Dry Needling Versus Manual Pressure

Reference:Llamas-Ramos R et al Comparison of the short-term outcomes between trigger point dry needling and trigger point manual therapy for the management of chronic mechanical neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2014 Nov;44(11):852-61.

Sitting in front of you is a patient reporting of pain in the upper traps region aggravated by various postures and neck movements. You rule out any articular and neural involvements. Upon palpation, you inevitably feel a tight band and point tenderness in the trapezius muscle.

So what do you do?

Option #1: Trigger point (TrP) dry needling (DN) where you apply a needle into the active trigger points in the upper trapezius muscle until a local twitch response is obtained, then move the needle 2 to 3mm up and down for 30 seconds.

Option #2: TrP manual therapy (MT) where you apply various manual pressures over the trapezius region and passively stretch the muscle.

Question: Based on evidence-based practice, which one is the better option for the patient?

Answer: Either one!

This recent RCT conducted in Spain demonstrated that patients who received only 2 sessions of TrP DN or TrP MT had similar improvements in pain, function and cervical ROM after one week and at 2-week follow-up.

Since there was no control group for this study we are limited in our conclusions about the benefits of either one. As all good studies do, they make us come up with even more questions. For instance what if they compared TrP treatments to mobilization with movements (MWMs), thoracic manipulations, neck strengthening exercises or just cognitive behavioural therapy (CBT)?

Research can be so exciting!

Based on my personal experience, a patient with pure “muscle pain” may also benefit from Tissue Distraction Release with movement (TDR) for 3 minutes using silicone cups (…however no study has been done on this yet).
Just look up my cupping videos on Youtube by searching for “APTEI TDR”.

You may download my complimentary TDR manual on www.aptei.com/shop

Posted on: December 22, 2014

Categories: Cervical Spine

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