Immediate Effect of Ultrasound-Guided Dry Needling on Soleus Muscle Spasticity in Stroke Survivors.

BACKGROUND: Dry needling (DN) is commonly used to treat various neuromuscular syndromes. It is effective in reducing spasticity in stroke and other neurological conditions. The current study explores the immediate effect of ultrasound-guided dry needling on soleus muscle spasticity and thickness in individuals with stroke. METHODS: Approval was obtained from the Institutional Sub-ethics Committee of Dr. D. Y. Patil College of Physiotherapy, Pune. The trial was registered with the Clinical Trials Registry of India. Thirty stroke survivors having soleus muscle spasticity ranging from grade 1 to 4 on the Modified Modified Ashworth Scale (MMAS) were selected. Spasticity was also assessed using the Modified Tardeau Scale (MTS) and H-reflex. Soleus muscle architecture was assessed by using ultrasonography (USG). Participants received a single session of DN for the spastic soleus muscle. Pre and immediate post-DN outcome measures were assessed. RESULTS: Based on USG findings, the thickness of the soleus muscle significantly increased by 2.67 mm (p<0.001) after dry needling treatment. The MMAS showed decreased spasticity by 1.47 (p<0.001) for ankle plantar flexors. A significant reduction of H-reflex values by 1.4 mV (p<0.001) was noted. The MTS also showed a significant increase in the range of ankle motion by 2.7 (p<0.001). All these indicate an immediate reduction of spasticity following DN. CONCLUSION: Based on the findings of the current study, we can conclude that a single session of USG-guided DN has an immediate beneficial effect on reducing soleus muscle spasticity and increased muscle thickness in individuals with stroke.

Dry needling effects on motor impairments in a patient with traumatic brain injury: A case study.

BACKGROUND: Motor impairments are common consequences of traumatic brain injury (TBI). It affects the individuals' participation in activities of daily living (ADLs). Dry needling treatment (DNT) uses a specialized needle to alter cortical activity. This case study aims to examine the effects of DNT on spasticity, balance, gait, and self-independence in a single patient with TBI. CASE DESCRIPTION: A twenty-six-year-old male with a history of TBI, resulting in muscle weakness on the right side of the body, spasticity, distributed balance, and difficulties with independent gait participated in this study. The Berg balance scale (BBS), 6-min walk test (6MWT), Modified Ashworth Scale (MAS), and Functional Independence Measure (FIM) were used to evaluate balance, gait, spasticity, and functional performance, respectively. OUTCOME: After 36 DNT sessions extended over 12 weeks, the patient demonstrated improvements in spasticity, balance, gait, and functional capacity both immediately after the intervention and at the 4-week follow-up. CONCLUSION: This case study demonstrates that DNT is considered a novel intervention for treating spasticity and improving balance, gait, and functional capacity post-TBI. Further research is recommended to verify these findings.

Placebo and nocebo effects of percutaneous needle electrolysis and dry-needling: an intra and inter-treatment sessions analysis of a three-arm randomized double-blinded controlled trial in patients with patellar tendinopathy.

Objective: This study aimed to investigate the influence of potential placebo and nocebo effects on pain perception of percutaneous needle electrolysis (PNE) in individuals with patellar tendinopathy. Methods: In this secondary analysis of a three-arm randomized double-blinded controlled trial, intra and inter-session pain perception data from 48 sporting participants with patellar tendinopathy between 18 and 45 years were investigated. Participants were divided into 3 parallel groups: "no-sham group" [PNE intervention], "single-sham group" [sham PNE by using dry needling], and "double-sham group" [sham PNE by using sham needles]. Every group received 4 sessions of the needling therapies targeting the patellar tendon over 8 weeks and was instructed to perform a unilateral eccentric exercise program of the quadriceps muscle on the affected side. Clinical and needle-related pain was assessed before, during, and after each treatment session using a visual analog scale. Results: No differences were found between groups intra- or inter-session in terms of pain reduction (P = 0.424) despite clinical pain decreased in all groups since the first treatment session (P < 0.001). Furthermore, although the double-sham group showed a lower percentage of participants reporting needle-related pain during needle intervention (P = 0.005), the needle-related pain intensity after needle intervention was similar between groups (P = 0.682). Moreover, there were no group differences for the duration of pain sensation after any needle intervention (P = 0.184), extending in many cases beyond 24 h. Conclusion: Needling therapies for individuals with patellar tendinopathy are prone to elicit placebo effects regarding clinical pain and nocebo effects regarding needling-related pain. Clinicians and physical therapists treating musculoskeletal pain conditions should consider the added value and potential mechanisms of action before routinely using needle techniques.

The Effect of Acupuncture on Brain Iron Deposition and Body Iron Metabolism in Vascular Cognitive Impairment: Protocol for a Randomized Controlled Trial.

BACKGROUND: Vascular cognitive impairment (VCI) persistently impairs cognition and the ability to perform activities of daily living, seriously compromising patients' quality of life. Previous studies have reported that disorders of serum iron metabolism and iron deposition in the brain can lead to inflammation, abnormal protein aggregation and degeneration, and massive neuronal apoptosis in the central nervous system, which in turn leads to a progressive decline in cognitive processes. Our previous clinical studies have found acupuncture to be a safe and effective intervention for treating VCI, but the specific mechanisms require further exploration. OBJECTIVE: The objective of the trial is to evaluate the clinical efficacy of Tongdu Xingshen acupuncture and to investigate whether it can improve VCI by regulating brain iron deposition and body iron metabolism. METHODS: In total, 42 patients with VCI and 21 healthy individuals will participate in this clinical trial. The 42 patients with VCI will be randomized into acupuncture and control groups, while the 21 healthy individuals will be in the healthy control group. Both the control and acupuncture groups will receive conventional medical treatment and cognitive rehabilitation training. In addition, the acupuncture group will receive electroacupuncture treatment with Tongdu Xingshen for 30 minutes each time, 6 times a week for 4 weeks. Meanwhile, the healthy control group will not receive any intervention. All 3 groups will undergo baseline assessments of brain iron deposition, serum iron metabolism, and neuropsychological tests after enrollment. The acupuncture and control groups will be evaluated again at the end of 4 weeks of treatment, as described earlier. By comparing neuropsychological test scores between groups, we will examine the efficacy of Tongdu Xingshen acupuncture in treating VCI. Additionally, we will test the correlations between neuropsychological test scores, brain iron deposition, and body iron metabolism indexes to explore the possible mechanisms of Tongdu Xingshen acupuncture in treating VCI. RESULTS: Participants are currently being recruited. The first participant was enrolled in June 2023, which marked the official start of the experiment. As of the submission of the paper, there were 23 participants. The recruitment process is expected to continue until June 2025, at which point the processing and analysis of data will begin. As of May 15, 2024, up to 30 people have been enrolled in this clinical trial. CONCLUSIONS: This study will provide data on the effects of Tongdu Xingshen acupuncture on cerebral iron deposition as well as somatic iron metabolism in patients with VCI. These results will help to prove whether Tongdu Xingshen acupuncture can improve VCI by regulating brain iron deposition and body iron metabolism, which will provide the clinical and theoretical basis for the wide application of acupuncture therapy in VCI rehabilitation. TRIAL REGISTRATION: China Clinical Registration Agency ChiCTR2300072188; https://tinyurl.com/5fcydtkv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56484.

Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial.

Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the "static needling", the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception. Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).

The Effect of Ankle Muscles Dry Needling on Brain Activity Map Based on fMRI: a Study Protocol for Randomized Controlled Trial.

Importance: Neuromodulation may be one of the underlying mechanisms of dry needling (DN); however, the mechanism has not yet been fully clarified. Objective: This randomized controlled trial is designed to evaluate DN stimulation of the tibialis anterior and peroneus longus muscles in chronic ankle instability (CAI) and healthy subjects, employing functional magnetic resonance imaging (fMRI). Design: Clinical study protocol, SPIRIT compliant. Setting: Brain Mapping Laboratory. Population: A total of thirty participants aged between 18 and 40 years old will be included in this study. Twenty healthy participants will be randomized into 2 groups (real DN and sham DN). Ten patients with CAI will also be recruited to the third group and receive only real DN for comparison. Exposures: Real and sham DN. Main Outcomes and Measures: The voxel count, coordinates of peak activation, and peak intensity will be obtained as primary outcomes to report brain map activation. Measurements will be taken before, during, and after DN treatment. The strength of the ankle dorsiflexors, active dorsiflexion range of motion, and McGill pain questionnaire short-form will be used as secondary outcome measures. Results: The results from this study will be published in peer-reviewed journals and disseminated as presentations at national and international congresses. Conclusion: This trial will explore brain responses to real and sham DN in healthy participants and to real DN in CAI patients. Overall, our results will provide preliminary evidence of the neural mechanism of DN.

Dry Needling in Overhead Athletes with Myofascial Shoulder Pain: A Systematic Review.

The treatment of myofascial pain in athletes requires a set of rehabilitation techniques that aim to be effective quickly. In this context, dry needling (DNY) has shown interesting results due to its ability to reduce pain in the short term. Thus, the aim of this study was to investigate the role of DNY in managing myofascial shoulder pain in overhead athletes. PubMed, Scopus and Web of Science were screened up to March 2024, to identify studies that met the following inclusion criteria: overhead athletes with shoulder pain with a DNY approach for myofascial trigger points (MTrPs), RCT, case-control study, feasibility study as the study design. Exclusion criteria were studies that did not include athletes, studies that did not focus on the treatment of MTrPs with DNY, other reviews, no full-text availability and papers written in a language other than English. Out of 399 articles, 165 were excluded as duplicates. Of the 234 articles screened, only 6 articles met the inclusion criteria. A total of 6 studies were included in the systematic review. Initial results showed that DNY improved pain rapidly and in the short term; however, there is still no consensus on the minimum number and the interval between treatments. Major findings reported a rapid potential decrease in perceived pain, shoulder disability and an increase in muscle strength; in this scenario, DNY might be a valid solution in a sports rehabilitation setting.

Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report.

Key Clinical Message: The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract: Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.

Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography.

OBJECTIVE: To investigate the structural alterations, neovascularity, and elasticity of tendons and the relationship between elasticity and the Patient Rated Tennis Elbow Evaluation score after undergoing US-guided fenestration or surgery in patients with chronic lateral elbow tendinopathy. METHODS: Participants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models. RESULTS: Fenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome. CONCLUSIONS: Fenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity. CRITICAL RELEVANCE STATEMENT: Fenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity's potential for quantitatively monitoring tendon elasticity during healing. KEY POINTS: Reliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking. Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity. Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment.

Immediate Effects of Instrument-Assisted Soft-Tissue Mobilization Versus Dry Needling on Trigger Point Pain and Tightness of Calf Muscles in Long-Distance Runners.

Introduction Muscle tightness is frequently identified as a potential precursor to muscle injuries. Reclaiming flexibility and enhancing range of motion (ROM) is crucial for preventing injuries and achieving improvements in performance. The present study examines the immediate effects of instrument-assisted soft-tissue mobilization (IASTM) and dry needling (DN) in reducing trigger point pain and calf tightness in long-distance runners. Methodology A total of 40 long-distance runners were recruited in the study (30 males and 10 females). The procedure was performed under the author's surveillance at the sports complex. These recruited players were placed into two groups: the IASTM (n=20) and the DN (n=20) group. The outcome measures used were the pressure algometer for assessing pain pressure threshold and the lunge test. An iPhone Measure app (Measure app, Apple App Store 2023) is used to assess ankle dorsiflexion ROM. The evaluation took place both prior to and immediately following the intervention and 48 hours after the intervention. Result The analysis within each group revealed a significant alteration in pain pressure threshold for both the IASTM and DN groups (p≤0.05), along with a relative enhancement in ankle dorsiflexion ROM observed in the IASTM group (p≤0.05). Between-group analysis revealed a notable difference with an effect size difference of Cohen's d=1.06 (large difference) in pain pressure threshold, d=0.21 (small difference) in lunge test, and d=0.57 (medium difference) in ankle dorsiflexion ROM. Conclusion The present study concludes that both groups, IASTM and DN, showed significant effects in improving pain pressure threshold in long-distance runners. However, DN showed better results. IASTM showed significant results in enhancing the ankle dorsiflexion ROM immediately. This implies that it can be used in conjunction with stretching to decrease pain and enhance flexibility, hence improving performance and preventing injuries.

Using Dry Needling to Improve the Quality of Life of Patients With Shoulder Dysfunction Following Neck Dissection: An Innovative Case Report.

The spinal accessory nerve manipulation or sacrifice during neck dissection results in trapezius muscle denervation and atrophy, leading to shoulder disability. Patients start experiencing pain and weakness while moving their shoulders, including elevation, rotation, and abduction, as well as reduced range of motion (ROM) and dropping of the shoulders. There are several ways to treat the condition, including using painkillers or undergoing physical therapy. Physical therapy plays a major role in improving shoulder function. Dry needling (DN) is an emerging treatment modality that involves eliciting a local twitch response in the region of myofascial trigger points, which can reduce pain and increase the ROM. This case report documents how DN improved shoulder function in a 51-year-old female who had pain when moving the shoulders and limited ROM after undergoing a modified radical neck dissection.

Navigating the layers of concern for safe dry needling of the rectus abdominis: a cadaveric study.

OBJECTIVES: To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. METHODS: Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. RESULTS: Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. DISCUSSION/CONCLUSION: Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice.

Effects of different treatments on pain, functional disability, position sense and range of motion in elite bodybuilders with chronic low back pain.

Back pain is one of the major global challenges and is one of the most prevalent musculoskeletal disorders occurring in 80% of people at least once in their lifetime. Therefore, the need to find appropriate treatment methods for this issue is very important. The objective is to examine the short-term and acute effects of a treatment session with dry needling, massage therapy, stretching exercises and Kinesio tape on pain, functional disability, position sense and range of motion in elite bodybuilders with non-specific chronic low back pain. The sample of this quasi-experimental study consisted of 48 bodybuilders with non-specific chronic low back pain (all male, mean age = 25.96 ± 2.18 years; mean weight = 74.45 ± 4.51 kg; mean height = 173.88 ± 3.74 cm; mean BMI = 24.60 ± 0.74 kg/m2) who randomly were placed in 4 dry needling, massage therapy, stretching exercises and Kinesio tape groups. The duration of each intervention was 30 min. The dependent variables in this study included the massage range of motion, position sense tests and visual pain scale that were taken separately from each subject in pretest, posttest (acute effect) and follow-up test (72 h after posttest; short-term effect). The results of a 4 (groups) × 3 (time) the mixed ANOVAs showed that pain in the short-term phase was significantly lower in the dry needling group than in the stretching and massage groups (P < 0.05). Also in the acute effect phase, the flexion range of motion was significantly lower in the dry needling group than in the massage group (P < 0.05). Furthermore, the two groups of stretching and massage exercises showed significantly greater range of motion (P < 0.05). Other comparisons were not significant (P > 0.05). The findings of the study showed that both massage and stretching treatment have higher acute effects, while dry needling treatment was more effective in follow up. On the other hand, these findings show that these treatment methods can have immediate and lasting positive effects in improving the performance in elite bodybuilders with non-specific chronic low back pain.

Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: A multicenter randomized clinical trial.

OBJECTIVE: The purpose of this study was to assess the effects of adding electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization, and ultrasound in patients with lateral elbow tendinopathy. DESIGN: Randomized, single-blinded, multicenter, parallel-group trial. SETTING: Thirteen outpatient physical therapy clinics in nine different US states. PARTICIPANTS: One hundred and forty-three participants (n = 143) with lateral elbow tendinopathy were randomized. INTERVENTION: Cervical spine manipulation, extremity manipulation, and percutaneous tendon electrical dry needling plus multimodal physical therapy (n = 73) or multimodal physical therapy (n = 70) alone. MAIN MEASURES: The primary outcome was elbow pain intensity and disability as measured by the Patient-Rated Tennis Elbow Evaluation at baseline, 1 week, 4 weeks, and 3 months. Secondary outcomes included the Numeric Pain Rating Scale, Tennis Elbow Functional Scale, Global Rating of Change, and medication intake. RESULTS: The 2 × 4 analysis of covariance demonstrated that individuals with lateral elbow tendinopathy receiving electrical dry needling and thrust manipulation plus multimodal physical therapy experienced significantly greater improvements in disability (Patient-Rated Tennis Elbow Evaluation: F = 19.675; P < 0.001), elbow pain intensity (Numeric Pain Rating Scale: F = 22.769; P < 0.001), and function (Tennis Elbow Function Scale: F = 13.269; P < 0.001) than those receiving multimodal physical therapy alone at 3 months. The between-group effect size was large for pain and disability (Patient-Rated Tennis Elbow Evaluation: standardized mean difference = 1.13; 95% confidence interval: 0.78, 1.48) in favor of the electrical dry needling and thrust manipulation group. CONCLUSIONS: The inclusion of percutaneous tendon electrical dry needling and thrust manipulation into a multimodal program of exercise, mobilization and ultrasound was more effective than multimodal physical therapy alone in individuals with lateral elbow tendinopathy.Trial Registration: www.clinicaltrials.gov NCT03167710 May 30, 2017.

A survey study for the dental students' satisfaction with the "needling therapies for temporomandibular disorders" lectures.

Background/purpose: Dry needling therapy and acupuncture can effectively relieve myofascial pain in temporomandibular disorders (TMDs). This study evaluated dental students' satisfaction with the "needling therapies for TMDs" lectures given in 2022 and 2023. Materials and methods: The "needling therapies for TMDs" lectures included mainly a dry needling therapy lecture and an acupuncture lecture which were given to the fifth-year dental students in both 2022 and 2023. An additional needling therapy demonstration lecture was given in 2023 only. Immediately after the lectures, the students were asked to complete an online-based questionnaire with four survey questions regarding their satisfaction with (1) the dry needling therapy, (2) the acupuncture, (3) the overall, and (4) the needling therapy demonstration lectures using 5-point Likert scale ratings. Results: Fifty-three (80 %) of 66 and 60 (81 %) of 74 students answered the questions in 2022 and 2023, respectively. The satisfaction rates improved from 70 % in 2022 to 83 % in 2023 for the dry needling therapy lecture, from 64 % in 2022 to 85 % in 2023 for the acupuncture lecture, and from 70 % in 2022 to 88 % in 2023 for the overall lecture. The satisfaction rate was 88 % in 2023 for the needling therapy demonstration lecture. Conclusion: The results of this study suggest that inclusion of the needling therapy demonstration lecture in 2023 can results in a marked increase in the satisfaction rates for the lectures. The relatively-lower satisfaction rate for the acupuncture lecture in 2022 may be due to the difficulty in understanding the mechanisms underlying the acupuncture therapy.

Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study.

Tension-type headache is the most prevalent type of headache and is commonly associated with myofascial pain syndrome and the presence of active myofascial trigger points. This randomized controlled trial aimed to assess the impact of dry needling on the total number of active trigger points, pain intensity, and perceived clinical change in tension-type headache subjects. Thirty-two subjects were randomly assigned to the control and dry needling groups. The presence of active trigger points in 15 head and neck muscles, the headache intensity, and the perceived clinical change were evaluated. A single dry needling technique was administered at each active trigger point across three sessions. Significant differences were observed in the post-treatment measures favouring the dry needling group, including reductions in the headache intensity scores (p = 0.034) and the total number of active trigger points (p = 0.039). Moreover, significant differences in the perception of clinical change were found between the control and treatment groups (p = 0.000). Dry needling demonstrated positive effects in reducing the number of active trigger points and improving the short-term headache intensity in tension-type headache patients. A single dry needling session applied in the cranio-cervical area resulted in a self-perceived improvement compared to the control subjects.

Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial.

Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.

Lumbopelvic manipulation alone versus combined with dry needling in physically active patients with patellofemoral pain syndrome: A randomized clinical trial.

INTRODUCTION: Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD: Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS: The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION: The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.

Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS. METHODS: Thirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor. RESULT: After DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7-0.08), p < 0.05, d = 0.56 (0.1-1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (-6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to -0.02)] compared to the control group. CONCLUSION: The findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

Treating Lateral Epicondylopathy With Dry Needling and Exercise: A Case Series.

CONTEXT: Lateral epicondylopathy (LE) is a common overuse injury affecting elbow, wrist, and hand function. It is characterized by weakness and pain in the muscles and tendons of the forearm responsible for the extension of your wrist and fingers. Trigger point dry needling is a technique reported to be beneficial in managing pain and dysfunction after LE diagnosis. LE is also commonly treated with conservative treatment, such as joint and soft tissue mobilization, self-care home programs, and anti-inflammatory use. We explored a different dry needling approach consisting of in situ dry needling with electric stimulation combined with targeted therapeutic exercise to treat LE in 3 cases. CASE PRESENTATION: Three patients were referred for dry needling once a week for 6 weeks and home-based exercise therapy for LE. They were clinically evaluated using grip strength, a visual analog scale to assess pain, and Patient-Rated Tennis Elbow Evaluation Test scores. These were measured at 4 time points (weeks 0, 2, 4, and 6). MANAGEMENT AND OUTCOMES: The dry needling intervention incorporated 8 locations in the upper-extremity with 2 electric stimulation channels. The patients had reduced pain as measured by a visual analog scale, increased function as measured by the Patient-Rated Tennis Elbow Evaluation Test, and increased grip strength over 6 weeks. CONCLUSIONS: This case series illustrates the use of dry needling and a home exercise program to provide a favorable outcome in a patient with LE. Patients had an 80% to 100% reduction in pain and similar improvements in function that were significantly beyond the minimum clinically important difference. This dry needling approach is a safe and effective treatment of LE in the short term.