Exercise and dry needling for shoulder pain and dysfunction
Shoulder pain is a significant health problem permeating all levels of health care. With astounding costs and treatment options there still exists no consensus on an effective treatment protocol. Conservative treatment is often the first option when confronted with subacromial pain and options vary from: exercise, manual therapy, acupuncture, dry needling and therapeutic modalities.
Exercise alone has likely shown to be the most efficacious treatment method, however new research is emerging to support the use and application of trigger point dry needling (TrP-DN). Considering these things, the authors set out to determine the efficacy of exercise and dry needling versus exercise alone on patients with subacromial pain. Overall, it was shown that the addition of dry needling was effective at improving shoulder pain-related disability. However there was no greater improvement in shoulder pain between the 2 populations.
50 subjects diagnosed with subacromial pain according to the Dutch Orthopedic Association Clinical Practice Guideline were included and randomly allocated into 2 groups: those undergoing exercises versus exercise and TrP-DN. All participants received the same exercise program while those receiving TrP-DN pragmatically received needling in the most affected areas. The outcome measures were shoulder pain and shoulder pain-related dysfunction. Patients were assessed at baseline, 1 week, and month 3, 6 and 12.
Trigger points are defined as hypersensitive tender spots of skeletal muscle capable of eliciting pain and motor dysfunction. By including the application of TrP-DN in their study design, the authors wanted to see if they could enhance the outcome of pain and pain-related dysfunction. Upon investigation, it was shown that those undergoing needling + exercises exhibited statistically higher improvements in function at all reporting periods compared to exercise alone. Despite this, there was no change in pain reported outcomes at any reporting periods.
Previous evidence suggests that trigger points can lead to alterations in motor patterns and muscle activity, therefore affecting shoulder dysfunction. By normalizing the trigger points in the population at hand, it can account for the improvements in shoulder dysfunction. Considering these things, dry needling appears to be a tangible addition to treatment when looking at patients with shoulder dysfunction.
> From: Arias-Buria et al., J Pain 18 (2017) 11-18(Epub ahead of print). All rights reserved to American Pain Societ. Click here for the online summary.