About this trial
Currently, no previous studies have investigated how the position of a muscle before dry needling may influence the outcome and effectiveness of the treatment.
This study aims to demonstrate whether the position of the upper trapezius muscle during dry needling treatment influences the outcome of that treatment in subjects with neck pain.
A total of 46 participants with chronic neck pain will be recruited and randomly assigned to two groups: a dry needling group with the muscle in a stretched position and a dry needling group with the muscle in a shortened position. A total of two treatment sessions will be performed, separated by a 7-day interval. The primary outcome measure will be the intensity of neck and head pain, measured using the visual analog scale (VAS). Other variables to be measured include the cervical disability index, kinesiophobia, and catastrophizing (using a self-completion questionnaire), as well as participants' expectations and post-needling pain.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age between 18 and 65 years
Neck pain lasting more than 3 months
Current neck pain greater than 3/10 on the VAS (Visual Analog Scale)
Presence of active trigger points in the upper trapezius muscle, meeting the following criteria: Painful point within a taut band whose palpation reproduces the patient's symptoms.
Disqualifiers
Neck pain with a medical diagnosis (fractures, arthritis, fibromyalgia, etc.)
Radicular pain (paresthesia, burning, electric shocks)
Whiplash or any recent trauma
Previous surgery
Trial design
Parallel
Treatments tested in this trial
Dry needling technique with the shoulder in full adduction.
Other interventionTen incisions will be made in a posteroanterior direction while the patient lies prone and the muscle is grasped with a pincer grip between the first three fingers. The technique will be applied to the area that is mechanically most hyperalgesic and related to the reproduction of the patient's pain.
Dry needling technique with the shoulder in 90° abduction.
Other interventionTen incisions will be made in a posteroanterior direction while the patient lies prone and the muscle is grasped with a pincer grip between the first three fingers. The technique will be applied to the area that is mechanically most hyperalgesic and related to the reproduction of the patient's pain.
Treatment groups
Trial outcomes
Primary outcomes
The visual analog scale (VAS)
Intensity of neck and head pain: This was measured using the visual analog scale (VAS). It consists of a 10 cm horizontal line, where 0 cm on the left side represents "no pain" and 10 cm on the right side represents "maximum pain." The subject marks a perpendicular line at the point they consider to represent their pain intensity. The examiner then places a millimeter ruler on the scale, assigning a numerical value to the line drawn by the patient. The VAS has proven to be a valid and reliable tool (intraclass correlation coefficient \[ICC\] 0.71-0.99).
Secondary outcomes
Disability Associated with Neck Pain
The degree of disability associated with neck pain will be measured using the Neck Disability Index (NDI) questionnaire in its Spanish version. The NDI is a 10-item questionnaire, and each item is scored on a scale of 0 to 5 points, with a range of 0 to 50 points. The higher the score, the greater the degree of disability. The NDI has proven to be a reliable tool (ICC 0.98).
Kinesiophobia with the Tampa Kinesiophobia Scale (TSK-11)
The Tampa Kinesiophobia Scale (TSK-11) short version will be used to assess fear of movement. It is an 11-item scale rated on a four-point scale ranging from "strongly agree" to "strongly disagree." Scores range from 11 to 44, with higher scores indicating greater fear of movement and/or (re)injury. This questionnaire has demonstrated similar properties to the original TSK scale, proving to be a valid and reliable instrument.
Catastrophizing with the Pain Catastrophizing Scale (PCS)
Catastrophizing Scale (PCS). The PCS has 13 items scored from 0 to 4 and is composed of three subscales: rumination, magnification, and helplessness. The overall score ranges from 0 to 52. Higher scores indicate a greater degree of pain catastrophizing. A total score \>30 represents a clinically significant level of pain catastrophizing. This questionnaire has been shown to be reliable (ICC 0.94).
Local twitch response (LTRs)
Local twitch response (LTRs). The LTRs produced by needle insertion during dry needling will be counted. LTRs are generally associated with better treatment outcomes. A higher number of LTRs indicates better results, and a lower number of LTRs indicates worse results.
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