Effects of dry needling of active trigger points in the scalene muscles in individuals with mechanical neck pain: a randomized clinical trial

Abstract

Objective:

The aim of this study was to compare the effects of dry needling (DN) versus pressure release over scalene muscle trigger points (TrPs) on pain, related disability, and inspiratory vital capacity in individuals with neck pain.

Methods:

In this randomized, single-blind trial, 30 patients with mechanical neck pain and active TrPs in the scalene musculature were randomly allocated to trigger point dry needling (TrP-DN; n = 15) or pressure release (n = 15) groups. The DN group received a single session of DN of active TrPs in the anterior scalene muscles, and the pressure release group received a single session of TrP pressure release over the same muscle lasting 30 s. The primary outcome was pain intensity as assessed by a numerical pain rate scale (NPRS, 0–10). Secondary outcomes included disability (neck disability index, NDI) and inspiratory vital capacity. Outcomes were assessed at baseline and 1 day (immediately post), 1 week, and 1 month after the treatment session. Data were expressed as mean score difference (Δ) and standardized mean difference (SMD).

Results:

Patients receiving DN exhibited a greater decrease in pain intensity than those receiving TrP pressure release at 1 month (Δ 1.2 (95% CI–1.8, –0.6), p = 0.01), but not immediately (1 day) or 1 week after. Patients in the DN group exhibited a greater increase in inspiratory vital capacity at all follow-up time points (Δ 281 mm (95% CI 130, 432) immediately after, Δ 358 mm (95% CI 227, 489) 1 week after, and Δ 310 mm (95% CI 180, 440) 1 month after treatment) than those in the pressure release group (p = 0.006). Between-group effect sizes were large at all follow-up time points (1.1 > SMD > 1.3) in favor of DN.

Conclusion:

This trial suggests that a single session of DN over active TrPs in the scalene muscles could be effective at reducing pain and increasing inspiratory vital capacity in individuals with mechanical neck pain. Future studies are needed to further confirm these results.

Keywords

dry needling neck pain respiratory function scalene trigger point release

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References

Martin

Deyo

Mirza

, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299(6): 656–664.

Vos

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet 2017; 390(10100): 1211–1259.

Kim

Wiest

Clark

, et al. Identifying risk factors for first-episode neck pain: a systematic review. Musculoskelet Sci Pract 2018; 33: 77–83.

Jull

Falla

Does increased superficial neck flexor activity in the craniocervical flexion test reflect reduced deep flexor activity in people with neck pain?

Man Ther 2016; 25: 43–47.

Simons

Travell

Simons

Myofascial pain and dysfunction: the trigger point manual. 3rd ed. Philadelphia, PA: Wolters Kluwer, 2019.

Chiarotto

Clijsen

Fernandez-de-Las-Penas

, et al. Prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil 2016; 97(2): 316–337.

Heneghan

Smith

Tyros

, et al. Thoracic dysfunction in whiplash associated disorders: a systematic review. PLoS ONE 2018; 13: e0194235.

Kapreli

Vourazanis

Strimpakos

Neck pain causes respiratory dysfunction. Med Hypotheses 2008; 70(5): 1009–1013.

Dimitriadis

Kapreli

Strimpakos

, et al. Pulmonary function of patients with chronic neck pain: a spirometry study. Respir Care 2014; 59(4): 543–549.

10.

Dimitriadis

Kapreli

Strimpakos

, et al. Respiratory weakness in patients with chronic neck pain. Man Ther 2013; 18(3): 248–253.

11.

Comerford

Mottram

SL.

Movement and stability dysfunction: contemporary developments. Man Ther 2001; 6(1): 15–26.

12.

Dommerholt

Fernandez-de-las Penas

Trigger point dry needling: an evidence and clinical-based approach. 2nd ed. London: Churchill Livingstone: Elsevier, 2019.

13.

Cagnie

Castelein

Pollie

, et al. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. Am J Phys Med Rehabil 2015; 94(7): 573–583

14.

Zwarenstein

Treweek

Gagnier

, et al. CONSORT group; Pragmatic Trials in Healthcare group. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008; 337: 2390.

15.

Childs

Flynn

Fritz

, et al. Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty. J Orthop Sports Phys Ther 2005; 35(5): 300–306.

16.

Fernandez-de-Las-Penas

Dommerholt

International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: a Delphi study. Pain Med 2018; 19(1): 142–150.

17.

Gerwin

Shannon

Hong

, et al. Interrater reliability in myofascial trigger point examination. Pain 1997; 69(1–2): 65–73.

18.

Hong

CZ.

Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994; 73(4): 256–263.

19.

Perreault

Dunning

Butts

The local twitch response during trigger point dry needling: is it necessary for successful outcomes. J Bodyw Mov Ther 2017; 21(4): 940–947.

20.

Fernandez-Carnero

Gilarranz-de-Frutos

Leon-Hernandez

, et al. Effectiveness of different deep dry needling dosages in the treatment of patients with cervical myofascial pain: a pilot RCT. Am J Phys Med Rehabil 2017; 96(10): 726–733.

21.

Gay

Alappattu

Coronado

, et al. Effect of a single session of muscle-biased therapy on pain sensitivity: a systematic review and meta-analysis of randomized controlled trials. J Pain Res 2013; 6: 7–22.

22.

Jensen

Turner

Romano

, et al. Comparative reliability and validity of chronic pain intensity measures. Pain 1999; 83(2): 157–162.

23.

Cleland

Childs

Whitman

JM.

Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil 2008; 89(1): 69–74.

24.

Vernon

Mior

The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14: 409–415.

25.

Macdemid

Walton

Avery

, et al. Measurement properties of the Neck Disability Index: a systematic review. J Orthop Sports Phys Ther 2009; 39: 400–417.

26.

American Thoracic Society/European Respiratory Society. ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med 2002; 166(4): 518–624.

27.

Carlesso

Macdermid

Santaguida

LP.

Standardization of adverse event terminology and reporting in orthopaedic physical therapy: application to the cervical spine. J Orthop Sports Phys Ther 2010; 40(8): 455–463.

28.

Tekin

Akarsu

Durmus

, et al. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clin Rheumatol 2013; 32(3): 309–315.

29.

Cerezo-Tellez

Torres-Lacomba

Fuentes-Gallardo

, et al. Effectiveness of dry needling for chronic nonspecific neck pain: a randomized, single-blinded, clinical trial. Pain 2016; 157(9): 1905–1917.

30.

Lucas

Rich

Polus

BI.

Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points. Clin Biomech (Bristol, Avon) 2010; 25(8): 765–770.

31.

Arendt-Nielsen

Madeleine

Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Med 2012; 13(7): 957–964.

32.

Ibarra

Wang

, et al. Latent myofascial trigger points are associated with an increased antagonistic muscle activity during agonist muscle contraction. J Pain 2011; 12(12): 1282–1288.

33.

Maher

Hayes

Shinohara

Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elastography. Arch Phys Med Rehabil 2013; 94(11): 2146–2150.

34.

Cagnie

Dewitte

Barbe

, et al. Physiologic effects of dry needling. Curr Pain Headache Rep 2013; 17(8): 348.

35.

George

Robinson

ME.

Dynamic nature of the placebo response. J Orthop Sports Phys Ther 2010; 40(8): 452–454.

36.

Fernandez-de-Las-Penas

Nijs

Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019; 12: 1899–1911.