Dry Needling for Hamstring Flexibility: A Single-Blind Randomized Controlled Trial

in Journal of Sport Rehabilitation
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: Hamstring muscle tightness is one of the most common problems in athletic and healthy people. Dry needling (DN) was found to be an effective approach for improving muscle flexibility, but there is no study to compare this approach with static stretching (SS) as a common technique for the increase of muscle length. Objective: To compare the immediate effects of DN and SS on hamstring flexibility in healthy subjects with hamstring tightness. Study Design: A single-blind randomized controlled trial. Setting: A musculoskeletal physiotherapy clinic at Tehran University of Medical Sciences. Subjects: Forty healthy subjects (female: 32, age range: 18–40 y) with hamstring tightness were randomly assigned into 2 groups of DN and SS. Intervention: The DN group received a single session of DN on 3 points of the hamstring muscles, each for 1 minute. The SS group received a single session of SS of the hamstrings, consisting of 3 sets of 30-second SS with a 10-second rest between sets in the active knee extension test (AKET) position. Main Outcome Measures: The AKET, muscle compliance, passive peak torque, and stretch tolerance were measured at the baseline, immediately, and 15 minutes after the interventions. Results: Improvements in all outcomes was better for the DN group than for the SS group. DN increased muscle compliance significantly 15 minutes after the intervention, but it did not improve in the SS group. Conclusion: DN is effective in improving hamstring flexibility compared with SS. One session of DN can be an effective treatment for hamstring tightness and increase hamstring flexibility. The improvements suggest that DN is a novel treatment for hamstring flexibility.

Alaei, Nakhostin Ansari, Naghdi, Fakhari, and Komesh are with the Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Nakhostin Ansari and Naghdi are with the Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; and with the Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran. Dommerholt is with Bethesda Physiocare, Bethesda, MD, USA; and with Myopain Seminars, Bethesda, MD, USA.

Nakhostin Ansari (nakhostin@sina.tums.ac.ir) is corresponding author.
  • 1.

    Choksi P, Tank K. To study the efficacy of muscle energy technique on muscle strength and flexibility in patients. Indian J Physiother Occup Ther. 2016;10(3):41. doi:

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

    Medeiros DM, Cini A, Sbruzzi G, Lima CS. Influence of static stretching on hamstring flexibility in healthy young adults: systematic review and meta-analysis. Physiother Theory Pract. 2016;3(6):438445. PubMed ID: 27458757 doi:

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

    Serefoglu A, Sekir U, Gür H, Akova B. Effects of static and dynamic stretching on the isokinetic peak torques and electromyographic activities of the antagonist muscles. J Sports Sci Med. 2017;16(1):613. PubMed ID: 28344445

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

    Konrad A, Stafilidis S, Tilp M. Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties. Scand J Med Sci Sports. 2017;27(10):10701080. PubMed ID: 27367916 doi:

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

    Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contracture: an abridged republication of a cochrane systematic review. J Physiother. 2017;63(2):6775. PubMed ID: 28433236 doi:

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

    Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014;19(4):252265. PubMed ID: 25143704 doi:

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

    Morihisa R, Eskew J, McNamara A, Young J. Dry needling in subjects with muscular trigger points in the lower quarter: a systematic review. Int J Sports Phys Ther. 2016;11(1):1. PubMed ID: 26900495

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Ansari NN, Naghdi S, Fakhari Z, Radinmehr H, Hasson S. Dry needling for the treatment of poststroke muscle spasticity: a prospective case report. NeuroRehabilitation 2015;36(1):6165. PubMed ID: 25547766 doi:

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

    Fakhari Z, Ansari NN, Naghdi S, Mansouri K, Radinmehr H. A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke. NeuroRehabilitation 2017;40(3):325336. PubMed ID: 28222554 doi:

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

    Ansari NN, Alaei P, Naghdi S, Fakhari Z, Komesh S, Dommerholt J. Immediate effects of dry needling as a novel strategy for hamstring flexibility: a single-blinded clinical pilot study. J Sport Rehabil. 2020;29(2):156161. PubMed ID: 30526283 doi:

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

    Neto T, Jacobsohn L, Carita AI, Oliveira R. Reliability of the active-knee-extension and straight-leg-raise tests in subjects with flexibility deficits. J Sport Rehabil. 2015;24(4):20142020. PubMed ID: 25364856 doi:

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

    Hamid MSA, Ali MRM, Yusof A. Interrater and intrarater reliability of the active knee extension (AKE) test among healthy adults. J Phys Ther Sci. 2013;25(8):957961. PubMed ID: 24259893 doi:

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

    Guex K, Fourchet F, Loepelt H,Millet GP. Passive knee-extension test to measure hamstring tightness: influence of gravity correction. J Sport Rehabil. 2012;21(3):231234. PubMed ID: 22100435 doi:

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

    De Weijer VC, Gorniak GC, Shamus E. The effect of static stretch and warm-up exercise on hamstring length over the course of 24 hours. J Orthop Sports Phys Ther. 2003;33(12):727733. PubMed ID: 14743986 doi:

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

    Nishikawa Y, Aizawa J, Kanemura N, et al. Immediate effect of passive and active stretching on hamstrings flexibility: a single-blinded randomized control trial. J Phys Ther Sci. 2015;27(10):31673170. PubMed ID: 26644667 doi:

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

    O’Sullivan K, Murray E, Sainsbury D. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord. 2009;10(1):37. PubMed ID: 19371432 doi:

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

    Power K, Behm D, Cahill FA, Carroll M, Young WA. An acute bout of static stretching: effects on force and jumping performance. Med Sci Sports Exerc. 2004;36(8):13891396. PubMed ID: 15292748 doi:

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

    Lari AY, Okhovatian F, Sadat Naimi S, Baghban AA. The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females. Man Ther. 2016;21:204209. PubMed ID: 26304789 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Mejuto-Vázquez MJ, Salom-Moreno J, Ortega-Santiago R, Truyols-Domínguez S, Fernández-de-las-Peñas C. Short-term changes in neck pain, widespread pressure pain sensitivity, and cervical range of motion after the application of trigger point dry needling in patients with acute mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44(4):252260. PubMed ID: 24568260 doi:

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

    Tsai C-T, Hsieh L-F, Kuan T-S, 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:

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

    Halbertsma JP, van Bolhuis AI, Göeken LN. Sport stretching: effect on passive muscle stiffness of short hamstrings. Arch Phys Med Rehabil. 1996;77(7):688692. PubMed ID: 8669996 doi:

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

    Ylinen J, Kankainen T, Kautiainen H, Rezasoltani A, Kuukkanen T, Häkkinen A. Effect of stretching on hamstring muscle compliance. J Rehabil Med. 2009;41(1):8084. PubMed ID: 19197574 doi:

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

    Rihvk I, Clough A, Clough P. Investigation to compare static stretching and proprioceptive neuromuscular facilitation contract–relax stretching effects on the visco-elastic parameters of the biceps femoris muscle. Int Musculoskelet Med. 2010;32(4):157162. doi:

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

    Folpp H, Deall S, Harvey LA, Gwinn T. Can apparent increases in muscle extensibility with regular stretch be explained by changes in tolerance to stretch? Aust J Physiother. 2006;52(1):4550. PubMed ID: 16515422 doi:

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

    Magnusson SP, Simonsen E, Aagaard P, Sørensen H, Kjaer M. A mechanism for altered flexibility in human skeletal muscle. J Physiol. 1996;497(1):291298. PubMed ID: 8951730 doi:

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

    Reid DA, McNair PJ. Effects of a six-week lower limb stretching programme on range of motion, peak passive torque and stiffness in people with and without osteoarthritis of the knee. NZ J Physiother. 2011;39(1):5.

    • Search Google Scholar
    • Export Citation
  • 27.

    Magnusson SP. Passive properties of human skeletal muscle during stretch maneuvers. Scand J Med Sci Sports. 1998;8(2):6577. PubMed ID: 9564710 doi:

  • 28.

    Magnusson SP, Simonsen EB, Aagaard P, Kjaer M. Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am J Sports Med. 1996;24(5):622628. PubMed ID: 8883682 doi:

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

    Braithwaite FA, Walters JL, Li LS, Moseley GL, Williams MT, McEvoy MP. Effectiveness and adequacy of blinding in the moderation of pain outcomes: systematic review and meta-analyses of dry needling trials. PeerJ. 2018;6:e5318. PubMed ID: 30083458 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 379 379 139
Full Text Views 8 8 6
PDF Downloads 7 7 4