Research Article

Comparing Between the Effects of Dry Needling and Shock Wave in the Treatment of Trapezius Myofascial Pain


Introduction: Musculoskeletal disorders are important causes of pain. Trigger points are one of the common reasons for myofascial pain. This study aimed to compare a single session of dry needling versus a single session of shock wave therapy on the level of pain and Range of Motion (ROM) in the people with Myofascial Pain Syndrome (MPS) of the upper trapezius muscle.
Materials and Methods: Sixteen men with active trigger points of upper trapezius muscle were voluntarily attended in this study. They were randomly assigned into two groups. The patients were under a single session treatment of either dry needling or shock wave therapy. Level of pain (by Visual Analog Scale [VAS]) and active ROM of neck lateral flexion (by goniometer) were evaluated once before the treatment and immediately after the intervention.
Results: The VAS scores and the neck ROMs were substantially improved at both groups of study immediately after the treatment (P<0.012). However, there were no significant differences between the two groups of interventions in terms of the VAS and ROM scores (P>0.05).
Conclusion: Both dry needling and shock wave therapy can improve neck pain and ROM in patients with active trigger points in the upper trapezius muscle.

Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. International Journal of Osteopathic Medicine. 2006; 9(4):120-36. [DOI:10.1016/j.ijosm.2006.07.007]

Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of Physical Medicine and Rehabilitation. 2008; 89(1):16-23. [DOI:10.1016/j.apmr.2007.10.018] [PMID]

Simons DG, Travell JG, Simons LS. Travell & Simons’ myofascial pain and dysfunction: Upper half of body. New York: Lippincott Williams & Wilkins; 1999.

Hidalgo-Lozano A, Fernández-de-las-Peñas C, Díaz-Rodríguez L, González-Iglesias J, Palacios-Ceña D, Arroyo-Morales M. Changes in pain and pressure pain sensitivity after manual treatment of active trigger points in patients with unilateral shoulder impingement: A case series. Journal of Bodywork and Movement Therapies. 2011; 15(4):399-404. [DOI:10.1016/j.jbmt.2010.12.003] [PMID]

Oliveira-Campelo NM, de Melo CA, Alburquerque-Sendín F, Machado JP. Short-and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: A randomized controlled trial. Journal of Manipulative & Physiological Therapeutics. 2013; 36(5):300-9. [DOI:10.1016/j.jmpt.2013.04.008] [PMID]

Huguenin LK. Myofascial trigger points: The current evidence. Physical Therapy in Sport. 2004; 5(1):2-12. [DOI:10.1016/j.ptsp.2003.11.002]

Zhuang X, Tan S, Huang Q. Understanding of myofascial trigger points. Chinese Medical Journal. 2014; 127(24):4271-7. [DOI:10.3760/cma.j.issn.0366-6999.20141999]

Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta‐analysis of randomised controlled trials. European Journal of Pain. 2009; 13(1):3-10. [DOI:10.1016/j.ejpain.2008.02.006] [PMID]

Sciotti VM, Mittak VL, DiMarco L, Ford LM, Plezbert J, Santipadri E, et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001; 93(3):259-66. [DOI:10.1016/S0304-3959(01)00325-6]

Hertling D, Kessler RM. Management of common musculoskeletal disorders: Physical therapy principles and methods. New York: Lippincott Williams & Wilkins; 2006.

Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, Olyaei G, Nourbakhsh MR. The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: Study protocol of a controlled clinical trial. BMJ Open. 2013; 3(5):e002825. [DOI:10.1136/bmjopen-2013-002825] [PMID] [PMCID]

Ji HM, Kim HJ, Han SJ. Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius. Annals of Rehabilitation Medicine. 2012; 36(5):675. [DOI:10.5535/arm.2012.36.5.675] [PMID] [PMCID]

Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. The Journal of the American Board of Family Medicine. 2010; 23(5):640-6. [DOI:10.3122/jabfm.2010.05.090296] [PMID]

Itoh K, Katsumi Y, Hirota S, Kitakoji H. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complementary Therapies in Medicine. 2007; 15(3):172-9. [DOI:10.1016/j.ctim.2006.05.003] [PMID]

de Abreu Venâncio R, Guedes Pereira Alencar F, Zamperini C. Different substances and dry-needling injections in patients with myofascial pain and headaches. Randomized Controlled Trial. 2008; 26(2):96-103. [DOI:10.1179/crn.2008.014] [PMID]

Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: A systematic review. Archives of Physical Medicine and Rehabilitation. 2001; 82(7):986-92. [DOI:10.1053/apmr.2001.24023] [PMID]

Yeganeh Lari A, Okhovatian F, Naimi SS, Akbarzadeh Baghban A. [Dry needling versus muscle energy technique in treatment of latent trigger point upper trapezius (Persian)]. Journal of Modern Rehabilitation. 2016; 9(5):12-20.

Müller-Ehrenberg H, Licht G. Diagnosis and therapy of myofascial pain syndrome with focused shock waves (ESWT). Medizinisch-Orthopädische Technik. 2005; 5:1-6.

Liang HW, Wang TG, Chen WS, Hou SM. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy. Clinical Orthopaedics and Related Research. 2007; 460:219-25. [DOI:10.1097/BLO.0b013e31804ffd19] [PMID]

Rompe JD, Hopf C, Küllmer K, Heine J, Bürger R. Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow. The Journal of Bone and Joint Surgery. 1996; 78(2):233-7. [DOI:10.1302/0301-620X.78B2.0780233] [PMID]

Hammer DS, Adam F, Kreutz A, Rupp S, Kohn D, Seil R. Ultrasonographic evaluation at 6-month follow-up of plantar fasciitis after extracorporeal shock wave therapy. Archives of Orthopaedic and Trauma surgery. 2005; 125(1):6-9. [DOI:10.1007/s00402-003-0591-z] [PMID]

Wang F, Yang K, Chen R, Wang C, Sheen-Chen SM. Extracorporeal shock wave promotes growth and differentiation of bone-marrow stromal cells towards osteoprogenitors associated with induction of TGF-β1. Bone & Joint Journal. 2002; 84(3):457-61. [DOI:10.1302/0301-620X.84B3.0840457]

Ottomann C, Hartmann B, Tyler J, Maier H, Thiele R, Schaden W, et al. Prospective randomized trial of accelerated re-epithelization of skin graft donor sites using extracorporeal shock wave therapy. Journal of the American College of Surgeons. 2010; 211(3):361-7. [DOI:10.1016/j.jamcollsurg.2010.05.012] [PMID]

Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine. 2001; 8(12):1153-7. [DOI:10.1111/j.1553-2712.2001.tb01132.x] [PMID]

Kamali Hakim I, Ebrahimi Takamjani I, Sarrafzadeh J, Ezzati K. What is the acute effect of dry needling on the active trigger points of upper trapezius muscle? the effect of eliciting local twitch response on clinical outcomes. Physical Treatments-Specific Physical Therapy Journal. 2017; 7(1):49-57. [DOI:10.29252/nrip.ptj.7.1.49]

Melzack R. The short-form McGill pain questionnaire. Pain. 1987; 30(2):191-7. [DOI:10.1016/0304-3959(87)91074-8]

Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Archives of Physical Medicine and Rehabilitation. 2011; 92(4):657-62. [DOI:10.1016/j.apmr.2010.11.030] [PMID]

Fouda KZ, El Laithy MH. Effect of low energy versus medium energy radial shock wave therapy in the treatment of chronic planter fasciitis. International Journal of Physiotherapy. 2016; 3(1):5-10. [DOI:10.15621/ijphy/2016/v3i1/88900]

Härdle W, Simar L. Applied multivariate statistical analysis. Springer; 2007.

Llamas-Ramos R, Pecos-Martín D, Gallego-Izquierdo T, Llamas-Ramos I, Plaza-Manzano G, Ortega-Santiago R, et al. Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: A randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy. 2014; 44(11):852-61. [DOI:10.2519/jospt.2014.5229] [PMID]

Dommerholt J, Mayoral del Moral O, Gröbli C. Trigger point dry needling. Journal of Manual & Manipulative Therapy. 2006; 14(4):70E-87E. [DOI:10.1179/jmt.2006.14.4.70E]

Koritnik B, Eržen I, Sketelj J. Muscle activity-resistant acetylcholine receptor accumulation is induced in places of former motor endplates in ectopically innervated regenerating rat muscles. International Journal of Developmental Neuroscience. 2001; 19(3):339-46. [DOI:10.1016/S0736-5748(01)00018-1]

Sarrafzadeh J, Ahmadi A, Yassin M. The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Archives of Physical Medicine and Rehabilitation. 2012; 93(1):72-7. [DOI:10.1016/j.apmr.2011.08.001] [PMID]

Cagnie B, Barbe T, De Ridder E, Van Oosterwijck J, Cools A, Danneels L. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. Journal of Manipulative & Physiological Therapeutics. 2012; 35(9):685-91. [DOI:10.1016/j.jmpt.2012.10.005] [PMID]

Dommerholt J. Dry needling in orthopedic physical therapy practice. Orthopaedic Physical Therapy. 2004; 16(3):15-20.

Park KD, Lee WY, Park MH, Ahn JK, Park Y. High-versus low-energy extracorporeal shock-wave therapy for myofascial pain syndrome of upper trapezius: A prospective randomized single blinded pilot study. Medicine. 2018; 97(28):e11432. [DOI:10.1097/MD.0000000000011432] [PMID] [PMCID]

Jeon JH, Jung YJ, Lee JY, Choi JS, Mun JH, Park WY, et al. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Annals of Rehabilitation Medicine. 2012; 36(5):665-74. [DOI:10.5535/arm.2012.36.5.665] [PMID] [PMCID]

Ramon S, Gleitz M, Hernandez L, Romero LD. Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia. International Journal of Surgery. 2015; 24(Part B):201-6. [DOI:10.1016/j.ijsu.2015.08.083] [PMID]

Lee JH, Jung KH, Park YH. Extracorporeal shock wave therapy for myofascial pain syndrome of upper trapezius. Journal of the Korean Society of Physical Medicine. 2012; 7(2):183-90. [DOI:10.13066/kspm.2012.7.2.183]

Luan S, Zhu ZM, Ruan JL, Lin CN, Ke SJ, Xin WJ, et al. Randomized trial on comparison of the efficacy of extracorporeal shock wave therapy and dry needling in myofascial trigger points. American journal of Physical Medicine & Rehabilitation. 2019; 98(8):677-84. [DOI:10.1097/PHM.0000000000001173] [PMID]

IssueVol 14 No 4 (2020) QRcode
SectionResearch Article(s)
Pain Range of motion Trigger point Upper trapezius muscle Dry needling Shock wave therapy

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How to Cite
Toghtamesh M, Bashardoust Tajali S, Jalaei S. Comparing Between the Effects of Dry Needling and Shock Wave in the Treatment of Trapezius Myofascial Pain. jmr. 14(4):225-232.