Post-needling Soreness After Internal Gastrocnemius Muscle Treatment
Condition: Heel Pain Syndrome
Study type: Interventional

Summary: 
      Mechanical hyperalgesia areas, also known as myofascial trigger points, are treated by manual
      therapy or invasive technics. Dry needling achieves an improvement of the symptomatology in
      70% of the subjects, being the acute patients the most benefited. However, bruising,
      bleeding, pain during treatment or post-needling soreness. Plantar fasciitis is the most
      common cause of interior heel pain, affects approximately 10% of the general population and
      is one of the most benefited pathologies in the long term by the application of dry needling
      The gauge of the needle chosen for the treatment can influence post-needling soreness
      intensity and pressure pain threshold.

      Objective To evaluate the relation between post-needling soreness intensity and needle
      diameter on the treatment of the most hyperalgesic point of the internal gastrocnemius.

      Hypothesis Post-needling soreness intensity and pressure pain threshold depend on needle
      diameter applied in the treatment of the most hyperalgesic point of the internal
      gastrocnemius.
    

Detailed description: 
      Intervention:

      Two zones are established:

        -  Zone 1: where researcher nº 1 controls the data management and sample randomization.

        -  Zone 2: where researcher nº 2 locates the most hyperalgesic area and measures pressure
           point threshold variable and researcher nº 3 performs dry needling puncture.

      Researcher nº 1 explains to the subjects how the study works, collects the confidential
      documents and scores the independent variables (sex, age and BMI). Every subject receives an
      identification code and is randomly assign to a intervention group (A, B or C) Researcher nº
      2 makes delivery of the document where the variables pressure pain threshold and
      post-needling soreness intensity will be written down. Firstly, the visual analogue scale
      compliance prior to the intervention is requested. After that, the subject is placed in prone
      position on the stretcher with a slight knee flexion and the most hyperalgesic area in the
      internal gastrocnemius of the lower limb with plantar fasciitis is located and marked.

      Researcher nº 2 performs the algometry at the most hyperalgesic area (3 measurements with 30
      seconds between them), writes down the results of pressure pain threshold variable and leaves
      the room.

      Researcher nº 3 receives a needle from researcher nº 1 ignoring its diameter (colour tab is
      removed). Firstly, contamination is prevented by disinfection, then, 10 insertions are made
      at the marked point (the number of local twitch response are counted) and the needle used is
      thrown in the sanitary waste container. Ischemic compression is performed for 60 seconds
      followed by an analytical stretch of the internal gastrocnemius for 30 seconds.

      Once researcher nº 3 has finished the intervention leaves the room and researcher nº 2
      returns to repeat the measurements (post-needling soreness intensity, by filling in VAS, and
      pressure pain threshold, performing algometry).

      Researcher nº 2 reminds the subject to complete VAS at 12, 24, 48 and 72 hours (suggesting
      setting an alarm) and makes an appointment 48 hours after to perform the third measure of
      pressure pain threshold variable.

      When all the data needed for the study has been collected, researcher nº1 gathers results and
      exports them for statistical interpretation.
    

Intervention name(s): Dry needling treatment with a thinner needle; Dry needling treatment with a medium-sized needle; Dry needling treatment with a thickest needle
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): We will make an application with the dry needling technique with a fine needle on the myofascial trigger points of the gastrocnemius muscle.; We will make an application with the dry needling technique with a medium-sized needle on the myofascial trigger points of the gastrocnemius muscle.; We will make an application with the dry needling technique with the thickest needle on the myofascial trigger points of the gastrocnemius muscle.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment