Title
Comparison of the Short-Term Outcomes Between Trigger Point Dry Needling Versus Trigger Point Manual Therapy for the Management of Chronic Mechanical Neck Pain: A Randomized Clinical Trial.

Author(s)
Llamas-Ramos R1, Pecos-Mart?n D, Gallego-Izquierdo T, Llamas-Ramos I, Plaza-Manzano G, Ortega-Santiago R, Cleland J, Fern?ndez-de-Las-Pe?as C.

Published
Sep, 2014

Published In
J Orthop Sports Phys Ther. 2014 Sep 30:1-34

Abstract
Study Design Randomized clinical study. Objectives To compare the effects of trigger point dry needling (TrP-DN) and trigger point (TrP) manual therapy on pain, function, pressure pain sensitivity, and cervical range of motion in subjects with chronic mechanical neck pain. Background Recent evidence suggests that TrP-DN could be effective in the treatment of neck pain. However, no studies have directly compared the outcomes of TrP-DN and TrP manual therapy in this population. Methods Ninety-four patients (mean ? SD age: 31 ? 3 years old; 66% female) were randomized into a TrP-DN group (n=47), or a TrP manual therapy group (n=47). Neck pain intensity (11-point numeric pain rating scale [NPRS]), cervical range of motion, and pressure pain thresholds (PPT) over the spinous process of C7 were measured at baseline, immediately after treatment and at a 1-week and 2-week follow-up. The Spanish version of the Northwick Park Neck Pain Questionnaire (NPQ) was used to measure disability/function at baseline and the 2-week follow-up. Mixed-model repeated measured ANOVAs were used to determine if a Group * Time interaction existed on the effects of the treatment on each outcome variable with group as the between-subjects variable and time as the within-subjects variables. Results The ANOVA revealed that subjects receiving TrP-DN had similar outcomes to individuals receiving TrP manual therapy in terms of pain, function and cervical range of motion. The 4x2 mixed model ANOVA also revealed a significant Group * Time interaction (P<0.001) for PPT: patients receiving TrP-DN experienced greater increase in PPT (decrease pressure sensitivity) than those receiving TrP manual therapy at all follow-up periods (between-groups differences, post-treatment: 59.0 [95%CI 40.0, 69.2], 1-week follow-up: 69.2 [49.5, 79.1], 2-weeks follow-up; 78.9 [49.5,89.0]). Conclusions The results of this clinical trial suggest that 2 sessions of TrP-DN and TrP manual therapy resulted in similar outcomes in terms of pain, disability and cervical range of motion. Those in the TrP-DN group experienced greater improvements in PPT over the cervical spine. Future trials are needed to examine the effects of TrP-DN and TrP manual therapy at long-term follow-up periods. Level of Evidence Therapy, Level 1b. J Orthop Sports Phys Ther, Epub 30 September 2014. doi:10.2519/jospt.2014.5229.

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