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Comparison of the Effects of Dry Needling and Low-Level Laser on the Latent Trigger Points of Upper Trapezius

Document Type : Research articles

Authors

1 Ph.D. Candidate, Department of Physical Therapy, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences,Tehran, Iran

2 Ph.D. in Physical Therapy, Department of Physical Therapy, Faculty of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences,Tehran, Iran

3 Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Myofascial pain syndrome (MPS) is one of the most frequent causes of chronic musculoskeletal pain which is characterized by myofascial trigger points (MTrPs). Hence, it is of crucial importance to identify practical approaches for the treatment of these points. Upper trapezius muscle (UT) is highly susceptible to the development of MTrPs that are commonly resulted from overuse and micro-trauma.
Objectives: The present study aimed to compare the effects of dry needling (DN) and low-level laser therapy (LLLT) regarding the reduction of pain and muscle thickness and improvement of the range of motion (ROM) and pressure pain threshold (PPT) in patients with latent MTrPs (LTrPs) in their UT muscles.
Methods: In total, 60 patients with LTrPs in UT muscle participated in this randomized clinical trial. The subjects were randomly divided into two treatment groups of DN and LLLT. The PPT was evaluated by visual analog scale (VAS) and algometer while ROM and muscle thickness were assessed using goniometer and ultrasonography, respectively. It should be noted that the variables were evaluated before the first and after the sixth sessions. Finally, the collected data were analyzed using independent and paired t-tests.
Results: Based on the results, the VAS and muscle thickness significantly reduced, while the PPT and cervical ROM increased in both groups after treatment (P<0.001). The independent t-test revealed a statistically significant improvement in the DN group in terms of PPT (9.9-14.17, P=0.009) and ROM (37.33-42.67, p=0.005), compared to the LLLT group. Nevertheless, no significant difference was found between the two groups regarding VAS and muscle thickness variables (P>0.05).
Conclusion: The DN and LLLT effectively improved symptoms in the UT muscles of patients with LTrPs. However, the DN was more effective in the improvement of ROM and PPT variables.

Keywords

References
  1. Simons DG, Travell J, Simons LS. Travell & Simons’s myofascial pain and dysfunction: the trigger point manual. 2nd ed. Baltimore: Williams & Wilkins; 1999. P. 184.
  2. Hakgüder A, Birtane M, Gürcan S, Kokino S, Turan FN. Efficacy of low level laser therapy in myofascial pain syndrome: an algometric and thermographic evaluation. Lasers Surg Med. 2003;33(5):339-43. doi: 10.1002/lsm.10241. [PubMed: 14677161].
  3. Simons DG. New aspects of myofascial trigger points: etiological and clinical. J Musculoskelet Pain. 2004;12(3):15-21. doi: 10.1300/J094v12n03_03.
  4. Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, Olyaei G, Nourbakhsh MR. The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial. BMJ Open. 2013;3(5):e002825. doi: 10.1136/bmjopen-2013-002825. [PubMed: 23793673].
  5. Grieve R, Barnett S, Coghill N, Cramp F. The prevalence of latent myofascial trigger points and diagnostic criteria of the triceps surae and upper trapezius: a cross sectional study. Physiotherapy. 2013;99(4):278-84. doi: 10.1016/j.physio.2013.04.002. [PubMed: 23830716].
  6. Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010;23(5):640-6. doi: 10.3122/jabfm.2010.05.090296. [PubMed: 20823359].
  7. Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clin Rheumatol. 2007;26(6):930-4. doi: 10.1007/s10067-006-0438-4. [PubMed: 17021664].
  8. Yeganeh Lari A, Okhovatian F, Naimi SS, Baghban AA. The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females. Man Ther. 2016;21:204-9. doi: 10.1016/j.math.2015.08.004. [PubMed: 26304789].
  9. Kietrys DM, Palombaro KM, Azzaretto E, Hubler R, Schaller B, Schlussel JM, et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43(9):620-34. doi: 10.2519/jospt.2013.4668. [PubMed: 23756457].
  10. Venere K, Ridgeway K. Trigger point dry needling: the data do not support broad applicability or robust effect. J Man Manip Ther. 2016;24(1):2-4. doi: 10.1080/10669817.2015.1106820. [PubMed: 27252575].
  11. Dommerholt J. Dry needling in orthopedic physical therapy practice. Orthop Phys Ther Pract. 2004;16(3):15-20.
  12. Baldry PE, Yunus MB, Inanici F. Myofascial pain and fibromyalgia syndromes. Edinburgh: Churchill Livingstone; 2001.
  13. Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine. 2005;30(8):944-63. doi: 10.1097/01.brs.0000158941.21571.01. [PubMed: 15834340].
  14. Unverzagt C, Berglund K, Thomas JJ. Dry needling for myofascial trigger point: a clinical commentary. Int J Phys Ther. 2015;10(3):402-18. [PubMed: 26075156].
  15. Gross AR, Dziengo S, Boers O, Goldsmith CH, Graham N, Lilge L, et al. Low level laser therapy (LLLT) for neck pain: a systematic review and meta-regression. Open Orthop J. 2013;7:396-419. doi: 10.2174/1874325001307010396. [PubMed: 24155802].
  16. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet. 2009;374(9705):1897-908. doi: 10.1016/S0140-6736(09)61522-1. [PubMed: 19913903].
  17. Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):00068. doi: 10.15406/mojor.2015.02.00068. [PubMed: 26858986].
  18. Bjordal J, Couppe C, Chow R, Tuner J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother. 2003;49(2):107-16. doi: 10.1016/s0004-9514(14)60127-6. [PubMed: 2775206].
  19. Simunovic Z. Low level laser therapy with trigger points technique: a clinical study on 243 patients. J Clin Laser Med Surg. 1996;14(4):163-7. doi: 10.1089/clm.1996.14.163. [PubMed: 9456632].
  20. Chow RT, David MA, Armati PJ. 830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of 830 nm laser. J Peripher Nerv Syst. 2007;12(1):28-39. doi: 10.1111/j.1529-8027.2007.00114.x. [PubMed: 17374099].
  21. Tekin L, Akarsu S, Durmuş O, Cakar E, Dinçer U, 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):309-15. doi: 10.1007/s10067-012-2112-3. [PubMed: 23138883].
  22. 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):298-305. doi: 10.1016/j.jbmt.2013.11.004. [PubMed: 24725800].
  23. Cerezo-Téllez E, Lacomba MT, Fuentes-Gallardo I, Mayoral Del Moral O, Rodrigo-Medina B, Gutiérrez Ortega C. Dry needling of the trapezius muscle in office workers with neck pain: a randomized clinical trial. J Man Manip Ther. 2016;24(4):223-32. doi: 10.1179/2042618615Y.0000000004. [PubMed: 27582622].
  24. Liu L, Huang QM, Liu QG, Ye G, Bo CZ, Chen MJ, et al. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96(5):944-55. doi: 10.1016/j.apmr.2014.12.015. [PubMed: 25576642].
  25. Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med. 2004;35(3):229-35. doi: 10.1002/lsm.20082. [PubMed: 15389743].
  26. Yamany AA, Salim SE. Efficacy of low level laser therapy for treatment myofascial trigger points of shoulder pain. World Appl Sci J. 2011;12(6):758-64.
  27. Ilbuldu E, Cakmak A, Disci R, Aydin R Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Photomed Laser Surg. 2004;22(4):306-11. doi: 10.1089/pho.2004.22.306. [PubMed: 15345173].
  28. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82(7):986-92. doi: 10.1053/apmr.2001.24023. [PubMed: 11441390].
  29. 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):3-10. doi: 10.1016/j.ejpain.2008.02.006. [PubMed: 18395479].
  30. Altan L, Bingöl U, Aykaç M, Yurtkuran M. Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int. 2005;25(1):23-7. doi: 10.1007/s00296-003-0396-y. [PubMed: 14673617].
  31. Simons DG, Travell J, Simons LS. Travell & Simons' myofascial pain and dysfunction. Upper half of body Baltimore. Philadelphia: Lippincott Williams & Wilkins; 1999.
  32. Rezasoltani A. Individual cervical muscle function in biomechanical studies: a review of literature. J Phys Ther Sci. 2001;13(2):139-43. doi: 10.1589/jpts.13.139.
  33. Adigozali H, Shadmehr A, Ebrahimi E, Rezasoltani A, Naderi F. Ultrasonography for the assessment of the upper trapezius properties in healthy females: a reliability study. Muscles Ligaments Tendons J. 2016;6(1):167-72. doi: 10.11138/mltj/2016.6.1.167. [PubMed: 27331047].
  34. Fernández-de-las-Peñas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Man Ther. 2007;12(1):29-33. doi: 10.1016/j.math.2006.02.002. [PubMed: 21882489].
  35. Gemmell H, Miller P, Nordstrom H. Immediate effect of ischaemic compression and trigger point pressure release on neck pain and upper trapezius trigger points: a randomised controlled trial. Clin Chiropractic. 2008;11(1):30-6. doi: 10.1016/j.clch.2007.09.001.
  36. Okhovatian F, Mehdikhani R, Sadat Naimi S. RETRACTED: Comparison between the immediate effect of manual pressure release and strain/counterstrain techniques on latent trigger point of upper trapezius muscle. Clin Chiropractic. 2012;15(2):55-61. doi: 10.1016/j.clch.2012.04.003.
  37. Sciotti VM, Mittak VL, DiMarco L, Ford LM, Plezbert J, Santipadri E, et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001;93(3):259-66. doi: 10.1016/S0304-3959(01)00325-6. [PubMed: 11514085].
  38. Cotchett MP, Landorf KB, Munteanu SE, Raspovic A. Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial. J Foot Ankle Res. 2011;4:5. doi: 10.1186/1757-1146-4-5. [PubMed: 21255460].
  39. Taheri P, Vahdatpour B, Andalib S. Comparative study of shock wave therapy and laser therapy effect in elimination of symptoms among patients with myofascial pain syndrome in upper trapezius. Adv Biomed Res. 2016;5:138. doi: 10.4103/2277-9175.187398. [PubMed: 27656607].
  40. 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):685-9. doi: 10.1016/j.jmpt.2012.10.005. [PubMed: 23206963].
  41. Sandberg M, Larsson B, Lindberg LG, Gerdle B. Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia. Eur J Pain. 2005;9(5):497-510. doi: 10.1016/j.ejpain.2004.11.002. [PubMed: 16139178].
  42. Sola AE. Myofascial trigger point therapy. Resid Staff Physician. 1981;27:38-45.
  43. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger points: the importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256-63. doi: 10.1097/00002060-199407000-00006. [PubMed: 8043247].
  44. Sadria G, Hosseini M, Rezasoltani A, Akbarzadeh Bagheban A, Davari A, Seifolahi A. A comparison of the effect of the active release and muscle energy techniques on the latent trigger points of the upper trapezius. J Bodyw Mov Ther. 2017;21(4):920-5. doi: 10.1016/j.jbmt.2016.10.005. [PubMed: 29037649].
  45. Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion-comparison of three METhods. Phys Ther. 1991;71(2):98-104. doi: 10.1093/ptj/71.2.98. [PubMed: 1989013].
  46. Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Arch Phys Med Rehabil. 2011;92(4):657-62. doi: 10.1016/j.apmr.2010.11.030. [PubMed: 21440713].
  47. Rowley NC. The relative effectiveness of a single dry needle insertion compared to multiple fanning dry needle insertions in the treatment of myofasciitis in the cervical and upper thoracic spine. [Doctoral Dissertation]. Durban, South Africa: Durban University of Technology; 2001.
  48. Hidalgo-Lozano A, Fernández-de-las-Peñas C, Alonso-Blanco C, Ge HY, Arendt-Nielsen L, Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Exp Brain Res. 2010;202(4):915-25. doi: 10.1007/s00221-010-2196-4. [PubMed: 20186400].
  49. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain. 1986;24(3):313-21. doi: 10.1016/0304-3959(86)90117-X. [PubMed: 3960573].
  50. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30(1):115-26. doi: 10.1016/0304-3959(87)90089-3. [PubMed: 3614975].
  51. Seifolahi A, Naimi SS, Soltani A, Hosseini S, Bagheban AA, Sadria G. Reliability of upper trapezius muscle thickness measurement using B-mode ultrasound images in patient with latent trigger point. J Rehabil Med. 2015;4(1):17-25.
  52. Shahimoridi D, Shafiei SA, Yousefian B. The effectiveness of the polarized low-level laser in the treatment of patients with myofascial trigger points in the trapezius muscles. J Lasers Med Sci. 2020;11(1):14-9. doi: 10.15171/jlms.2020.04. [PubMed: 32099622].
  53. Waseem I, Tanveer F, Fatima A. Can addition of low level laser therapy to conventional physical therapy be beneficial for management of pain and cervical range of motion in patients with trigger point of upper trapezius? Anaesth Pain Intensive Care. 2020;24(1):64-8. doi: 10.35975/apic.v24i1.1228.
  54. Rezaei S, Shadmehr A, Tajali SB, Moghadam BA, Jalaei S. The effect of laser therapy and ischemic compression on active trigger points in upper trapezius muscle. J Modern Rehabil. 2019;13(4):221-6. doi: 10.32598/JMR.13.4.221.
  55. Chang WH, Tu LW, Pei YC, Chen CK, Wang SH, Wong AM. Comparison of the effects between lasers applied to myofascial trigger points and to classical acupoints for patients with cervical myofascial pain syndrome. Biomed J. 2020;In Press. doi: 10.1016/j.bj.2020.05.020.
  56. Basford J. Low intensity laser therapy: still not an established clinical tool. Lasers Surg Med. 1995;16(4):331-42. doi: 10.1002/lsm.1900160404. [PubMed: 7651054].
  57. Chen JT, Chung KC, Hou CR, Kuan TS, Chen SM, Hong CZ. Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil. 2001;80(10):729-35. doi: 10.1097/00002060-200110000-00004. [PubMed: 11562554].
  58. Lee SH, Chen CC, Lee CS, Lin TC, Chan RC. Effects of needle electrical intramuscular stimulation on shoulder and cervical myofascial pain syndrome and microcirculation. J Chin Med Assoc. 2008;71(4):200-6. doi: 10.1016/S1726-4901(08)70104-7. [PubMed: 18436503].
  59. Atchabahian A, Schwartz G, Hall CB, Lajam CM, Andreae MH. Regional analgesia for improvement of long-term functional outcome after elective large joint replacement. Cochrane Database Syst Rev. 2015;2015(8):CD010278. doi: 10.1002/14651858.CD010278.pub2. [PubMed: 26269416].
  60. Ziaeifar M, Arab AM, Mosallanezhad Z, Nourbakhsh MR. Dry needling versus trigger point compression of the upper trapezius: a randomized clinical trial with two-week and three-month follow-up. J Man Manip Ther. 2019;27(3):152-61. doi: 10.1080/10669817.2018.1530421. [PubMed: 30935341].
  61. Tabatabaiee A, Ebrahimi-Takamjani I, Ahmadi A, Sarrafzadeh J, Emrani A. Comparison of pressure release, phonophoresis and dry needling in treatment of latent myofascial trigger point of upper trapezius muscle. J Back Musculoskelet Rehabil. 2019;32(4):587-94. doi: 10.3233/BMR-181302. [PubMed: 30584120].
  62. Rezaeian T, Mosallanezhad Z, Nourbakhsh MR, Norouzi M, Sajedi F. Effects of dry needling technique into trigger points of the sternocleidomastoid muscle in migraine headache: a randomized controlled trial. Am J Phys Med Rehabil. 2020;99(12):1129-37. doi: 10.1097/PHM.0000000000001504. [PubMed: 32544109].
  63. Ali H, Elzohiery A, Arafa M, Elkadery N. Dry needling versus ultrasonic in treating cervical myofascial pain syndrome. QJM. 2020;113(Suppl 1):hcaa064-5. doi: 10.1093/qjmed/hcaa064.005.
  64. Abbaszadeh-Amirdehi M, Ansari NN, Naghdi S, Olyaei G, Nourbakhsh MR. Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points. J Bodyw Mov Ther. 2017;21(1):48-52. doi: 10.1016/j.jbmt.2016.04.014. [PubMed: 28167189].
  65. Gerber LH, Shah J, Rosenberger W, Armstrong K, Turo D, Otto P, et al. Dry needling alters trigger points in the upper trapezius muscle and reduces pain in subjects with chronic myofascial pain. PM R. 2015;7(7):711-8. doi: 10.1016/j.pmrj.2015.01.020. [PubMed: 25661462].
  66. Rodríguez-Mansilla J, González-Sánchez B, De Toro García Á, Valera-Donoso E, Garrido-Ardila EM, Jiménez-Palomares M, et al. Effectiveness of dry needling on reducing pain intensity  in patients with myofascial pain syndrome: a Meta-analysis. J Tradit Chin Med. 2016;36(1):1-13. doi: 10.1016/s0254-6272(16)30001-2. [PubMed: 26946612].
  67. Charles D, Hudgins T, MacNaughton J, Newman E, Tan J, Wigger M. A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. J Bodyw Mov Ther. 2019;23(3):539-46. doi: 10.1016/j.jbmt.2019.04.001. [PubMed: 31563367].
  68. Koca İ, Boyaci A. A new insight into the management of myofascial pain syndrome. Gaziantep Med J. 2014;20(2):107-2. doi: 10.5455/GMJ-30-149824.
  69. Fleckenstein J, Zaps D, Rüger LJ, Lehmeyer L, Freiberg F, Lang PM, et al. Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: results of a cross-sectional, nationwide survey. BMC Musculoskelet Disord. 2010;11(1):32. doi: 10.1186/1471-2474-11-32. [PubMed: 20149248]. 

Iranian Red Crescent Medical Journal (IRCMJ)
Volume 23, Issue 2 - Serial Number 2
2021
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  • Receive Date: 20 October 2020
  • Revise Date: 27 May 2024
  • Accept Date: 27 January 2024
  • First Publish Date: 27 January 2024
  • Publish Date: 01 February 2021
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