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M. Alsaffar1, D.N. Alsiri1, V. Charles1
1Kuwait Ministry of Health, Physical Therapy, Kuwait, Kuwait
Background: Dry Needling (DN) is a growing invasive technique for managing musculoskeletal pain recognized over the last few years. The effectiveness of DN has been studied widely on myofascial pain.However, the evidences are inconclusive about its effectiveness.Systematic reviews and Meta analyses suggested that more studies are needed to support effectiveness of DN.
Purpose: The aim of this study was to evaluate the direct effect of DN on non-specific leg pain of the gastrocnemius medius muscle.
Methods: A case series repeated measure research design was used. The study included adults with non-specific leg pain aged ³ 18 years. The effectiveness of DN was evaluated using sonoelastography as the primary outcome measure,where the DN technique was guided with B-mode ultrasound. Sonoelastographyis an ultrasound-based system used to evaluate the mechanical properties of the tissues qualitatively and semi-quantitatively. Secondary outcome measures included pain intensity (measured using visual analogue scale) and ankle range of motion(evaluated with ankle wall test). Additionally, Foot and Ankle Outcome Score (FAOS) was used. Data were analyzed using SPSS and compared before, immediately after, and one week after DN using paired sample t-tests.
Results: Five women were included aged 29.6 (2.8) years; mean (standard deviation) with BMI of 27.9 (2.51) kg/m2. Statistically significant reduction was found in trigger point pain; 6.60 (0.92) and 3.40 (1.40) for pre and immediately post DN with p value = 0.024, respectively, and 3.60 (0.91), in trigger point pain after one week of DN with p value = 0.001). however, no statistically significant change was identified on gastrocnemius elasticity measured with sonoelastogtraphy; 2.91 (0.75) and 3.15 (1.01) mean and (SD) for pre and immediately post DN, respectively, and 3.44 (0.37) one-week post DN (p > 0.05). Similarly, no statistically significant changes were identified in stretch pain 0.8 (0.8), and 0.2 (0.2)for pre and immediately post DN, respectively, and 0 (0) one week post DN.No statistically significant change inankle dorsiflexionof 11.04(1.43) degrees and 12.24 (0.87) degrees for pre and immediately post DN, respectively, and 11.00 (1.30) degreesone week post DN (p > 0.05).However,No significant change was identified using the FAOS score; mean (SD) pre and one week post DN of the score items were respectively: pain from 92.22 (3.21) to 92.77( 2.57), symptoms from 86.42 (4.71) to 90.71( 4.99), activities of daily livingfrom 94.70(2.35) to 96.17 (1.19), sport from 87.00 (5.38) to 92.00(3.74), and quality of life score from 83.75 (7.28) to 83.55 (8.07).
Conclusion(s): DN can be an effect intervention to manage trigger point pain. However, such technique might not improve stretch pain, ROM or function. Although the used design is feasible and can help to generate hypothesis, the finding should be considered with caution due to the small sample size of this study.
Implications: DN could be used with patients to manage trigger point pain.
Funding, acknowledgements: no fund
Keywords: Dry Needle, trigger point, pain
Topic: Musculoskeletal
Did this work require ethics approval? Yes
Institution: Ministry of health\ Kuwait
Committee: Ethics commentary of Kuwait Ministry of Health (626/2017).
Ethics number: (626/2017)
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