The effect of dry needling of myofascial trigger points on muscle stiffness and motoneuron excitability in healthy subjects

Background: Myofascial trigger points (MTrPs) are hypersensitive nodules in a taut band (TB) of skeletal muscle. Dry needling (DN) is an invasive technique recommended for the treatment of MTrPs. However, to our knowledge, no studies have investigated the influence of the DN technique on modification of muscle stiffness and neurophysiological properties of MTrPs. Objective: The objective was to examine the effect of DN on muscle stiffness and motoneuron excitability of a latent medial MTrP (nodule and TB) of the soleus muscle in non-injured subjects. Methods: A double-blinded randomised controlled trial of 46 subjects with latent medial MTrPs of the soleus was conducted, in which all received one session of DN. The intervention group (n = 23) were subjected to DN into the MTrP (the nodule), while the control group (n = 23) were subjected to DN into the TB. Assessment was carried out at baseline (pre-test), after the intervention (post-test) and 1 week after the intervention (follow-up). Biomechanical variables (muscle resistive force at 10°/s and 180°/s, muscle extensibility and strength), as measured with an isokinetic dynamometer, and neurophysiological variables (H-reflex), were recorded. Results: There were no statistically significant differences in biomechanical or neurophysiological assessments between groups. Considering the intra-group analysis, subjects in the intervention group exhibited increased maximal isometric voluntary force to ankle plantarflexion (MIVFp) at both post-intervention and follow-up assessment (p < 0.0125; 0.2 < d < 0.5), while no changes were found in the control group. Conclusion: One session of DN targeting latent MTrPs did not change muscle stiffness, muscle extensibility or motoneuron excitability. Further research on subjects with muscle tone disorders should be considered to better address the impact of DN on muscle tone. Trial registration number: NCT02575586 (ClinicalTrials.gov).

Reductions in motoneuron excitability during sustained isometric contractions are dependent on stimulus and contraction intensity

Cervicomedullary stimulation provides a means of assessing motoneuron excitability. Previous studies demonstrated that during low-intensity sustained contractions, small cervicomedullary evoked potentials (CMEPs) conditioned using transcranial magnetic stimulation (TMS-CMEPs) are reduced, whilst large TMS-CMEPs are less affected. Since small TMS-CMEPs recruit motoneurons most active during low-intensity contractions while large TMS-CMEPs recruit a high proportion of motoneurons inactive during the task, these results suggest that reductions in motoneuron excitability could be dependent on repetitive activation. To further test this hypothesis, this study assessed changes in small and large TMS-CMEPs across low- and high-intensity contractions. Twelve participants performed a sustained isometric contraction of the elbow flexor for 4.5 min at the electromyography (EMG) level associated with 20% maximal voluntary contraction force (MVC; low-intensity) and 70% MVC (high-intensity). Small and large TMS-CMEPs with amplitudes of ~15 and ~50% Mmax at baseline, respectively, were delivered every minute throughout the tasks. Recovery measures were taken at 1, 2.5 and 4-min post-exercise. During the low-intensity trial, small TMS-CMEPs were reduced at 2-4 min (p≤0.049) by up to −10% Mmax, while large TMS-CMEPs remained unchanged (p≥0.16). During the high-intensity trial, small and large TMS-CMEPs were reduced at all time-points (p<0.01) by up to −14% and −33% Mmax, respectively, and remained below baseline during all recovery measures (p≤0.02). TMS-CMEPs were unchanged relative to baseline during recovery following the low-intensity trial (p≥0.24). These results provide novel insight into motoneuron excitability during and following sustained contractions at different intensities, and suggest that contraction-induced reductions in motoneuron excitability depend on repetitive activation.

Somatic Proximity of the Axon Initial Segment Predicts Motoneuron Excitability

As the neuronal site where voltage gated channel density is highest, the axon initial segment (AIS) plays a key role in establishing a neuron’s action potential threshold, i.e. excitability. Among the properties of AIS that gain attention are length (AISl) and distance from the soma (AISd), which are variously found to change together with neuronal excitability following experimentally-induced perturbations in neural activity. The present study was designed to test the possibility that variation in AIS structural parameters regulates the native range in intrinsic excitability for one class of mature neurons. Spinal motoneurons were selected for their naturally large range in excitability and for their experimental accessibility to in vivo study. We began by determining whether AIS length or distance differed for motoneurons in motor pools that exhibit different activity profiles. Motoneurons sampled from the medial gastrocnemius (MG) motor pool exhibited values for average AISd that were significantly more than for motoneurons from the soleus (SOL) motor pool, which is more readily activated in low-level movements. Next, we tested whether AISd covaried with intrinsic excitability of individual motoneurons. Using anesthetized rats, we measured rheobase current intracellularly from MG motoneurons before labeling them for later immunohistochemical study of AIS. This combinatory approach revealed a significant correlation between AISd and rheobase, for 16 motoneurons sampled within the MG motor pool. Among multiple electrophysiological and morphological parameters measured here, AISd stood out as the dominant predictor of motoneuron excitability. These findings suggest an important role for AISd in setting the intrinsic excitability of spinal motoneurons.

Spinal contribution to neuromuscular recovery differs between elbow-flexor and knee-extensor muscles after a maximal sustained fatiguing task

By comparing the changes in motoneuron excitability in elbow-flexor and knee-extensor muscles after sustained fatiguing maximal voluntary contractions, this study shows that motoneuron recovery behavior depends on the muscle performing the exercise. A different recovery pattern in motoneuron excitability occurs in elbow flexors as it recovered by 60 s whereas knee extensors were unaffected by fatigue. This finding can help to increase understanding of the effect of a fatigue and subsequent recovery on neural processes.