Effects of Dry Needling on Muscle Stiffness in Latent Myofascial Trigger Points: A Randomized Controlled Trial

  • Jorge Sánchez-Infante
    Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain

    Hospital Universitario Virgen de la Salud, Castilla La Mancha, Toledo, Spain
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  • Alfredo Bravo-Sánchez
    Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
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  • Fernando Jiménez
    Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
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  • Javier Abián-Vicén
    Address reprint requests to Javier Abián-Vicén, PT, PhD, Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Avenida Carlos III s/n, Toledo 45071, Spain
    Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
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Published:February 23, 2021DOI:


      • Dry needling is effective for reducing muscle stiffness in latent trigger points.
      • Muscle thickness does not show changes after dry needling in latent trigger points.
      • Dry needling increased the pressure pain threshold in latent trigger points.


      The aim of this study was to analyze the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on muscle stiffness. A total of 51 recreational physically active subjects with LTrPs in the upper trapezius volunteered to participate and were randomly divided into a DN-group (n = 27) and a sham-DN group (n = 24). Volunteers received 1-session of DN or placebo treatment. Muscle stiffness, measured with strain and shear-wave elastography, pressure pain threshold (PPT), post-needling soreness, and muscle thickness were evaluated before treatment, and at 30-min, 24-hours, and 72-hours follow-up after treatment. The DN-group showed lower values from baseline for muscle stiffness measured with shear-wave elastrography at 24-hours (from 44.44 ± 15.97 to 35.78 ± 11.65 kpa; P < .01) and at 72-hours (35.04 ± 12.61 kpa; P < .01) and with strain elastography at 72-hours (from 1.75 ± 0.50 to 1.36 ± 0.40 AU; P < .01). The DN-group showed higher values of PPT than the sham-DN group at 72-hours (4.23 ± 0.75 vs. 5.19 ± 1.16 kg/cm2; P < .05). There was a progressive decrease in post-needling soreness compared to pain during needling of 33.13 ± 21.31% at 30-min, 80.92 ± 10.06% at 24-hours, and a total decrease in post-needling soreness in all participants at 72-hours. DN therapy is effective in reducing short-term muscle stiffness and increasing the PPT in volunteers with LTrPs in the upper trapezius after a treatment session.


      This study found that one session of DN intervention in latent trigger points of the upper trapezius muscle reduced muscle stiffness and the pressure pain threshold for the dry needling group compared to the sham dry needling group.

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        • Adigozali H
        • Shadmehr A
        • Ebrahimi E
        • Rezasoltani A
        • Naderi F
        B mode, Doppler and ultrasound elastography imaging on active trigger point in women with myofascial pain syndrome treated by dry needling.
        Muscles Ligaments Tendons J. 2019; 9: 417-424
        • Azevedo DC
        • de Lima Pires T
        • de Souza Andrade F
        • McDonnell MK
        Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region.
        Eur J Pain. 2008; 12: 226-232
        • Bang H
        • Flaherty SP
        • Kolahi J
        • Park J
        Blinding assessment in clinical trials: A review of statistical methods and a proposal of blinding assessment protocol.
        Clin Res Regul Aff. 2010; 27: 42-51
        • Baraja-Vegas L
        • Martín-Rodríguez S
        • Piqueras-Sanchiz F
        • Faundez-Aguilera J
        • Bautista IJ
        • Barrios C
        • Garcia-Escudero M
        • Fernández-de-Las-Peñas C
        Localization of muscle edema and changes on muscle contractility after dry needling of latent trigger points in the gastrocnemius muscle.
        Pain Med. 2019; 20: 1387-1394
        • Braithwaite FA
        • Walters JL
        • Li LSK
        • Moseley GL
        • Williams MT
        • McEvoy MP
        Blinding strategies in dry needling trials: Systematic review and meta-analysis.
        Phys Ther. 2019; 99: 1461-1480
        • Calvo-Lobo C
        • Diez-Vega I
        • Martínez-Pascual B
        • Fernández-Martínez S
        • de la Cueva-Reguera M
        • Garrosa-Martín G
        • Rodríguez-Sanz D
        Tensiomyography, sonoelastography, and mechanosensitivity differences between active, latent, and control low back myofascial trigger points: A cross-sectional study.
        Medicine (Baltimore). 2017; 96: e6287
        • Celik D
        • Mutlu EK
        Clinical implication of latent myofascial trigger point.
        Curr Pain Headache Rep. 2013; 17: 353
        • Dommerholt J
        • Finnegan M
        • Hooks T
        • Chou LW
        A critical overview of the current myofascial pain literature – July 2018.
        J Bodyw Mov Ther. 2018; 22: 673-684
        • Eftekharsadat B
        • Babaei-Ghazani A
        • Zeinolabedinzadeh V
        Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial.
        Med J Islam Repub Iran. 2016; 30: 401
        • Fernández-de-las-Peñas C
        • Alonso-Blanco C
        • Fernández-Carnero J
        • Carlos Miangolarra-Page J
        The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: A pilot study.
        J Bodyw Mov Ther. 2006; 10: 3-9
        • Fernández-de-Las-Peñas C
        • Dommerholt J
        International Consensus on diagnostic criteria and clinical considerations of myofascial trigger points: A Delphi study.
        Pain Med. 2018; 19: 142-150
        • Ga H
        • Choi JH
        • Park CH
        • Yoon HJ
        Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients—A randomised trial.
        Acupunct Med. 2007; 25: 130-136
        • Ga H
        • Koh HJ
        • Choi JH
        • Kim CH
        Intramuscular and nerve root stimulation vs lidocaine injection to trigger points in myofascial pain syndrome.
        J Rehabil Med. 2007; 39: 374-378
        • Ganesh GS
        • Singh H
        • Mushtaq S
        • Mohanty P
        • Pattnaik M
        Effect of cervical mobilization and ischemic compression therapy on contralateral cervical side flexion and pressure pain threshold in latent upper trapezius trigger points.
        J Bodyw Mov Ther. 2016; 20: 477-483
        • Gattie E
        • Cleland JA
        • Snodgrass S
        The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis.
        J Orthop Sports Phys Ther. 2017; 47: 133-149
        • Ge HY
        • Arendt-Nielsen L
        Latent myofascial trigger points.
        Curr Pain Headache Rep. 2011; 15: 386-392
        • Grabowski PJ
        • Slane LC
        • Thelen DG
        • Obermire T
        • Lee KS
        Evidence of generalized muscle stiffness in the presence of latent trigger points within infraspinatus.
        Arch Phys Med Rehabil. 2018; 99: 2257-2262
        • Hong CZ
        Lidocaine injection versus dry needling to myofascial trigger point: The importance of the local twitch response.
        Am J Phys Med Rehabil. 1994; 73: 256-263
        • Ishikawa H
        • Muraki T
        • Morise S
        • Sekiguchi Y
        • Yamamoto N
        • Itoi E
        • Izumi SI
        Changes in stiffness of the dorsal scapular muscles before and after computer work: A comparison between individuals with and without neck and shoulder complaints.
        Eur J Appl Physiol. 2017; 117: 179-187
        • James KE
        • Bloch DA
        • Lee KK
        • Kraemer HC
        • Fuller RK
        An index for assessing blindness in a multi-centre clinical trial: disulfiram for alcohol cessation—A VA cooperative study.
        Stat Med. 1996; 15: 1421-1434
        • Koo TK
        • Guo JY
        • Brown CM
        Test-retest reliability, repeatability, and sensitivity of an automated deformation-controlled indentation on pressure pain threshold measurement.
        J Manipulative Physiol Ther. 2013; 36: 84-90
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Liu L
        • Huang QM
        • Liu QG
        • Ye G
        • Bo CZ
        • Chen MJ
        • Li P
        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: 944-955
        • Luan S
        • Zhu ZM
        • Ruan JL
        • Lin CN
        • Ke SJ
        • Xin WJ
        • Liu CC
        • Wu SL
        • Ma C
        Randomized trial on comparison of the efficacy of extracorporeal shock wave therapy and dry needling in myofascial trigger points.
        Am J Phys Med Rehabil. 2019; 98: 677-684
        • Lucas KR
        • Rich PA
        • Polus BI
        Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: The effects of latent myofascial trigger points.
        Clin Biomech. 2010; 25: 765-770
        • Maher RM
        • Hayes DM
        • Shinohara M
        Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elastography.
        Arch Phys Med Rehabil. 2013; 94: 2146-2150
        • Martín-Pintado-Zugasti A
        • Rodríguez-Fernández Á L
        • 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: 301-308
        • Martín-Pintado Zugasti A
        • Rodríguez-Fernández Á L
        • García-Muro F
        • López-López A
        • Mayoral O
        • Mesa-Jiménez J
        • Fernández-Carnero J
        Effects of spray and stretch on postneedling soreness and sensitivity after dry needling of a latent myofascial trigger point.
        Arch Phys Med Rehabil. 2014; 95
        • Mohamadi M
        • Piroozi S
        • Rashidi I
        • Hosseinifard S
        Friction massage versus kinesiotaping for short-term management of latent trigger points in the upper trapezius: A randomized controlled trial.
        Chiropr Man Therap. 2017; 25: 25
        • Nouged E
        • Dajani J
        • Ku B
        • Al-Eryani K
        • Padilla M
        • Enciso R
        Local anesthetic injections for the short-term treatment of head and neck myofascial pain syndrome: A systematic review with meta-analysis.
        J Oral Facial Pain Headache. 2019; 33: 183-198
        • Oliveira-Campelo NM
        • de Melo CA
        • Alburquerque-Sendín F
        • Machado JP
        Short- and medium-term effects of manual therapy on cervical active range of motion and pressure pain sensitivity in latent myofascial pain of the upper trapezius muscle: A randomized controlled trial.
        J Manipulative Physiol Ther. 2013; 36: 300-309
        • Shah JP
        • Danoff JV
        • Desai MJ
        • Parikh S
        • Nakamura LY
        • Phillips TM
        • Gerber LH
        Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
        Arch Phys Med Rehabil. 2008; 89: 16-23
        • Shah JP
        • Phillips TM
        • Danoff JV
        • Gerber LH
        An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.
        J Appl Physiol (1985). 2005; 99: 1977-1984
        • Simons DG
        • Travell JG
        • Simons LS
        Travell & Simons' Myofascial Pain and Dysfunction: Upper Half of Body. 1. Lippincott Williams & Wilkins, 1999
        • 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: 587-594
        • Tough EA
        • White AR
        • Richards SH
        • Lord B
        • Campbell JL
        Developing and validating a sham acupuncture needle.
        Acupunct Med. 2009; 27: 118-122
        • Vázquez-Justes D
        • Yarzábal-Rodríguez R
        • Doménech-García V
        • Herrero P
        • Bellosta-López P
        Effectiveness of dry needling for headache: A systematic review.
        Neurologia. 2020;
        • Yeganeh Lari A
        • Okhovatian F
        • 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: 204-209