Dry Needling Technique, Physical Therapy, Trigger Point Pain
Conditions
Keywords
dry needling, latent trigger point, physical therapy
Brief summary
This randomized single-blind clinical trial aims to compare the effects of different dry needling and electrical dry needling techniques applied to latent myofascial trigger points in the extensor digitorum muscle of the dominant forearm in healthy adults. Participants will be randomly allocated to one of five groups: a control group, a Hong fast-in and fast-out dry needling group, a rotational dry needling group, a bipolar electrical dry needling group, or a monopolar electrical dry needling group. The main outcomes will be post-needling soreness intensity and duration. Secondary outcomes will include pain during the needling procedure, pressure pain threshold assessed by algometry, handgrip strength, range of motion of finger flexion and wrist palmar flexion, perceived comfort during the intervention, and perceived interference of post-needling soreness with daily activities. Assessments will be performed at baseline, 5 minutes after the intervention, and at 24, 48, and 72 hours after the intervention.
Detailed description
Myofascial trigger points are hyperirritable spots located within a taut band of skeletal muscle. Latent myofascial trigger points do not cause spontaneous pain but may contribute to motor dysfunction, increased fatigability, reduced range of motion, and altered muscle performance. Dry needling is a commonly used physiotherapy technique for the treatment of myofascial trigger points. However, post-needling soreness is one of the most frequent adverse effects associated with this intervention and may influence patient comfort, adherence, and functional performance in the hours following treatment. Electrical dry needling, also known as intramuscular electrical stimulation, combines dry needling with transcutaneous electrical nerve stimulation applied through the inserted needle. Different modalities of electrical dry needling are used in clinical practice, including bipolar and monopolar applications. Nevertheless, limited evidence is available regarding the effect of these techniques on post-needling soreness, particularly when short-duration monopolar stimulation is applied using a pointer-type device. The aim of this randomized single-blind clinical trial is to compare the effects of different dry needling and electrical dry needling techniques applied to latent myofascial trigger points in the extensor digitorum muscle of the dominant forearm in healthy adults. The primary objective is to compare the effect of electrical dry needling versus Hong fast-in and fast-out dry needling on the intensity and duration of post-needling soreness. Secondary objectives include comparing post-needling soreness among the different dry needling techniques, analyzing immediate changes in handgrip strength, assessing changes in finger flexion and wrist palmar flexion range of motion, evaluating pain during the needling procedure, assessing pressure pain threshold by algometry, and analyzing perceived comfort and interference of post-needling soreness with daily activities. Healthy adults with a latent myofascial trigger point in the extensor digitorum muscle of the dominant forearm will be recruited. Participants will be randomly assigned to one of five groups: control group, Hong fast-in and fast-out dry needling group, rotational dry needling group, bipolar electrical dry needling group, or monopolar electrical dry needling group. Participants in the control group will not receive any dry needling intervention but will undergo the same assessment schedule as the intervention groups. In the Hong fast-in and fast-out dry needling group, a sterile needle will be inserted into the latent myofascial trigger point and repeated fast-in and fast-out movements will be performed. In the rotational dry needling group, a sterile needle will be inserted into the latent myofascial trigger point and a rotational dry needling technique will be applied according to the study protocol. In the bipolar electrical dry needling group, a sterile needle will be inserted into the latent myofascial trigger point, an adhesive electrode will be placed near the needle, and a TENS current will be applied for 15 minutes. In the monopolar electrical dry needling group, a sterile needle will be inserted into the latent myofascial trigger point and stimulation will be applied using a Pointer Plus Excel-II device for 3 minutes. Outcome assessments will be performed at baseline and 5 minutes after the intervention. Post-needling soreness intensity and duration will also be recorded at 24, 48, and 72 hours after the intervention. The study will use separated roles for recruitment, assessment, intervention delivery, and data analysis in order to reduce bias. Outcome assessors and the researcher responsible for data analysis will be blinded to group allocation.
Interventions
OTHERHong fast-in and fast-out dry needling
The skin will be disinfected with 0.5% alcoholic chlorhexidine. With the participant in supine position, a sterile needle will be inserted into the latent myofascial trigger point of the extensor digitorum muscle. Once the needle has reached the trigger point, 10 fast-in and fast-out movements will be performed. The number of local twitch responses will be recorded.
OTHERRotational dry needling
The skin will be disinfected with 0.5% alcoholic chlorhexidine. With the participant in supine position, a sterile needle will be inserted into the latent myofascial trigger point of the extensor digitorum muscle. Once the needle has reached the trigger point, the rotational dry needling technique will be applied according to the predefined study protocol.
OTHERBipolar electrical dry needling
The skin will be disinfected with 0.5% alcoholic chlorhexidine. With the participant in supine position, a sterile needle will be inserted into the latent myofascial trigger point of the extensor digitorum muscle. Once a local twitch response has been obtained, the needle will remain inserted and will act as the negative pole. An adhesive electrode connected to the positive pole will be placed approximately one centimeter from the needle. A TENS current will be applied for 15 minutes at a frequency of 2 Hz and a pulse width of 120 milliseconds. The intensity will be increased until visible, non-painful contractions of the extensor digitorum muscle are achieved.
OTHERMonopolar electrical dry needling
The skin will be disinfected with 0.5% alcoholic chlorhexidine. With the participant in supine position, a sterile needle will be inserted into the latent myofascial trigger point of the extensor digitorum muscle. Once a local twitch response has been obtained, the needle will remain inserted in the trigger point. The metallic tip of the Pointer Plus Excel-II device will be placed in contact with the needle, and a TENS current will be applied for 3 minutes at a frequency of 2 Hz and a pulse width of 220 milliseconds. The intensity will be increased until visible, non-painful contractions of the extensor digitorum muscle are achieved.
Sponsors
University Rovira i Virgili
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The study was conducted using a single-blind design. The researchers responsible for recruitment and assessments were unaware of each participant's intervention group, which helped reduce detection bias. Data analysis will be performed by an external researcher. The principal investigator will manage the study documentation, informed consent process, and randomization. Double blinding was not possible because the intervention involved invasive physical techniques, including dry needling and electrical dry needling. Therefore, participants could perceive differences between the procedures and were aware of whether they received an intervention or were allocated to the control group.
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
Yes
Inclusion criteria
* Adults aged 18 to 40 years. * Healthy participants with a latent myofascial trigger point in the extensor digitorum muscle of the dominant forearm. * No pathology affecting the upper limb where the intervention will be applied. * No episode of pain in the upper limb during at least the previous two months. * No contraindications to dry needling or electrical dry needling techniques. * Voluntary signature of the informed consent form. * Willingness to follow the protocol proposed by the research team.
Exclusion criteria
* Needle phobia. * Coagulation disorders. * Pregnancy. * Thyroid disorders. * Altered skin integrity in the treatment area. * Epilepsy. * Local or systemic infection. * Diagnosed neurological disorders affecting pain perception or neuromuscular function in the region of interest, such as multiple sclerosis or peripheral neuropathies. * Generalized chronic pain conditions, such as fibromyalgia. * Weekly use of analgesic medication, including anti-inflammatory drugs, opioids, or other pain-relieving medication.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post-needling soreness intensity | 1 week | Post-needling soreness intensity will be assessed using a numerical pain rating scale. Participants will rate the intensity of local soreness perceived in the needling area, clearly differentiated from any other type of pain. Higher scores indicate greater pain intensity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of post-needling soreness | 1 week | The duration of post-needling soreness will be recorded in hours, from the moment of onset until complete disappearance, based on participant self-report during the 24-, 48-, and 72-hour follow-up assessments. |
| Pain during needling | Immediately after the intervention | Pain perceived during the application of the dry needling or electrical dry needling technique will be assessed using a numerical pain rating scale. Participants will be asked to report the intensity of pain experienced during the procedure. |
| Pressure pain threshold | 1 week | Pressure pain threshold will be assessed using pressure algometry over the treated region. The value will be recorded as the minimum pressure that induces the first sensation of pain. |
| Handgrip strength | 1 week | Handgrip strength will be assessed using a hand dynamometer and recorded in kilograms. Measurements will be performed at baseline, 5 minutes after the intervention, and 1 week after the intervention. |
| Range of motion of finger flexion and wrist palmar flexion | 1 week | Range of motion of finger flexion and wrist palmar flexion will be assessed using a two-arm goniometer and recorded in degrees. |
Countries
Spain
Contacts
CONTACTTania López Hernández, Phd
PRINCIPAL_INVESTIGATORTania López Hernández
Unviersitat Rovira i Virgili
Outcome results
None listed