el tratamiento de tendinopatías crónicas, cuando se realiza combinado con un programa de ejercicios enfocado en la progresión de las cargas.

This work presents an analysis of the scientific production developed between 2014 and 2021 on percutaneous intratissue electrolysis. The objective is to analyze the bibliograpHy on the diffe-rent EPI interventions. The study was carried out through a systemic review following a methodological process according to PRISMA using various sources for the collection of information, such as: Pubmed, Scienciedirect, Europe PMC, Hindawi, Cochrane, Sage Journal, Thiem Connect, Pedro, Puerta Of the investigation. Selection and quality criteria were applied to these documents, with a subsequent analysis using qualitative techniques. In conclusion, intratissue percutaneous electrolysis turns out to be a favorable tool in the treatment of chronic tendinopathies as long as it is combined with an exercise program focused on load progression.

Comparative Study Of Dry Needling V/S Transcutaneous Electrical Nerve Stimulation In The Treatment Of Hamstring Strain In Football Players

Background:Myofascial pain syndrome is defined as sensory, motor and autonomic symptoms that are caused trigger points (MTrP). It is defined as a hyperirritable spot in skeletal muscle, which is associated with hypersensitive palpable nodule in a taut band. Objectives: Present study was undertaken to add on to available treatment methods for myofascial Trigger points and to find out the effectiveness of dry needling and Transcutaneous Electrical Nerve Stimulation (TENS) therapy for treating myofascial trigger point. Material And Methods:In this study, 32 participants were recruited based on inclusion and exclusion criteria. Dry Needling and TENS therapy was administered to them for a period of 2 weeks, 6 sessions in 2 weeks. Pre and post assessme nt were taken using following outcome measures-Pain Pressure Threshold, Numerical Pain Rating Scale (NPRS), Functional Assessment Scale for Acute Hamstring Injuries (FASH)Result:There was significant decrease in Pain due to hamstring injury on NPRS, agility score and increase in Pain Pressure threshold in patients which is suggestive of decrease in pain and improve functional independency. The outcome of Pressure Algometer, Agility score and NPRS were statistically analyzed. It was found to be effective with significant P value<0.000. Conclusion:Statistically both Dry Needling and TENS are competent enough to alleviate pain but clinically TENS having better response in pain depletion and in increase in functional independency compared to Dry Needling.

Effectiveness of Dry Needling in Bothersome Chronic Tinnitus in Patients with Myofascial Trigger Points

Abstract Introduction Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s. Objective To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP. Methods Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases. Results The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN (p= 0.024 and p = 0.011, respectively). The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN (p< 0.05). Conclusion The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.

Supplementing massage with dry needling can better relieve facial pain / 中华物理医学与康复杂志

Objective:To observe any effect of dry needling of myofascial trigger points on substance P and synaptophysin expression in the spinal dorsal horn.Methods:Sixty-four Sprague-Dawley rats were randomly divided into a control group ( n=16) and a model group ( n=48). Myofascial trigger points were induced in the model group by a blunt strike and eccentric running. That group was then randomly divided into a no-treatment group ( n=15), a massage group ( n=16), and a dry needling group (16 rats). The rats in the two treatment groups received 4 weeks of dry needling or Chinese massage. Pressure pain thresholds were recorded before the experiment and after the 4 weeks. The content of substance P and synaptophysin in the spinal dorsal horn were measured using immunoblotting and immunohistochemistry. Results:After the treatment 14 rats (93%) in the model group had trigger points, significantly higher than the 8 rats (50%) in the massage group and the 7 rats (44%) in the dry needling group. After treatment, the average pressure pain thresholds of the no-treatment and massage groups was significantly lower than the control group′s average, while the difference between the dry needling group and the control group was not significant. The average pressure pain threshold had improved significantly in the no-treatment group, the massage group and the dry needling group, and the averages of the massage group and the dry needling group were significantly higher than that of the no-treatment group. The level of substance P was significantly higher in the no-treatment group than in the other three groups and the ratio of substance P to Glyceraldehyde 3-phosphate dehydrogenase (GAPDH)was significantly higher. The substance P: GAPDH ratio of the massage group was significantly higher than that of the control group.Conclusions:Dry needling and massage are effective in relieving myofascial pain, at least in rats. Both can reduce the content of substance P in the spinal dorsal horn.

Improvement of Trigeminal Neuralgia after Massage Therapy and Dry Needling

@#Trigeminal neuralgia is a debilitating disease that can lead to depression and even suicide. Trigeminal neuralgia is usually treated using carbamazepine; however, many patients are refractory to such medical treatment. Thus, other treatment modalities are required, such as physical treatment and dry needling. The objective of this case report is to describe the management of trigeminal neuralgia in a 35 years old Malay housewife, who had left side atypical trigeminal neuralgia involving V2 region in the last four years, which was refractory to medical treatment. The application of Malay massage, combined with dry needling executed along the distribution of trigeminal nerve showed an improvement of pain on the Visual Analog Scale (VAS) from 7–8/10 to 0-1/10 after 11 sessions. Therefore, Malay massage combined with dry needling can be used as a non-pharmaceutical approach to managing trigeminal neuralgia.

Immediate Effect Of Dry Needling Vs Ultrasound On Releasing Trigger Points In Quadriceps In Patients With Patello-Femoral Pain Syndrome On Pain

Background: Patello-femoral pain syndrome is a very common complaint seen in adolescence and young adults characterized by pain around and behind the patella. There has been prevalence of trigger points in the quadriceps leading to disruption of the VMO/VL firing pattern due to muscle inhibition by pain. Current studies suggest the use of strengthening exercises for hip and knee not focusing on releasing the trigger points. Releasing these trigger points could give additional benefit to the patient and can also be employed along with other conventional therapies. Purpose of the study: To find out which treatment method gives faster results and works directly on the pain and function of the patient. Objectives: To assess the immediate effect of Dry Needling Vs Ultrasound on releasing Trigger points in Quadriceps in patients with Patello-femoral Pain Syndrome on pain and knee/lower extremity function. Study Design: Randomized Control trail Setting: OPD setting. Participants: 70 patients with chronic anterior knee pain, without any ligament, bony or sensory involvement around the knee. Main outcome measures: Numerical Pain rating scale and Pressure Algometer. Results: In the ultrasound group there was a change of 38.60% seen in NRPS post values with a mean difference of 2.21±1.21 and for pressure algometer a change of 36.23% was seen with a mean difference of 3.08±4.40. In the dry needling group there was a change of 64.53% seen in NRPS post values with a mean difference of 3.07±1.48 and for pressure algometer a change of 56.86% was seen with a mean difference of 8.36±6.90. When compared within group dry needling had a better effect than ultrasound on both NRPS and Pressure algomter. Conclusion: The current study indicates that Dry needling is more effective than ultrasound for reducing pain and increasing functional outcome in patients with patellofemoral pain syndrome.

Safe acupuncture and dry needling during pregnancy: New Zealand physiotherapists' opinion and practice / 中西医结合学报

OBJECTIVE@#Acupuncture guidelines have advised caution when treating women during pregnancy, because historical "forbidden" acupuncture points are believed to stimulate miscarriage or early labor. Despite recent research demonstrating that acupuncture is a useful and safe treatment tool for pregnancy-related low-back pain (LBP) and pelvic girdle pain (PGP), it is postulated that fear of miscarriage and subsequent blame by association, restricts its provision. More recently, an increase in dry needling (DN) courses for physiotherapists has potentiated the rapid growth in DN practice in New Zealand (NZ). Many dry needlers do not consider DN to be a form of acupuncture; it is unknown if they have similar safety concerns.@*METHODS@#NZ registered physiotherapists practicing acupuncture and/or DN were invited to participate in an electronic survey to examine their practice and level of understanding in regard to safe needling during pregnancy.@*RESULTS@#Of 124 respondents, only 60 (48%) would needle pregnant women, with a further 66% of those still expressing safety concerns. NZ physiotherapists practicing DN only, were more likely to needle areas related to "forbidden" points in all trimesters. However, overall, NZ physiotherapists were less likely to needle "forbidden" points than their UK peers.@*CONCLUSION@#Conflicting literature and a "fear of blame" influences NZ physiotherapists' decisions to offer needling (both acupuncture and DN) during pregnancy. Further training in this field is recommended to ensure safe practice and adequate provision of acupuncture treatment options for pregnant women suffering musculoskeletal pain, such as LBP and PGP. Further research, particularly into DN, for women during pregnancy, is warranted.

Non-acupoint effects: based on the analysis of traditional acupuncture-moxibustion theory / 中国针灸

Based on the traditional theory in (), the acupuncture effects of non-acupoints on the body surface were explored. There are the effects of the non-acupoints on meridians, the effects of five tissues (local effects, resonance effects, five- effects and particular effects) and regional effects (nearby effects, structural corresponding effects, holistic effects and the special effects on the specific regions), etc. The innovative recognitions are proposed. ① Stimulating the non-acupoint sites on the body surface generates definite effects, not limited to the local nearby effects. For example, the resonance effects and five- effects are generated by stimulating five tissues. The counter-acting force presents between five tissues and five- organs. ② The regional effects are rich in content and its mechanisms on the induction, coordination and correspondence are not in reference to , meridian and collateral, but are related to the characteristics of activity of the regional body itself. ③ Acupuncture presents not only the effects of the abstract meridian-collateral and the acupoints, but also the effects of concrete five tissues and regions. Acupuncture therapeutic effects may result from the cumulative effects, especially related to the stimulation of the strength by the needle tip. ④ Regarding the differences in the effects between the meridian points and non-acupoint stimulation, the former attaches the importance on " ", which is abstract and dynamic and the later on "shape", which is concrete and static.

Ultrasound-guided dry needling for myofascial trigger points in treatment of plantar fasciitis / 中国医学影像技术

Objective: To explore the clinical effect of ultrasound-guided dry needling of myofascial trigger points in treatment of plantar fasciitis. Methods: Totally 48 patients with plantar fasciitis were randomly divided into 2 groups. Patients in the simple treatment group (n=24) received sole non-weight-bearing plantar fascia stretching training, and the ones in the combined treatment group (n=24) received ultrasound-guided dry needling for myofascial trigger points combined with stretching training. The numeric pain-rating scale (NPRS) of the first move, American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS), physical component summary (PCS) and mental component summary (MCS) of 36-item short-form health survey were evaluated before (T0) as well as 1 month (T1) and 3 months (T2) after treatment respectively. Results: The overall differences of NPRS, AOFAS, PCS and MCS were significant before and after treatment in both two groups (all P0.05). Conclusion: Ultrasound-guided dry needling for myofascial trigger points combined with stretching training and sole non-weight-bearing plantar fascia stretching training are both effective for treatment of plantar fasciitis, while the former is better for relieving pain and improving ankle function.

A efetividade de dois tratamentos para disfunção temporomandibular muscular: estudo piloto / The effectiveness of two treatments for muscle temporomandibular dysfunction: pilot study

Objetivo: comparar a eficácia de dois protocolos de tratamento para disfunção temporomandibular (DTM) de origem muscular. Sujeitos e método: Estudantes da Faculdade Especializada na Área de Saúde do Rio Grande do Sul foram selecionados por meio de questionário, para avaliar a presença de sinais e sintomas de DTM e diagnóstico de DTM muscular pelos Critérios de Diagnóstico para Transtornos da Pesquisa Temporomandibular. Dez estudantes compuseram a amostra, divididos em dois grupos, de acordo com o protocolo de tratamento: G1 ­ hipertermia induzida, exercícios mandibulares e massagem; e G2 ­ agulhamento seco, hipertermia induzida, exercícios mandibulares e massagem. Os alunos foram instruídos a realizar o protocolo do tratamento G1 todos os dias em casa e na instituição de ensino por três sessões, que ocorreram a cada cinquenta dias. O agulhamento seco foi realizado no G2 apenas nas segunda e terceira sessões de tratamento. Para avaliar a efetividade dos dois tratamentos antes e após cada sessão, avaliaram-se: abertura bucal (AB), por meio de régua milimetrada; dor, pela escala visual analógica; força de mordida (FM), usando um medidor de força digital; e qualidade de vida, avaliada imediatamente antes do início do tratamento e depois do término do tratamento. Resultados: a dor mostrou diferença estatística significativa no G2 após a segunda sessão (p=0,020) e a terceira sessão (p=0,047). Os demais resultados mostram que não houve diferença estatisticamente significativa entre os grupos (p>0,05). Conclusão: considera-se que neste estudo piloto ambos os tratamentos foram eficazes para DTM muscular, uma vez que todos os pacientes apresentaram melhora dos sintomas. Não houve diferença estatisticamente significativa entre os tratamentos, exceto a dor pós-procedimento, causada pela técnica do agulhamento seco. (AU)

Objective: the present study aims to compare the efficacy of two treatment protocols for temporomandibular dysfunction (TMD) of muscular origin. Subjects and method: students of the Faculdade Especializada na área de Saúde do Rio Grande do Sul, that were selected through the questionnaire to evaluate the presence of TMD signs and symptoms and diagnosis of muscular TMD from the Diagnostic Criteria for Temporomandibular Research Disorders. Ten students composed the sample, divided into two groups according to the treatment protocol: hyperthermia induced by G1, mandibular exercises and massage; G2 ‒ dry needling, induced hyperthermia, mandibular and massage exercises. Students were instructed to complete the G1 treatment protocol every day at home and at the educational institution for three sessions that occurred every fifty days. Dry needling was performed in G2 only in the second and third treatment sessions. To evaluate the effectiveness of the two treatments before and after each session, we evaluated: mouth opening (AB), through a millimeter ruler; visual analogue scale; bite force (FM) using a digital force gauge and quality of life was assessed immediately prior to initiation of treatment and after termination of treatment. Results: pain obtained a statistically significant difference in G2 after the second session (p=0.020) and the third session (p=0.047). The other results show that there was no statistically significant difference between the groups (p>0.05). Conclusion: it is considered that in this pilot study both treatments were effective for muscular TMD, since all the patients presented improvement of the symptoms. There was no statistically significant difference between treatments, except for post- -procedure pain, caused by the dry needling technique. (AU)

Understanding of the trigger points of myalgia: acupuncture and dry needling exploration and modern acupuncture mechanism / 中国针灸

The similarities and differences between trigger points of myalgia and acupoints were explored. Nodules could be detected by B-ultrasound at trigger points of myalgia, but not acupoints. In clinical symptoms, the referred pain pathway of trigger points of myalgia is similar with the pathway of acupuncture meridian. Therefore, the location of trigger points of myalgia should take referred pain as pathway, which is similar with locating acupoints as meridian. Acupuncture at trigger points of myalgia takes jumping feeling as criterion, while acupuncture at acupoints are mainly based on acid swelling and numbness. From clinical observation to basic experimental research, a lot of pathophysiological evidence is provided for trigger point of myalgia. It is believed that the trigger point of myalgia might be the precise acupoint in modern scientific research, and the meridian is the synthesis of the mechanics of nerve, blood vessel and fascia. Although acupuncture and dry needling are different in theory, but the scientific foundation of TCM and western medicine is coherent.

Effects of Inner Heating Dry Needle Therapy on Nonspecific Chronic Neck Pain: A Ultrasound Elastography Study / 中国康复理论与实践

@#Objective To explore the clinical effect of inner heating dry needle therapy on nonspecific chronic neck pain (NCNP). Methods From October, 2017 to March, 2018, 60 patients with NCNP were randomly divided into needle group (n=30) and magner group (n=30). The needle group received inner heating dry needle therapy, and the magner group received hot magner therapy. They were measured the strain ratio (SR) of bilateral trapezius muscles, scalp clamp muscles, cephalospinal muscles, semispinalis muscles and multifidus muscles with ultrasound elastography before, and one week and one month after treatment, respectively, while they were assessed with Visual Analogue Scale (VAS) of pain and Neck Disability Index (NDI). Results The scores of VAS and NDI decreased in both groups one week and one month after treatment (t>2.693, P<0.05), and decreased more in the needle group than in the magner group (F>8.048, P<0.001). SR of all the muscles decreased in the needle group one week and one month after treatment (F>6.22, P<0.01), and only decreased in the right cephalospinal muscles in the magner group (F=4.35, P<0.05).Conclusion Inner heating dry needle therapy could recover the neck muscle elasticity to relieve pain and improve ceivical function in patients with NCNP.

Effect of Dry Needling Stimulation of Myofascial Trigger Point on Sample Entropy of Electromyography of Gastrocnemius Injured Site in Rats / 针刺研究

OBJECTIVE: To attempt to establish an objective quantitative indicator to characterize the trigger point activity, so as to evaluate the effect of dry needling on myofascial trigger point activity. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into blank control group, dry needling (needling) group, stretching exercise (stretching) group and needling plus stretching group (n＝6 per group). The chronic myofascial pain (trigger point) model was established by freedom vertical fall of a wooden striking device onto the mid-point of gastrocnemius belly of the left hind-limb to induce contusion, followed by forcing the rat to make a continuous downgrade running exercise at a speed of 16 m/min for 90 min on the next day which was conducted once a week for 8 weeks. Electromyography (EMG) of the regional myofascial injured point was monitored and recorded using an EMG recorder via electrodes. It was considered success of the model if spontaneous electrical activities appeared in the injured site. After a 4 weeks' recovery, rats of the needling group were treated by filiform needle stimulation (lifting-thrusting-rotating) of the central part of the injured gastrocnemius belly (about 10 mm deep) for 6 min, and those of the stretching group treated by holding the rat's limb to make the hip and knee joints to an angle of about 180°, and the ankle-joint about 90° for 1 min every time, 3 times altogether (with an interval of 1 min between every 2 times). The activity of the trigger point was estimated by the sample entropy of the EMG signal sequence in reference to Richman's and Moorman's methods to estimate the curative effect of both needling and exercise. RESULTS: After the modeling cycle, the mean sample entropies of EMG signals was significantly decreased in the model groups (needling group [0.034±0.010], stretching group [0.045±0.023], needling plus stretching group [0.047±0.034]) relevant to the blank control group (0.985±0.196, P0.05), suggesting a better efficacy of dry needling in easing trigger point activity. CONCLUSION: Dry needling is able to relieve myofascial trigger point activity in rats, which is better than that of simple passive stretching therapy.

Comments on the definition of "acupuncture science" / 中国针灸

The experts in China believe that the substance of "dry needling" is in the category of acupuncture therapy for the treatment by needle inserting the human body. But, its recognition has not been implied from the definition of "acupuncture science". Since 1970 s, the different definitions of it are closely related to TCM theories, due to which, it has been limited. This flaw restricts the development of acupuncture theory, narrows the connotation of acupuncture science and goes against the communication of traditional Chinese acupuncture theory. No matter regarding the theory or technique, the acupuncture therapy nowadays changes greatly in its connotation. Rather than guided by TCM theories, acupuncture therapy mainly includes the nerve trunk stimulation theory, the cerebral function orientation therapy, biological holographic therapy, fascia stimulation therapy and trigger therapy, etc. Expect that the medical devices used in these therapies are same as the traditional acupuncture, these methods cannot be regarded in the category of acupuncture science when the current definition of it is considered. Hence, the writer is trying to define "acupuncture science" as: acupuncture science refers to the science for the methodology and mechanism of therapeutic devices, e.g. acupuncture therapy and moxibustion therapy, for the prevention and treatment of disease by stimulating the body, and its theory includes but not limits in traditional Chinese medical theory.