Evolution of Myofascial Pain, Post-dry Needling. Repair and Measuring With Elastography, of Myofascial Tissue.
Condition: Myofascial Pain Syndromes; Dry Needling, Technique for the Treatment of the Myofascial Trigger Points; Elastography
MeSH terms: Myofascial Pain Syndromes; Fibromyalgia
Study type: Interventional

Summary: 
      This study evaluates the deep dry needling technique as a percutaneous technique included in
      the professional field of physiotherapy.

      The project quantifies a significant limit on the number of local twitch responses necessary
      for the favorable treatment of myofascial pain and analyzes the injury degree and/or the
      repair of myofascial tissue, with "Elastography".
    

Detailed description: 
      The myofascial shoulder pain caused by myofascial trigger points, is one of the main causes
      of medical consultation and functional disability in the general population and particularly
      in the amateur athlete.

      Nowadays, many physiotherapists all over the world, study and practice the dry needling as a
      therapeutic tool for the treatment of myofascial trigger points. The most used modality is
      the technique described by Hong:

        -  This technique introduces an acupuncture needle in the skin until reaching the
           dysfunctional muscle fiber. To do so, it uses maneuvers "fast in" and "fast out" of
           needle, until the extinction of local twitch responses or the tolerance of the patient.

        -  The local twitch response is defined as a reflex and transitory contraction of a group
           of muscle fibers associated with a myofascial trigger points.

        -  The technique eliminates muscle contractile activity by mechanical interruption of their
           muscle fibers, mechanism which finishes with the sensitization of nearby nerves and with
           the start of the nociceptive modulation peripheral, segmental and central.

      The dry needling technique, in its eagerness to obtain local twitch responses, pierces the
      muscle fibers both dysfunctional and normal, the fascial tissue that wraps the myofascial
      trigger points and also neuro-vascular structures. That is, the treatment of myofascial
      trigger points with dry needling, makes reference to a mechanical trauma done with a
      acupuncture needle.

      The myofascial tissue injured can suffer repair or regeneration, which is mainly due to the
      extension of the lesion. The process of healing of a wound is strictly regulated by multiple
      growth factors and cytokines, which are released into the wound. The alterations that disturb
      the healing process, can lead to chronic wounds that do not heal or to an excessive fibrosis.

      The pathobiological processes, in form of fibrosis, would present changes in stiffness and
      elasticity of the neo-tissue. The quantitative elastography, is shown as an effective tool to
      measure the amount of fibrosis, occasioned by repeated percussion of the acupuncture needle
      on the myofascial tissue.
    

Intervention name(s): High Intensity Dry Needling; Low intensity Dry Needling; Fascial Mechanotransduction Dry Needling; Technique Placebo of Dry Needling
Intervention type(s): Other; Other; Other; Other
Intervention description(s): This technique follows the criteria established by Dr Hong C-Z. This technique is known as "fast in and fast out technique" and uses repeated insertion of the acupuncture needle in the myofascial trigger point, with the aim to get multiple local twitch responses. The technique ends when the local twitch responses disappear.; Technique proposed by the main investigator and based on the studies of Professor Dr. Jay P. Shah and the mechanisms of neuromodulation that transmits us the acupuncture scientific evidence.; The Fascial Mechanotransduction Dry Needling Technique, strikes with the acupuncture needle until it reaches and pierces the myofascial trigger point. Then the acupuncture needle is rolled in the connective tissue, which causes an intense coupler that we define as "needle grasp". Finally, the acupuncture needling is pulled-out twice.
The screwing and the two pull-out of the acupuncture needle is performed in the infraspinatus and supraspinatus muscles and we describe it as mechanotransduction cycle. Each cycle lasts 30 seconds and the whole technique lasts 3 minutes per session.; Technique with a total duration of 3 minutes per session:
To locate the myofascial trigger points of infraspinatus and supraspinatus muscles and put each bridle on them.
Monitor longitudinally taut band, with index and middle fingers.
Percuss with tube and needle placebo (Sham needle) on Infraspinatus.
Remove the tube and needle placebo from the device. Reintroducing the placebo needle into the tube and strike on the supraspinatus. Repeat this sequence without interruption for 3 minutes.
Remove the bridles and perform hemostasis with cotton.
We will give end to the technique placebo of dry needling.
Other intervention name(s): Control Group
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Myofascial pain.; Myofascial trigger point.; Infraspinatus muscle.; Deep dry needling.; Local twitch response.; Fascial mechanotransduction.; Needle grasp.; Myofascial fibrosis.; Elastography.