Thomas Perreault1, James Dunning2, Raymond Butts3. 1. Faculty, American Academy of Manipulative Therapy Fellowship in Orthopedic Manual Physical Therapy, Senior Instructor, Spinal Manipulation Institute & Dry Needling Institute, Montgomery, AL, USA. Electronic address: tommy.perreault@gmail.com. 2. Faculty, American Academy of Manipulative Therapy Fellowship in Orthopedic Manual Physical Therapy, Senior Instructor, Spinal Manipulation Institute & Dry Needling Institute, Montgomery, AL, USA; Alumno de Doctorado, Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain. 3. Faculty, American Academy of Manipulative Therapy Fellowship in Orthopedic Manual Physical Therapy, Senior Instructor, Spinal Manipulation Institute & Dry Needling Institute, Montgomery, AL, USA.
Abstract
BACKGROUND: Myofascial trigger point (MTrP) injection and trigger point dry needling (TrPDN) are widely accepted therapies for myofascial pain syndrome (MPS). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. OBJECTIVE: This is the first review exploring the available literature, regardless of study design, on the neurophysiological effects and clinical significance of the LTR as it relates to reductions in pain and disability secondary to MTrP needling. METHODS: PubMed, MEDLINE, Science Direct and Google Scholar were searched up until October 2016 using terms related to trigger point needling and the LTR. RESULTS: and Discussion: Several studies show that eliciting a LTR does not correlate with changes in pain and disability, and multiple systematic reviews have failed to conclude whether the LTR is relevant to the outcome of TrPDN. Post needling soreness is consistently reported in studies using repeated in and out needling to elicit LTRs and increases in proportion to the number of needle insertions. In contrast, needle winding without LTRs to MTrPs and connective tissue is well supported in the literature, as it is linked to anti-nociception and factors related to tissue repair and remodeling. Additionally, the positive biochemical changes in the MTrP after needling may simply be a wash out effect related to local vasodilation. While the LTR during TrPDN appears unnecessary for managing myofascial pain and unrelated to many of the positive effects of TrPDN, further investigation is required.
BACKGROUND: Myofascial trigger point (MTrP) injection and trigger point dry needling (TrPDN) are widely accepted therapies for myofascial pain syndrome (MPS). Empirical evidence suggests eliciting a local twitch response (LTR) during needling is essential. OBJECTIVE: This is the first review exploring the available literature, regardless of study design, on the neurophysiological effects and clinical significance of the LTR as it relates to reductions in pain and disability secondary to MTrP needling. METHODS: PubMed, MEDLINE, Science Direct and Google Scholar were searched up until October 2016 using terms related to trigger point needling and the LTR. RESULTS: and Discussion: Several studies show that eliciting a LTR does not correlate with changes in pain and disability, and multiple systematic reviews have failed to conclude whether the LTR is relevant to the outcome of TrPDN. Post needling soreness is consistently reported in studies using repeated in and out needling to elicit LTRs and increases in proportion to the number of needle insertions. In contrast, needle winding without LTRs to MTrPs and connective tissue is well supported in the literature, as it is linked to anti-nociception and factors related to tissue repair and remodeling. Additionally, the positive biochemical changes in the MTrP after needling may simply be a wash out effect related to local vasodilation. While the LTR during TrPDN appears unnecessary for managing myofascial pain and unrelated to many of the positive effects of TrPDN, further investigation is required.
Authors: Mohammadreza Pourahmadi; Mohammad Ali Mohseni-Bandpei; Abbasali Keshtkar; Bart W Koes; César Fernández-de-Las-Peñas; Jan Dommerholt; Mehrdad Bahramian Journal: Chiropr Man Therap Date: 2019-09-26
Authors: Zuzanna Nowak; Maciej Chęciński; Aleksandra Nitecka-Buchta; Sylwia Bulanda; Danuta Ilczuk-Rypuła; Lidia Postek-Stefańska; Stefan Baron Journal: Int J Environ Res Public Health Date: 2021-09-10 Impact factor: 3.390
Authors: Zaid Al-Boloushi; Eva Maria Gómez-Trullén; Mohammad Arian; Daniel Fernández; Pablo Herrero; Pablo Bellosta-López Journal: BMJ Open Date: 2020-08-20 Impact factor: 2.692