Background: The effect of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy are unknown. Objectives: To determine the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to exercise in a patient population with Achilles tendinopathy. Methods: This single-factor, pretest-posttest control group design included 22 subjects between the ages of 24 and 65 years with Achilles tendinopathy. Subjects were randomly assigned to either a control group (MT+Ex) or experimental group (TDN+MT+Ex). Subjects in both groups completed 8 physical therapy treatment sessions over 4 weeks. The intervention for the TDN+MT+Ex group included TDN to MTPs in the gastrocnemius, soleus or tibialis posterior each session while the same soft tissue mobilization and exercise program was conducted in both groups. Results: Within group analysis was performed for each group at 4 week and 90 day follow up. Significant improvement (p < .05) was achieved for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 90 days. The GROC was significant for MT + Ex at 90 days. The MCID for the FAAM, GROC were surpassed in both groups at 4 weeks and 90 days. NPRS surpassed the MCID for the MT + Ex group at 4 weeks. Conclusion: A large RCT to investigate the effects of TDN on MTP in Achilles tendinopathy is feasible with modifications. Recommendations: Special considerations for data collection sites should be given to the health care system, insurance payor, and financial burden to subjects.

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Abstract Aim: The aim of this study was to investigate if treatment with “dry needling” in myofascial triggerpoints (MTrPs) in the rotatorcuff muscles may affect impingement symptoms such as pain during provocative tests, shoulder mobility, and function. The research questions were: Does the value of pain change on the Visual Analog Pain Scale (VAS) between before and after treatment? Do the positive provocative tests for impingement change between before and after treatment? Does the active shoulder mobility change between before and after treatment? Does the self-rated function change between before and after treatment? Method: The study was a prospective randomized intervention study and 19 persons with impingement symptoms (mean ± standard deviation; 58 ± 18 years, and shoulder pain duration 3.9 ± 1.6 months) were randomized into two groups. The groups were tested before, directly after and 3 weeks after treatment. The intervention group was treated twice, with a week in between, with “dry needling” in MTrPs. The control group was also treated on two occasions but was instead given a superficial needle in the infraspinatus muscle. All subjects were treated by the same physiotherapist. Pain was evaluated on the VAS when subjects performed active shoulder flexion before and after treatment. Provocative tests for shoulder impingement (Neer sign, Hawkins-Kennedy test and Jobe test) as well as range of motion tests were performed before, after and three weeks after treatment. The frequencies of positive/negative provocative tests were presented. Shoulder function was evaluated with the QuickDASH questionnaire. Significance level p≤0.05 was used in the study and a tendency was identified between 0.05 ≤ p &lt; 0.1. Results: There was a tendency (p=0.086) with decreased pain (VAS) in the intervention group after the treatment. Among the impingement tests only significant improved results was observed for Neer sign test three weeks after the treatment (p=0.025) No significant difference could be seen on the active shoulder mobility between before and after the treatment. The perceived function in the intervention group, measured with the Quick DASH questionnaire, showed a tendency (p=0.086) towards a better function. Conclusions: The study showed a tendency towards that”dry needling”  in MTrPs may affect impingement symptoms such as pain and function. The provocative tests for shoulder impingement, Neer sign, showed a significant decrease in pain after treatment. More studies with larger population is needed to make a statement about the effect of “dry needling” in MTrPs as a treatment for shoulder impingement symptoms. / Sammanfattning Syfte och frågeställningar: Syftet med studien var att undersöka om behandling med ”dry needling” (intramuskulär nålstimulering) i myofasciella triggerpunkter (MTrPs) i rotatorcuffmuskulaturen kan påverka impingementsymptom såsom smärta vid provokationstester, axelledsrörlighet och funktion. Frågeställningarna var: Förändras smärtskattning på visuell analog skala(VAS) vid aktiv axelflexion efter jämfört med före behandling? Förändras de positiva provokationstesterna för impingement efter jämfört med före behandling? Förändras den aktiva axelledsrörligheten efter jämfört med före behandling? Förändras den självskattade funktionen efter jämfört med före behandling? Metod: Studien var en prospektiv randomiserad interventionsstudie, 19 forskningspersoner (fp) med impingementsymptom, (medelålder 58 ± 18 år, besvärsdurationens medeltid 3.9 ± 1.6 mån), randomiserades till två grupper. Grupperna undersöktes före, direkt efter och tre veckor efter avslutad behandling. Interventionsgruppen behandlades vid två tillfällen, med en veckas mellanrum, med ”dry needling” i MTrPs medan kontrollgruppen vid två tillfällen istället fick en ytlig akupunkturnål i m infraspinatus. Behandlingen av alla fp utfördes av en och samma fysioterapeut. Smärta utvärderades med (VAS) vid aktiv axelflexion direkt före och efter behandling. Provokationstester (Neer sign, Hawkins-Kennedy test och Jobe test) samt rörlighetsmätning utfördes före, efter och tre veckor efter avslutad behandling. Frekvensen positiva/negativa provokationstesttest summerades. Funktionen utvärderades med frågeformuläret QuickDASH. Signifikansnivå p&lt; 0.05 används i studien och en tendens identifierades mellan 0.05 ≤ p &lt; 0.1. Resultat: Det fanns en tendens (p=0.086) till minskad smärta (VAS) i interventionsgruppen efter jämfört med före behandling. Bland impingementtesterna sågs enbart ett signifikant förbättrat resultat för Neers sign tre veckor efter avslutad behandling jämfört med före behandling (p=0.025). Ingen signifikant skillnad kunde ses gällande rörligheten före och efter behandling. Den upplevda funktionsförmågan mätt med frågeformuläret QuickDASH visade en tendens (p=0.086) mot bättre funktion i interventionsgruppen. Slutsats: Studien har visat tendenser på att ”dry needling” i MTrPs kan påverka impingementsymptom såsom minskad smärta och bättre självskattad funktion efter behandling jämfört med före. Impingementtestet Neer sign visade en signifikant minskad smärta efter behandling. Fler studier med större grupper, större ålderspann och längre behandlingstid behövs för att kunna uttala sig om effekten av ”dry needling” i MTrPs som behandlingsmetod vid impingementsymptom i axeln. / <p>Fristående kurs i Idrottsvetenskap inriktning idrottsmedicin 2013-2015</p>

The temporomandibular myofascial pain presents a major challenge in the diagnosis of temporomandibular disorders. Due to the characteristics of this condition, intramuscular injection procedures are often needed for adequate control of symptoms and treatment. Thus, the aim of this study was to evaluate the effectiveness of injection with different substances or dry needling in temporomandibular myofascial pain. The study design consisted of a systematic review of randomized clinical trials and research databases consulted were: Pubmed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus and Web of Science until October 2014. The selection of studies was carried out by two independent reviewers, who applied eligibility criteria to obtain the final sample of primary studies. After application of the inclusion criteria were selected fifteen studies. Due to the heterogeneity of the primary studies it was not possible to perform a meta-analysis. The narrative analysis of the results showed that most of the studies had methodological limitations and biases that have compromised the quality of its findings. Thus, there is a need of conducting further randomized clinical trials, with follow-up and larger samples, to evaluate the real effectiveness of the technique and evaluated substances. / A dor miofascial temporomandibular apresenta um grande desafio diagnóstico dentro das Disfunções Temporomandibulares. Devido às características dessa condição, procedimentos de infiltração intramuscular muitas vezes são necessários para o adequado controle e tratamento dos sintomas. Assim, o objetivo desse estudo é avaliar a efetividade de infiltrações com diferentes substâncias ou agulhamento à seco em dor miofascial temporomandibular. O delineamento do estudo consistiu em uma revisão sistemática de ensaios clínicos randomizados e as bases de pesquisa consultadas foram: Pubmed, EMBASE, CENTRAL/Cochrane, Lilacs, Scopus e Web of Science no período até outubro de 2014. A seleção dos estudos foi realizada por dois avaliadores independentes, que aplicaram critérios de elegibilidade para a obtenção da amostra final de estudos primários. Após a aplicação dos critérios de inclusão quinze estudos foram selecionados. Devido à heterogeneidade dos estudos primários não foi possível realizar uma meta-análise. A análise narrativa dos resultados mostrou que a maioria dos estudos apresentava limitações metodológicas e vieses que comprometeram a qualidade de seus achados. Assim, existe a necessidade da condução de novos ensaios clínicos randomizados, com tempo de acompanhamento e amostras maiores, para avaliar a real efetividade da técnica e das substâncias avaliadas.