Comparison of Dry Needling and Activator Trigger Point Therapy on Upper Trapezius Trigger Points.
Condition: Trigger Point Pain, Myofascial
MeSH terms: Myofascial Pain Syndromes
Study type: Interventional

Summary: 
      The aim of this study was to compare the effects of Dry needling and Activator trigger point
      therapy on upper trapezius trigger points.Randomized controlled trial was conducted on
      Sixty-eight patients with active upper trapezius trigger points meeting the inclusion
      criteria i.e Age limit 20-45 both genders, presence of unilateral or bilateral upper
      trapezius Trigger Points. For bilateral presence of trigger points, the more painful side was
      selected. If more than one trigger points were present on the side to be treated, most
      painful trigger point was treated. Patients fulfilling essential criteria to identify the
      trigger points. According to Simon's criteria, which included a palpable taut band that was
      detected with palpation, the presence of a sensitive nodule in the taut band which was
      determined with algometry and referral pain. Exclusion criteria was specific neck pain, e.g.
      radiculopathy, systemic or inflammatory pain., evidence of spinal cord compression, recent
      neck surgery or trauma, long-term use of corticosteroids, anticoagulant use, e.g. Warfarin,
      presence of a blood coagulation disorder, contraindication for needling such as local
      infection, pregnancy with threatened abortion. Participants were selected by purposive
      sampling, group randomization using lottery method technique. All the participants were
      assessed using Numeric pain rating scale to measure pain, algometer to measure pain pressure
      threshold and inclinometer to measure cervical lateral flexion range of motion. A demographic
      form was used to collect data from patients. Patients were randomly assigned in dry needling
      and activator therapy group. Treatment was given at a frequency of 2 sessions per week and
      total 6 sessions were given to both group during a course of 3 weeks. The data was analyzed
      using SPSS 21.
    

Detailed description: 
      A myofascial trigger point (TrP) has been described as a hyperirritable spot located in a
      taut band of muscle; or a small pea or rope-like nodular or crepitant (crackling, grating)
      area within the muscle, which is painful to palpation or compression and refers pain,
      tenderness, or an autonomic response to a remote area. Some investigators stated that when
      pressure is applied to a TrP, a -jump sign‖ or -jump response‖ is elicited whereby the
      patient reacts with facial grimacing or by jumping away from the examiner.Patients with
      myofascial trigger points are generally characterized by the presence of one or more of the
      following symptoms: local pain, referred pain according to a typical pattern, pain when
      exerting compression or stretch on the muscle, local twitch response (LTR) provoked by the
      snapping palpation of the taut band, reduced force, and decreased range of motion (ROM). A
      combination of these symptoms can result in less functionality and quality-of-life. As a
      consequence, pain, ROM, and functionality are frequently used to measure the effect of
      treatment in patients with myofascial pain syndrome . Myofascial trigger points can be
      further differentiated as active or latent . Active and latent myofascial trigger points
      elicit local and referred pain, however active myofascial trigger points also reproduce
      patient symptoms, whereas latent myofascial trigger points do not .

      Dry needling is a minimally invasive procedure in which an acupuncture needle is inserted
      directly into an myofascial trigger points.The advantages of dry needling are being
      increasingly documented and include an immediate reduction in local, referred, and widespread
      pain , and restoration of range of motion and muscle activation patterns.Dry needling is
      typically used to treat muscles, ligaments, tendons, subcutaneous fascia, scar tissue,
      peripheral nerves, and neurovascular bundles for the management of a variety of
      neuromusculoskeletal pain syndromes Chiropractic activator tool is an instrument for
      assisting with manipulation having cushioned head devices which require the applicator to pre
      - load or arm the device by pulling a handle against the action of a strong spring force.

      A study was conducted in 2015 which concluded that Dry needling can be recommended to relieve
      myofacial trigger point pain of neck and shoulders in short and medium terms.

      A study conducted in 2015 and found that There is moderate evidence that ischemic compression
      results in pain reduction, whereas there is strong evidence that dry needling has a positive
      effect on pain reduction. This decrease is greater compared with active range of motion
      exercises as well as no or placebo intervention A study conducted in 2014 and reported that
      dry needling is beneficial for decreasing pain immediately after treatment and at a 4-wk
      follow-up in patients with neck pain.

      A research in 2019 showed that both extracorporeal shock wave therapy and dry needling can be
      employed to treat myofacial trigger point of the upper trapezius muscle in patients with non
      specific neck pain .

      A research conducted in 2018 observed the changes in the ROM and neck disability index with
      Superficial dry needling and Deep dry needling techniques, but these changes were more
      significant in patients treated with Deep dry needling, especially in the follow-up periods A
      research in 2008 suggested that both ischaemic compression and activator trigger point
      therapy have an equal immediate clinically important effect on upper trapezius trigger point
      pain A study in 2008 suggested that activator trigger point therapy appeared to be more
      effective than myofascial band therapy or sham ultrasound in treating patients with
      non-specific neck pain and upper trapezius trigger points
    

Intervention name(s): Activator instrument; dry needle
Intervention type(s): Device; Device
Intervention description(s): activator instrument was placed perpendicular over the identified trigger point and 10 thrusts were delivered, with a rate of one thrust per second; By wrist flexion and extension movements, the trigger point was needled in different directions and tried to elicit at least one local twitch response during the procedure and patient's familiar referral pain was tried to obtain . Each dry needling procedure lasted 1-2 minutes
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Activator therapy; Dry needling,; Myofascial pain; Upper trapezius.