Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes With Unilateral Shoulder Impingement Syndrome

in Journal of Sport Rehabilitation
View More View Less
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: Chronic musculoskeletal disorders in the shoulder joint are often associated with myofascial trigger points (MTrPs), particularly in the upper trapezius (UT) muscle. Dry needling (DN) is a treatment of choice for myofascial pain syndrome. However, local lesions and severe postneedle soreness sometimes hamper the direct application of DN in the UT. Therefore, finding an alternative point of treatment seems useful in this regard. Objective: To compare the efficacy of UT versus infraspinatus (ISP) DN on pain and disability of subjects with shoulder pain. The authors hypothesized that ISP DN could be as effective as the direct application of DN in UT MTrP. Design: Single-blind randomized clinical trial. Setting: Sports medicine physical therapy clinic. Participants: A total of 40 overhead athletes (age = 36 [16] y; 20 females and 20 males) with unilateral shoulder impingement syndrome were randomly assigned to the UT DN (n = 21) and ISP DN (n = 19) groups. Intervention: An acupuncture needle was directly inserted into the trigger point of UT muscle in the UT DN group and of ISP muscle in the ISP DN group. DN was applied in 3 sessions (2-day interval between each sessions) for each group. Main Outcome Measures: Pain intensity (visual analog scale), pain pressure threshold, and disability in the arm, shoulder, and hand were assessed before and after the interventions. Results: Pain and disability decreased significantly in both groups (P < .001) and pain pressure threshold increased significantly only in the ISP group (P = .02). However, none of the outcome measures showed a significant intergroup difference after treatments (P > .05). Conclusions: Application of DN for active MTrPs in the ISP can be as effective as direct DN of active MTrPs in the UT in improving pain and disability in athletes with shoulder pain, and may be preferred due to greater patient comfort in comparison with direct UT needling.

Kamali, Sinaei, and Morovati are with the Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. Kamali and Sinaei are with Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Morovati (mmorovvati1@gmail.com) is corresponding author.
  • 1.

    Borsa PA, Laudner KG, Sauers EL. Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med. 2008;38(1):1736. PubMed ID: 18081365 doi:10.2165/00007256-200838010-00003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bron C, Dommerholt J, Stegenga B, Wensing M, Oostendorp RA. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskeletal Disord. 2011;12(1):139. PubMed ID: 21711512 doi:10.1186/1471-2474-12-139

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Ge HY, Fernández-de-las-Peñas C, Yue SW. Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation. Chin Med. 2011;6(1):13. PubMed ID: 21439050 doi:10.1186/1749-8546-6-13

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, Olyaei G, Nourbakhsh MR. Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points. Acupunct Med. 2017;35(2):8592. PubMed ID: 27697768 doi:10.1136/acupmed-2016-011082

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Hidalgo‐Lozano A, Fernández‐de‐las‐Peñas C, Calderón‐Soto C, Domingo-Camara A, Madeleine P, Arroyo-Morales M. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck–shoulder muscles. Scand J Med Sci Sports. 2013;23(1):6673. doi:10.1111/j.1600-0838.2011.01331.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Ziaeifar M, Arab AM, Karimi N, Nourbakhsh MR. The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. J Bodyw Mov Ther. 2014;18(2):298305. PubMed ID: 24725800 doi:10.1016/j.jbmt.2013.11.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Gerwin RD. Myofascial trigger point pain syndromes. Semin Neurol. 2016;36(5):469473. PubMed ID: 27704503 doi:10.1055/s-0036-1586262

  • 8.

    de las Peñas CF, Campo MS, Carnero JF, Page JCM. Manual therapies in myofascial trigger point treatment: a systematic review. J Bodyw Mov Ther. 2005;9(1):2734. doi:10.1016/j.jbmt.2003.11.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain: a systematic review of the literature. Int J Osteopathic Med. 2006;9(4):120136. doi:10.1016/j.ijosm.2006.07.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    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. Eur J Pain. 2009;13(1):310. PubMed ID: 18395479 doi:10.1016/j.ejpain.2008.02.006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Tekin L, Akarsu S, Durmus¸ O, Çakar E, Dinçer Ü, Kıralp MZ. The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clin Rheumatol. 2013;32(3):309315. PubMed ID: 23138883 doi:10.1007/s10067-012-2112-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    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. J Manipulative Physiol Ther. 2012;35(9):685691. PubMed ID: 23206963 doi:10.1016/j.jmpt.2012.10.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Srbely JZ, Dickey JP, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010;42(5):463468. PubMed ID: 20544158 doi:10.2340/16501977-0535

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Tsai CT, Hsieh LF, Kuan TS, Kao MJ, Chou LW, Hong CZ. Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle. Am J Phys Med Rehabil. 2010;89(2):133140. PubMed ID: 19404189 doi:10.1097/PHM.0b013e3181a5b1bc

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Chou LW, Hsieh YL, Chen HS, Hong CZ, Kao MJ, Han TI. Remote therapeutic effectiveness of acupuncture in treating myofascial trigger point of the upper trapezius muscle. Am J Phys Med Rehabil. 2011;90(12):10361049. PubMed ID: 22019970 doi:10.1097/PHM.0b013e3182328875

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Hsieh YL, Kao MJ, Kuan TS, Chen SM, Chen JT, Hong CZ. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. Am J Phys Med Rehabil. 2007;86(5):397403. PubMed ID: 17449984 doi:10.1097/PHM.0b013e31804a554d

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: A systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42(2):8092. PubMed ID: 17720798 doi:10.1136/bjsm.2007.038406

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Dommerholt J, de las Penas CF. Trigger Point Dry Needling E-Book: An Evidence and Clinical-Based Approach. Churchill Livingstone Press, New York: Elsevier Health Sciences; 2013.

    • Search Google Scholar
    • Export Citation
  • 19.

    Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16(1):87101. PubMed ID: 6602967 doi:10.1016/0304-3959(83)90088-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain. 1986;24(3):313321. PubMed ID:3960573 doi:10.1016/0304-3959(86)90117-X

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Jester A, Harth A, Wind G, Germann G, Sauerbier M. Disabilities of the arm, shoulder and hand (DASH) questionnaire: determining functional activity profiles in patients with upper extremity disorders. J Hand Surg. 2005;30(1):2328. PubMed ID: 15620487 doi:10.1016/J.JHSB.2004.08.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Mousavi SJ, Parnianpour M, Abedi M, et al. Cultural adaptation and validation of the Persian version of the disabilities of the arm, shoulder and hand (DASH) outcome measure. Clin Rehabil. 2008;22(8):749757. PubMed ID: 18678575 doi:10.1177/0269215508085821

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Michener LA, Snyder AR, Leggin BG. Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status. J Sport Rehabil. 2011;20(1):115128. PubMed ID: 21411827 doi:10.1123/jsr.20.1.115

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2014;44(1):3039. PubMed ID: 24175606 doi:10.2519/jospt.2014.4893

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Calvo Lobo C, Romero Morales C, Rodríguez Sanz D, et al. Comparison of hand grip strength and upper limb pressure pain threshold between older adults with or without non-specific shoulder pain. PeerJ. 2017;5:2995. PubMed ID: 28289561

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Tseng CL, Kao MJ, Chou LW, Hong CZ. Injection of remote myofascial trigger points for pain control: a case report. Taiwan Rehabil Med J. 2008;36(1):4752.

    • Search Google Scholar
    • Export Citation
  • 27.

    Dommerholt J. Dry needling—peripheral and central considerations. J Man Manip Ther. 2011;19(4):223227. PubMed ID: 23115475 doi:10.1179/106698111X13129729552065

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Brockmeier SF, Dodson CC, Gamradt SC, Coleman SH, Altchek DW. Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes. Arthroscopy. 2008;24(8):961965. PubMed ID: 18657747 doi:10.1016/j.arthro.2007.08.016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Page P, Frank C, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, IL: Human Kinetics; 2010.

  • 30.

    Koppenhaver S, Embry R, Ciccarello J, et al. Effects of dry needling to the symptomatic versus control shoulder in patients with unilateral subacromial pain syndrome. Man Ther. 2016;26:6269. PubMed ID: 27497188 doi:10.1016/j.math.2016.07.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Osborne NJ, Gatt IT. Management of shoulder injuries using dry needling in elite volleyball players. Acupunct Med. 2010;28(1):4245. PubMed ID: 20351377 doi:10.1136/aim.2009.001560

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Martín-Pintado-Zugasti A, Rodríguez-Fernández ÁL, Fernandez-Carnero J. Postneedling soreness after deep dry needling of a latent myofascial trigger point in the upper trapezius muscle: characteristics, sex differences and associated factors. J Back Musculoskelet Rehabil. 2016;29(2):301308. PubMed ID: 26406209 doi:10.3233/BMR-150630

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Niddam DM, Chan RC, Lee SH, Yeh TC, Hsieh JC. Central modulation of pain evoked from myofascial trigger point. Clin J Pain. 2007;23(5):440448. PubMed ID: 17515743 doi:10.1097/AJP.0b013e318058accb

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Melzack R. Myofascial trigger points: relation to acupuncture and mechanisms of pain. Arch Phys Med Rehabil. 1981;62(3):114117. PubMed ID: 6972204

All Time Past Year Past 30 Days
Abstract Views 2587 2255 370
Full Text Views 72 45 2
PDF Downloads 51 31 2