Study Design Systematic review and meta-analysis. Background Myofascial pain syndrome (MPS) is associated with hyperalgesic zones in muscle called myofascial trigger points. When palpated, active myofascial trigger points cause local or referred symptoms, including pain. Dry needling involves inserting an acupuncture-like needle into a myofascial trigger point, with the goal of reducing pain and restoring range of motion. Objective To explore the evidence regarding the effectiveness of dry needling to reduce pain in patients with MPS of the upper quarter. Methods An electronic literature search was performed using the key word dry needling. Articles identified with the search were screened for the following inclusion criteria: human subjects, randomized controlled trial (RCT), dry needling intervention group, and MPS involving the upper quarter. The RCTs that met these criteria were assessed and scored for internal validity using the MacDermid Quality Checklist. Four separate meta-analyses were performed: (1) dry needling compared to sham or control immediately after treatment, (2) dry needling compared to sham or control at 4 weeks, (3) dry needling compared to other treatments immediately after treatment, and (4) dry needling compared to other treatments at 4 weeks. Results The initial search yielded 246 articles. Twelve RCTs were ultimately selected. The methodological quality scores ranged from 23 to 40 points, with a mean of 34 points (scale range, 0–48; best possible score, 48). The findings of 3 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can immediately decrease pain in patients with upper-quarter MPS, with an overall effect favoring dry needling. The findings of 2 studies that compared dry needling to sham or placebo treatment provided evidence that dry needling can decrease pain after 4 weeks in patients with upper-quarter MPS, although a wide confidence interval for the overall effect limits the impact of the effect. Findings of studies that compared dry needling to other treatments were highly heterogeneous, most likely due to variance in the comparison treatments. There was evidence from 2 studies that lidocaine injection may be more effective in reducing pain than dry needling at 4 weeks. Conclusion Based on the best current available evidence (grade A), we recommend dry needling, compared to sham or placebo, for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS. Due to the small number of high-quality RCTs published to date, additional well-designed studies are needed to support this recommendation. Level of Evidence Therapy, level 1a-. J Orthop Sports Phys Ther 2013;43(9):620–634. Epub 11 June 2013. doi:10.2519/jospt.2013.4668

Maximal physiologic responses to treadmill running and deep water running using a flotation device were compared in 12 trained men and 12 trained women. Although the men had significantly higher ventilation volumes, VO2max (liters of oxygen per minute and milliliters of oxygen per kilogram per minute), there were no significant differences in maximal heart rates or respiratory exchange ratios between the sexes. Significantly lower ventilation volumes, VO2max (LO2.min-1 and mlO2.kg-1.min-1), and heart rates were obtained in response to maximal water running compared to treadmill running, regardless of gender. Neither the men's nor women's maximal respiratory exchange ratios were significantly different between modes. The analysis of variance indicated that there were no significant interactions for any of the maximal responses to the tests between the sexes. The magnitude of these differences is similar to that found between treadmill running and cycling ergometry and should not preclude deep water running as a training technique. Caution, however, is advised if the training intensity is to be prescribed on the basis of land-determined heart rates.

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Purpose: The incidence of stereoscopic vision following surgery for infantile esotropia has been reported, but not from patients treated with simultaneous bimedial injection of botulinum toxin A. We previously reported other findings from 41 patients treated with botulinum toxin A before the age of 12 months. The purpose of this study was to report the incidence of stereopsis in these patients after long-term follow-up. Patients and Methods: Data were acquired by recording the response to subjective stereoscopic testing during the postinjection follow-up period when reliable subjective responses could be obtained. At least 5 years had passed following injection, and the mean age of the patients was 8 years. Results: Of the 41 patients, 11 were lost to follow-up, 10 had no stereopsis, 9 had gross stereopsis according to Titmus fly tests), 1 had 800 seconds of stereoscopic vision, 2 had 400 seconds, 2 had 200 seconds, 1 had 60 seconds, and 5 had 40 seconds. Conclusions: In this study, two-thirds of the patients acquired stereopsis following simultaneous bimedial injection of botulinum toxin A for infantile esotropia. Stereopsis acquisition following injection of botulinum toxin A had a success rate comparable with that reported for surgically corrected infantile esotropia. Bimediai injection of botulinum toxin A accompanied by alternate patching prior to injection and diligent attention at ages ranging from 4 to 12 months is a simple and efficacious method for the management of infantile esotropia. J Pediatr Ophthalmol Strabismus 2003;40:288-292.

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