Post-needling Soreness After Internal Gastrocnemius Muscle Treatment

Study Overview
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Brief Summary
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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
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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.

Official Title
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Post-Needling Soreness Depending On The Needle Diameter On Dry Needling On The Most Hyperalgesic Area Of The Internal Gastrocnemius In Plantar Fasciitis: A Randomised Controlled Trial

Conditions
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Heel Pain Syndrome

Intervention / Treatment
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* Procedure: Dry needling treatment with a thinner needle
* Procedure: Dry needling treatment with a medium-sized needle
* Procedure: Dry needling treatment with a thickest needle


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: 18-65. Plantar Fasciitis diagnosis. Presence of hyperalgesic area in the internal gastrocnemius. Exclusion Criteria: Belenophobia Hypothyroidism Presence of hyperalgesic area in the internal gastrocnemius - Diabetes Lymphedema o lymphatic surgery Muscle diseases Anticoagulant consumption Knee or ankle surgery Analgesic consumption during the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A treated with a 16-gauge needle<br>Group A is intervened on the gastrocnemius muscle with a 16-gauge needle. | Procedure: Dry needling treatment with a thinner needle<br>* We will make an application with the dry needling technique with a fine needle on the myofascial trigger points of the gastrocnemius muscle.<br>|
| Experimental: Group B treated with a 25-gauge needle<br>Group B is intervened on the gastrocnemius muscle with a 25-gauge needle. | Procedure: Dry needling treatment with a medium-sized needle<br>* We will make an application with the dry needling technique with a medium-sized needle on the myofascial trigger points of the gastrocnemius muscle.<br>|
| Experimental: Group C treated with a 32-gauge needle<br>Group C is intervened on the gastrocnemius muscle with a 32-gauge needle. | Procedure: Dry needling treatment with a thickest needle<br>* We will make an application with the dry needling technique with the thickest needle on the myofascial trigger points of the gastrocnemius muscle.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-needling soreness intensity | The investigators use a Visual Analog Scale (VAS) to determine the intensity of the patient's post-needing pain after and for 72 hours after DN.The VAS is a 100-mm line, oriented horizontally, with one end representing no pain and the other end representing worst pain. Subjects will be asked to rate their current pain with a mark on the scale. | Change From Baseline in Pain Scores on the Visual Analog Scale at 72 hours. | 
| Pressure Pain Threshold | The PPT serves to determine the sensitivity of hiperalgesic focus. The investigators will done it with one algometer. A lower threshold is a worse result. A higher threshold is a better result. | Change from Baseline Pressure Pain Threshold at 72 hours |