Post-needling soreness depending on the time of dry needling (before, during and after a manual therapy protocol) of an active myofascial trigger point in the upper trapezius muscle in patients with mechanical neck pain.

Patients will be randomly divided into 3 groups and all of them will receive a manual therapy and dry needling treatment. In each group, the dry needling will be performed at different times: 10 mins before manual therapy, 5 mins into the manual therapy and 10 mins after manual therapy. Description of the manual therapy: Pressure release over the upper trapezius will be applied. Briefly, pressure will be progressively increased over the upper trapezius until a definite increase in tissue resistance (barrier) will be perceived by the therapist. This pressure will be maintained until the clinician senses a relief of the taut band. This process will be repeated 3 times at each session. Patients also will receive a stretching intervention of the taut-band muscle fibers. The therapist applied moderate, slow pressure over the upper trapezius, sliding the fingers in opposite directions (3 longitudinal sweeps, with an approximate duration of 20 seconds per sweep). Trigger point manual therapy will be applied slowly, without inducing pain. Finally, passive stretching of the upper trapezius muscle will be also performed for 45 seconds. Description of the dry needling treatment: The dry needling treatment will be performed with disposable stainless-steel needles (0.32 × 40 mm) inserted into the skin over the upper trapezius area, using the fast-in and fast-out technique described by Hong. Once the upper trapezius is located with pincer palpation in the upper trapezius, the overlying skin will be cleaned with alcohol. The needle will be inserted into the upper trapezius until a local twitch response is obtained. A total of 10 repetitions will be made. The duration of the dry needling treatment will be 20 seconds. The manual therapy and the dry needling treatment will be administered by a physiotherapist.