ComparingMultipleVersusSustainedInsertionDryNeedlingTherapyforMyofascialNeckPain:ARandomizedControlledTrial

Myofascial pain syndrome (MPS) is a common condition characterized by painful trigger points in muscles, particularly affecting the neck and upper trapezius region. Dry needling (DN) has become a widely used treatment, but the optimal technique remains debated. Two main approaches exist: the Hong method (GH), which involves multiple rapid needle insertions over a short period, and sustained insertion (GS), where a single needle is left in place for a longer duration. Clinicians need evidence about which technique works better for reducing pain, improving muscle function, and minimizing side effects.

This study addresses this gap by directly comparing these two DN methods in people with myofascial neck pain.

The researchers conducted a randomized controlled trial with 30 participants who had active myofascial trigger points in their upper trapezius muscles and chronic neck pain. Participants were randomly assigned to either the GH group (n=15) or the GS group (n=15). Each person received both real dry needling on one side of their neck and sham needling (using a telescopic needle that did not penetrate the skin) on the other side, with the side randomly assigned. The GS method used a single needle insertion per trigger point for one minute, aiming to elicit a local twitch response.

The GH method used approximately 40 rapid needle insertions over two minutes without needle retention. Measurements were taken before treatment, 5 minutes after, 24 hours after, and 7 days after the session. The researchers assessed muscle tension and stiffness with a myotonometer, pressure pain threshold with an algometer, maximum isometric strength with a handheld dynamometer, blood perfusion with laser Doppler flowmetry, and vascular changes with Power Doppler ultrasound. They also recorded minor adverse events.

The GS method outperformed the GH method on several key outcomes. For pressure pain threshold (a measure of pain sensitivity), GS showed significantly higher values than GH at 5 minutes, 24 hours, and 7 days after treatment (p<0.001), indicating better pain relief. For maximum isometric strength, GS was significantly better than GH at 24 hours and 7 days (p<0.001). For muscle tension and muscle stiffness, the results favored GS as well: GH actually showed significantly higher (worse) muscle tension and stiffness at 24 hours and 7 days compared to GS (p<0.001), suggesting the multiple rapid insertions may have caused more tissue irritation.

For blood perfusion, GH showed higher values at 5 minutes and 7 days (p<0.001), but this was interpreted as a more acute inflammatory response rather than sustained benefit. For Power Doppler Score (indicating vascular activity), GS showed higher values at 5 minutes and 24 hours (p<0.001), suggesting more effective local tissue responses. Regarding safety, the GH group experienced substantially more adverse events: 33.3% had increased pain immediately after treatment, rising to 73.3% at 24 hours, compared to only 6.7% and 13.3% in the GS group. Hematomas occurred in 40% of GH participants versus 13.3% with GS.

Burning sensations and fainting were reported only in the GH group.

For patients with myofascial neck pain, the sustained insertion dry needling technique appears to be a safer and more effective choice than the Hong multiple-insertion method. The GS approach provides better pain relief, improves muscle strength more effectively, and causes less muscle tension and stiffness afterward. The higher rate of adverse events with the Hong method—including more post-treatment pain, bruising, and even fainting—suggests it may be too aggressive for many patients. Clinicians should consider using sustained insertion techniques, particularly for patients who are sensitive to pain or prone to adverse reactions.

The findings also challenge the assumption that more needle insertions necessarily produce better results; in this case, fewer insertions with longer retention was superior. Patients can feel more confident choosing a gentler needling approach that still provides meaningful benefits for neck pain and muscle function. Future research should examine longer-term outcomes and test these techniques in larger, more diverse populations.