Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial

Background Treatment of active myofascial trigger points includes both invasive and non-invasive techniques. Objectives To compare the effects of upper trapezius trigger point dry needling (DN) and strain–counterstrain (SCS) techniques versus sham SCS. Study Design Randomised controlled trial. Method 34 study subjects with active trigger points were randomly assigned to one of three treatment groups, and received either three sessions of DN (n=12), six sessions of SCS (n=10), or sham SCS (n=12) over a 3-week period. Subjective pain response and subjects’ own ratings of perceived disability were measured. Results The analysis of variance mixed model showed a significant time effect for pain (p<0.001), elicited pain (p<0.001), pain pressure threshold (p<0.01), and neck disability index (p=0.016). Pain at rest decreased in all groups, as follows: DN 18.5 mm (95% CI 4.3 to 32.7 mm); SCS 28.3 mm (95% CI 12.4 to 44.1 mm); sham SCS 21.9 mm (95% CI 3.5 to 40.1 mm). Reductions in disability score (points) were significant in the SCS group (5.5, 95% CI 1.6 to 9.4) but not in the DN (1.4, 95% CI −4.9 to 2.1) or sham SCS (1.8, 95% CI −6.4 to 2.7) groups. There was no significant group×time interaction effect for any variables studied. Conclusions There were no differences between the sham SCS, SCS, and DN groups in any of the outcome measures. DN relieved pain after fewer sessions than SCS and sham SCS, and thus may be a more efficient technique. Future studies should include a larger sample size. Trial Registration Number NCT01290653.

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Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial

Physical Therapy ◽

10.2522/ptj.20130255 ◽

2014 ◽

Vol 94 (8) ◽

pp. 1083-1094 ◽

Cited By ~ 63

Author(s):

Matthew P. Cotchett ◽

Shannon E. Munteanu ◽

Karl B. Landorf

Keyword(s):

Randomized Controlled Trial ◽

Adverse Events ◽

Trigger Point ◽

Controlled Trial ◽

Heel Pain ◽

Foot Pain ◽

Dry Needling ◽

Randomized Controlled ◽

Plantar Heel Pain ◽

End Point

Background Plantar heel pain can be managed with dry needling of myofascial trigger points; however, there is only poor-quality evidence supporting its use. Objective The purpose of this study was to evaluate the effectiveness of dry needling for plantar heel pain. Design The study was a parallel-group, participant-blinded, randomized controlled trial. Setting The study was conducted in a university health sciences clinic. Patients Study participants were 84 patients with plantar heel pain of at least 1 month's duration. Intervention Participants were randomly assigned to receive real or sham trigger point dry needling. The intervention consisted of 1 treatment per week for 6 weeks. Participants were followed for 12 weeks. Measurements Primary outcome measures included first-step pain, as measured with a visual analog scale (VAS), and foot pain, as measured with the pain subscale of the Foot Health Status Questionnaire (FHSQ). The primary end point for predicting the effectiveness of dry needling for plantar heel pain was 6 weeks. Results At the primary end point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain=−14.4 mm, 95% confidence interval [95% CI]=−23.5 to −5.2; FHSQ foot pain=10.0 points, 95% CI=1.0 to 19.1), although the between-group difference was lower than the minimal important difference. The number needed to treat at 6 weeks was 4 (95% CI=2 to 12). The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [<1%]). Limitations It was not possible to blind the therapist. Conclusion Dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.

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Autoregulated heavy slow resistance training combined with radial shockwave therapy for plantar heel pain: Protocol for a mixed‐methods pilot randomised controlled trial

Musculoskeletal Care ◽

10.1002/msc.1542 ◽

2021 ◽

Author(s):

Ian Burton

Keyword(s):

Mixed Methods ◽

Randomised Controlled Trial ◽

Resistance Training ◽

Controlled Trial ◽

Heel Pain ◽

Pilot Randomised Controlled Trial ◽

Shockwave Therapy ◽

Plantar Heel Pain ◽

Randomised Controlled

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Autoregulated Heavy Slow Resistance Training Combined with Radial Shockwave Therapy for Plantar Heel Pain: Protocol for a Mixed Methods Pilot Randomised Controlled Trial

10.31236/osf.io/ph8bc ◽

2020 ◽

Author(s):

Ian Burton

Keyword(s):

Mixed Methods ◽

Randomised Controlled Trial ◽

Resistance Training ◽

Controlled Trial ◽

Treatment Protocol ◽

Heel Pain ◽

Shockwave Therapy ◽

Plantar Heel Pain ◽

Pilot Rct ◽

Randomised Controlled

Background: Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population. Both heavy slow resistance training (HSRT) and extracorporeal shockwave therapy (ESWT) have shown effectiveness for treating PHP in isolation. However more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes, and better standardization of ESWT protocols are required. Autoregulation of resistance training involves self-selecting exercise dosage based on individual factors. Although autoregulation has proven effective for strength gains in athletes, it has not been investigated in tendinopathy. It is recommended that PHP not be treated by one treatment in isolation, with there being a need to investigate feasibility and effectiveness of combined treatments in PHP. Currently, no studies have investigated autoregulated HSRT combined with ESWT, despite their individual efficacy. The optimal treatment protocol for PHP is unknown, and there is a need to ascertain whether the addition of ESWT to autoregulated HSRT leads to better outcomes compared to either alone. Methods: A three-arm randomised controlled trial (RCT) comparing these groups would be the ideal way to investigate this question, with a pilot RCT testing trial procedures and process evaluation required prior to a definitive RCT. Patients expectations, feasibility and acceptability of combined ESWT and exercise for PHP also remain unknown. Therefore, the addition of qualitative interviews in a mixed methods pilot RCT would help ascertain acceptability and help explain the intervention outcomes.

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Comparing two dry needling interventions for plantar heel pain: a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-038033 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038033

Author(s):

Zaid Al-Boloushi ◽

Eva Maria Gómez-Trullén ◽

Mohammad Arian ◽

Daniel Fernández ◽

Pablo Herrero ◽

...

Keyword(s):

Controlled Trial ◽

Treatment Session ◽

Heel Pain ◽

Secondary Outcome ◽

Dry Needling ◽

Foot Health ◽

Plantar Heel Pain ◽

Vas Scores ◽

Randomised Controlled ◽

Pain Domain

ObjectivesTo compare the effectiveness of dry needling (DN) versus percutaneous needle electrolysis (PNE) for improving the level of pain, function and quality of life (QoL) of patients suffering from plantar heel pain (PHP) provoked by myofascial trigger points.DesignA prospective, parallel-group, randomised controlled trial with blinded outcome assessment.SettingA single treatment facility in the State of Kuwait.Participants118 participants were screened for eligibility. Of these, 102 participants were enrolled (30 men (49.5±8.9 years) and 72 women (48.1±8.8 years)) and 68 of them completed the trial.InterventionsTwo parallel groups, one study arm received DN and a stretching protocol whereas the other arm received percutaneous needling electrolysis with a stretching protocol.Primary and secondary outcome measuresThe primary outcome measure was the Foot Pain domain of the Foot Health Status Questionnaire, with 13 questions related to foot health-related domains. Secondary outcome measures included the 0–10 numerical rating scale pain visual analogue scale (VAS) scores, performed before and after each treatment session. In addition, QoL was measured using the EuroQoL-5 dimensions. All measurements were taken at baseline, at 4, 8, 12, 26 and 52 weeks.ResultsFoot Pain domain improved at all time points for DN group (p<0.001; 29.7 (17.8 to 41.5)) and percutaneous needling electrolysis group (p<0.001; 32.7 (18.3 to 47.0)), without significant differences between groups. Pain VAS scores decreased at all time points for both DN (p<0.001; −2.6 (−4.0 to −1.2)) and percutaneous needling electrolysis group (p<0.001; −3.0 (−4.5 to −1.6)). QoL improved at 4 weeks for both DN (p<0.01; 0.15 (0.5 to 0.25)) and percutaneous needling electrolysis group (p<0.01; 0.09 (0.01 to 0.17)) and at 8 and 52 weeks for the PNE group (p<0.01; 0.10 (0.02 to 0.18)), with significant differences between groups for the QoL at 52 weeks (p<0.05; 0.10 (0.01 to 0.18)). There were two small haematomas in the PNE group and one in the DN group. No serious adverse events were reported.ConclusionsBoth PNE and DN were effective for PHP management, reducing mean and maximum pain since the first treatment session, with long lasting effects (52 weeks) and significant differences between groups in the case of QoL at 52 weeks in favour of the PNE group.Trial registration numberNCT03236779.

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