Comparison of Kinesio Taping, Dry Needling and Lidocain Injection Methods in Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is a chronic pain syndrome characterized by the presence of trigger points in muscles and fascia in various parts of the body. Due to the pain, it has negative effects on function, restricting movements and daily life activities. Several invasive and non-invasive methods with proven effectiveness are described in the management of myofascial pain syndrome. In this study, investigators aimed to compare the effect of kinesiotaping with dry needling and lidocaine injection treatment. İnvestigators hypothesized, that the effect of kinesiotaping have similar results compared to the invasiv treatment methods in the treatment of MPS.

Sixty-six patients diagnosed with myofascial pain syndrome in the upper trapezius were included in this retrospective study. Patients were divided into three groups. Twenty-two patients were randomly selected among patients who received kinesiotaping treatment (n:22). Twenty-two patients who received dry needling treatment (group 2) and 22 patients who received lidocaine injection treatment were randomly selected as controls. Patients were evaluated using the Visual Analogue Scale (VAS) and the Short Form (SF-36) scales, which were completed before and 3 weeks after the treatment.

Myofascial pain syndrome (MPS) is a chronic pain syndrome characterized by the presence of trigger points in muscles and fascia in various parts of the body. Myofascial pain syndrome is one of the most common musculoskeletal problems in adults, and its prevalence varies between 30-93%. Patients have symptoms such as pain (local or referred), loss of muscle strength, stiffness, and restriction of range of motion. Although the etiology of myofascial pain syndrome is not well understood, causes such as posture disorder, trauma, and ergonomic problems appear as etiology. Simon criteria are often used in the diagnosis. Apart from this, anamnesis and detailed physical examination are important in the diagnosis of MPS.

Dry needling is a treatment method which uses needles similar to those used in acupuncture, without any injectable drug to myofascial trigger points. Dry needling shows its effect through the exposure to various chemical mediators. The observation of a local course response in dry needling shows that the treatment is effective. Side effects such as bleeding, localized pain, vasovagal syncope, and rarely pneumothorax may occur during the treatment of dry needling.

Lidocaine injection and Dry needling are different applications that injectable drugs are not use in dry needling. Lidocain injection applied by giving a local anesthetic substance on the trigger point. It has been reported in the conducted studies that it has a similar effect as dry needling and that local pain is less common after injection.

Kinesiotaping (KT) is a treatment method developed by Dr. Kenzo Kase, which has been initially applied in the treatment of pain, and its use has become widespread in recent years. KT tape is a thin and flexible tape that allows joint movements. KT tape is widely used in the treatment of pain relief, muscle relaxation, edema reducement, improvement of muscle strength, and posture correction. Although the exact mechanism of KT is not well known, it is believed to cause a decrease in nociceptor pressure, create a space in the subcutaneous area, convenience in the removal of chemical mediators from the tissue, and also stimulation of somotosensory and proprioceptive mechanisms.

In our study, investigators aimed to compare the effectiveness of non-invasive KT on myofascial pain syndrome treatment with invasive treatment methods such as dry needling and lidocaine injections. The investigators hypothesized, that the effect of kinesiotherapy have similar results compared to the invasiv treatment methods in the management of MPS.

After IRB approval and informed consent by all patients were obtained, investigators performed this retrospective study. Instutional review board was obtained by the ethics committee of Bağcılar Training and Research Hospital (Number: 018.07.2.03.057.r1.071). All patients between 18-70 years who were diagnosed with myofascial pain syndrome in the upper trapezius muscle between January 2017 to December 2018 at investigator 's institution were enrolled in this study. According to the power analysis result, 22 patients files were randomly selected among the patients received KT (group 1) using the coin method, and 22 files were randomly selected from the files of patients receiving dry needling (group 2) and lidocaine injection (group 3) treatment in the same way. There were no differences between the age and gender distributions of all 3 selected groups. Patients, who have received conventional physical therapy in the last 6 months, diagnosed with fibromyalgia or fibromyalgia treatment, with a history of neurological disease, malignancy, cervical disc hernia, and who have undergone surgical intervention in the shoulder or neck region or who have received treatment for the diagnosis of myofascial pain syndrome in the last year were excluded from our study.

All 3 treatment modalities were applied to the patients by the same physician. KT treatment was performed using the pain inhibition technique for KT treatment recipients in group 1 (n=22). A total of 3 sessions, one week apart, were applied to the patients using the application of KinesioTex Gold Band. Patients received the treatment in a sitting position. The application was performed while the patients were in the sitting position with the neck in lateral flexion and rotation to the contralateral side. Two 15 cm and 20 cm bands were used in the application, respectively. The first band origin was adhered to the acromion, maximum tension was applied to the first 5-6 cm of tape. Tension was not applied to the rest of the band. The second band was cut in a Y-shape. The application's origin was acromion. The upper part of the Y legs of the tape was applied to the C7 spinosus process and the lower part was applied to the T12 region. Maximum stress was applied to both ends of the tape.

The patients in group 2 who underwent dry needling were applied with 0.25x25 mm sterile acupuncture needles after cleaning the skin with alcohol while in a sitting position. The pistoning was performed on the trigger points in a radial manner and until the local twitch response was obtained. The needles were left in the pistoning area for another 10 minutes after the twitch response was obtained.

The pistoning was made to the patients in Group 3, sitting in an upright position. 2% lidocaine was injected with 26 Gauchl 0.45x13 mm disposable sterile needles into 3 trigger points where the pain was most felt, after sterilizing the skin with a local antiseptic.

All three groups underwent trapeze stretching exercises and were not given any medical treatment.

All patients were evaluated with VAS and SF-36 form before and 3 weeks after treatment. The VAS scale is a pain scale with marked 0-10 areas. Zero represents the absence of pain, while 10 represents very severe pain. The SF-36 form consists of 36 items to evaluate the daily life activities of the patients. It is used to evaluate many daily life functions such as general health status, physical condition, social status, emotional state. A high SF-36 score is one of the indicators of well-being in health.

Eligibility Criteria:
Inclusion Criteria:

* Beetween the age of 18-70
* Presence of myofascial pain syndrome in the upper trapezius muscle

Exclusion Criteria:

* Received conventional physical therapy in the last 6 months
* Diagnosed with fibromyalgia or fibromyalgia treatment
* History of neurological disease, malignancy, cervical disc hernia
* Undergone surgical intervention in the shoulder or neck region
* Received treatment for the diagnosis of myofascial pain syndrome in the last year