Dry Needling

This study evaluates whether adding mechanical vibration to dry needling (DN+V) is not inferior to dry needling alone (DN) for reducing low back pain intensity in adults with nonspecific low back pain (NSLBP), when both interventions are combined with a structured exercise program. The primary hypothesis is non-inferiority in pain reduction (Numeric Pain Rating Scale, NPRS) at 1 week after treatment, using a non-inferiority margin of 1 point on the 0-10 NPRS scale. If non-inferiority is confirmed, secondary analyses will explore whether DN+V is superior to DN alone in patient-reported treatment acceptability, pain experienced during the intervention, and post-needling soreness. Participants will be randomly assigned to one of two parallel groups: DN plus exercise, or DN+V plus exercise. Outcomes will be assessed at baseline and at multiple time points up to 4 weeks after treatment, including pain intensity, disability, acceptability, muscle strength, pressure pain threshold, quality of life, and global impression of change. Direct and indirect costs associated with both interventions will also be collected to provide data for a future economic evaluation of the cost-effectiveness of DN+V compared with DN.

Dry needling is a skilled intervention provided by trained physical therapists to treat pain, myofascial dysfunction, and a variety of other diagnosis. While there is research demonstrating the benefits of dry needling in reduction of pain and improvement in strength, research in regards the pediatric population is very limited. A recent retrospective chart review regarding dry needling trends and outcomes in the pediatric orthopedic population showed the pediatric population is tolerating this treatment and seeing benefits. Physical therapists are already pushing the boundaries and finding additional benefits in the use of dry needling with current patients. A diagnosis frequently seen in sports medicine is surgical reconstruction of the anterior cruciate ligament (ACL). Over the last couple of years, therapists have seen an increase in the use of quadriceps tendon autograft for reconstruction following ACL tears due to lower incidence rate of retears. Patients have been struggling to regain strength of the quadriceps to meet desired outcomes. The quadricep muscles are one of the major stabilizers of the knee and with a reduction in strength places the patient at a significant increase of retear. Subjects will be categorized into an experimental group (dry needling intervention + physical therapy) or the control group (physical therapy only) with a N of 20 in each group. The goal for this research is to determine if dry needling use in the subacute phase of post-operative ACLR following quadriceps autograft can assist with increasing quad strength and improve post-surgical outcomes.

The goal of this clinical trial is to learn if the addition of cadaver review improves: * the accuracy of physiotherapists who practice dry needling. * the perceived safety of dry needling by physiotherapists. Researchers will compare the effects of an anatomy review using cadaver material to that of an educational intervention not related to anatomy to see if the anatomy review improves the needling accuracy and safety of physiotherapist who practice dry needling as compared to the control intervention of education not related to anatomy. Participants will: * Needle three muscles related to safety and/or accuracy using ultrasound imaging to gather accuracy and safety measurements. * Take an initial knowledge exam capturing their knowledge on needling safety. * Be randomized into a control group or intervention group. * The control group will receive an online educational session not related to anatomy. * The intervention group will receive a cadaver anatomy review class focused on high-risk area. * Re-take a knowledge exam after their course (either cadaver lab or on-line education) to capture any change. * Needle the same three muscles again using ultrasound to capture accuracy and safety measurements. If reviewing anatomy using cadaver materials improve physiotherapists needling accuracy and safety, then this educational intervention could be recommended to be added to dry needling course instruction.

This study aims to compare the added effects of dry needling and dry cupping to conventional physical therapy on headache pain intensity, headache frequency, headache duration, upper cervical range of motion, and disability levels in patients with cervicogenic headache. It will be assumed that: * All patients will follow all the given instructions strictly during the study duration, regarding the assessment and the treatment procedure. * All participants will be evaluated under the same environmental conditions.