Theeffectofdryneedlingonpain,pressurepainthresholdanddisabilityinpatientswithamyofascialtriggerpointintheuppertrapeziusmuscle

Myofascial trigger points (TrPs) are hyperirritable spots in taut muscle bands that cause significant pain and disability, particularly in the upper trapezius (UT) muscle. These trigger points affect 30–85% of patients with musculoskeletal pain and can severely impact work, social activities, and quality of life. While trigger point compression technique (TCT) has been a standard manual therapy approach, dry needling (DN) has gained increasing interest among physical therapists. However, most previous studies on DN for UT trigger points examined only immediate effects or combined DN with other treatments.

No prior study had evaluated the clinical effectiveness of DN alone after one week of treatment specifically for UT muscle TrPs.

This randomized controlled trial recruited 33 patients with active TrPs in the UT muscle from an outpatient physical therapy clinic. Participants were randomly assigned to either a standard group (n=17) receiving trigger point compression technique or an experimental group (n=16) receiving dry needling. Both groups received three treatment sessions over one week. The TCT involved applying gradually increasing pressure to the trigger point until pain decreased by approximately 50%, then increasing pressure again, repeated for about 90 seconds until tenderness and tension released.

The DN technique involved repeatedly needling the trigger point forward and backward until no more local twitch responses occurred. Outcomes were measured before treatment and one week after the third session: pain intensity using a 0–100 mm visual analogue scale (VAS), pressure pain threshold (PPT) using a mechanical algometer, and disability using the 30-item Disabilities of Arm, Shoulder and Hand (DASH) questionnaire.

Both groups showed significant improvements from before to after treatment in all three outcomes (P < 0.05). In the DN group, mean VAS pain scores dropped from 6.56 to 1.34 (on a 0–10 scale); in the TCT group, from 6.23 to 3.05. Mean PPT increased from 10.61 to 16.43 in the DN group and from 10.87 to 14.5 in the TCT group. Mean DASH scores improved from 24.7 to 12.81 in the DN group and from 26.44 to 16.93 in the TCT group.

When comparing between groups using ANCOVA with pre-treatment scores as covariates, the DN group showed significantly greater improvement in pain intensity (VAS) than the TCT group (P = 0.01, F = 6.3). However, there was no statistically significant between-group difference for PPT (P = 0.08, F = 3.17) or DASH disability scores (P = 0.34, F = 0.91), though the PPT difference of 2.19 kg/cm² between groups was noted as potentially clinically important.

Dry needling appears to be more effective than trigger point compression technique for reducing pain intensity in patients with upper trapezius trigger points after one week of treatment. Both treatments provide meaningful improvements in pain, pressure pain threshold, and disability, but DN offers superior pain relief. This suggests DN may be particularly appropriate when pain reduction is the primary treatment goal. The lack of significant between-group differences for PPT and disability may reflect the small sample size, as the study was not powered to detect smaller effect sizes for these outcomes.

Clinicians can consider DN as a viable alternative or preferred option over manual compression for UT trigger points, especially for patients seeking faster or greater pain relief. Patients with myofascial pain syndrome in the upper trapezius may benefit from discussing DN with their physical therapist, particularly if they have not responded well to manual pressure techniques. Future research with larger samples and longer follow-up periods is needed to confirm these findings and determine whether the observed trends for PPT and disability would reach statistical significance with more participants.