Effects of Low‐Load Exercise on Postneedling‐Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome

Abstract

Background The application of dry needling usually is associated with postneedling‐induced pain. A postneedling intervention to reduce this adverse event is needed. Objective To determine the effectiveness of low‐load exercise on reducing postneedling‐induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. Design A 72‐hour follow‐up, single‐blind randomized controlled trial. Setting Urban hospitals. Participants Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle. Interventions All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low‐load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention. Outcome Measures Numerical Pain Rating Scale (0‐10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0‐10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling. Results The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling‐induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P < .001) and related disability (Disabilities of the Arm, Shoulder and Hand: P < .001; Shoulder Pain and Disability Index: P < .001) were observed 72 hours after needling, irrespective of the treatment group. Conclusions Low‐load exercise was effective for reducing postneedling‐induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short‐term pain and disability changes. Level of Evidence I

<p>Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm</p>

“…Nevertheless, it is commonly seen in clinical practice that most patients usually recover from post-needling induced-pain/soreness between 48 and 72 hours after the intervention. This clinical observation has been confirmed in recent studies investigating the effects of some post-needling techniques, eg, spray andstretch,48 ischemic compression,49 or low-load eccentric exercise 50. All these studies found that these interventions were effective for decreasing post-needling induced pain/soreness 12 hours after TrP-DN application, but at 48 and 72 hours after, all patients were recovered from post-needling induced-pain independent of the post-needling intervention.…”

Postneedling Soreness and Tenderness After Different Dosages of Dry Needling of an Active Myofascial Trigger Point in Patients With Neck Pain: A Randomized Controlled Trial

“…Mild adverse events after DDN, including bruising, bleeding, or soreness, are considered very common [12]. The presence of postneedling soreness was observed in a high proportion of pain patients after deep DDN techniques of MTrPs in the neck region (91.4%) [13], shoulder (100%) [14], or low back (83%) [15]. The clinical relevance of postneedling soreness remains uncertain, but it has been associated with reduced treatment adherence [16,17] and it is considered capable of influencing patients’ functionality in daily life activities [18].…”

“…The clinical relevance of postneedling soreness remains uncertain, but it has been associated with reduced treatment adherence [16,17] and it is considered capable of influencing patients’ functionality in daily life activities [18]. Previous studies have investigated the effectiveness of various therapies to reduce postneedling soreness, including manual therapy [19,20], ultrasound [16], or exercise [14].…”

“…According to this study, postneedling soreness is more prevalent and intense when clinicians perform DDN eliciting LTRs. The awareness about the DDN dosage‐dependent postneedling soreness prevalence, intensity, or duration may help clinicians to warn patients about the occurrence of soreness, schedule the treatment to take into account the patient's lifestyle [18], or provide treatment for postneedling soreness, such as manual therapy [20], exercise [14], or percutaneous transcutaneous electrical nerve stimulation [50]. The elicitation of LTRs during DDN and its greater dosages have shown to be positively associated with the clinical relevance of the pain improvements [13,51].…”

Biological Amnion Prevents Flexor Tendon Adhesion in Zone II: A Controlled, Multicentre Clinical Trial

“…However, fresh amniotic membrane cannot be preserved for a long time, and potential biological safety hazards, such as hepatitis virus and HIV contamination, substantially limit its clinical use [23]. After dehydration and micronization of fresh amnion, Gellhorn prepared suspension before injection to treat tendonitis and arthritis and achieved good results in relieving pain and improving function [24].…”