This study aims to evaluate the efficacy of a new invasive therapy for treating MTrPs:
dry needling with vibratory stimulus (DN+V). The following hypotheses are proposed:
DN+V will utilize vibration on the dry needling needles instead of an electrical
stimulus like in percutaneous electrolysis (PE), which could potentially damage some
tissues. The expectation is that DN+V will increase the mechanical stimulus applied
to the MTrP, yielding greater benefits in terms of pain relief, functional capacity,
muscle strength, and other variables of interest in individuals with NSLBP, possibly
requiring less treatment time compared to DN alone.
In DN, repeated insertions and withdrawals of the needle into the MTrP provoke a
hemorrhagic and inflammatory reaction that results in hypersensitivity and
microscopic tissue injury in the muscle, causing pain during treatment and
post-needling pain for the next 24-32 hours. A study showed that PE caused less
post-needling pain than DN, likely because PE typically involves a single puncture
per needle without needle manipulation.
DN+V will follow the same methodology as PE, with a single puncture and no needle
manipulation. Thus, it is expected that DN+V, being less invasive than DN, will
reduce pain during treatment and post-needling pain compared to DN. A study supports
this hypothesis, concluding that needle manipulation in DN produces greater
post-needling pain than DN without needle manipulation.
To test these hypotheses, a randomized clinical trial will be conducted: "RCT: Analysis
of the Effectiveness on Pain in Individuals with Nonspecific Low Back Pain by Adding a
Percutaneous Vibratory Stimulus to Dry Needling in the Treatment of MTrPs."
EXPECTED RESULTS This initial study will provide the first data on DN+V, focusing on
whether DN+V is easy to apply, well-tolerated by patients, and shows effects similar to
or better than DN in reducing NSLBP.
METHODOLOGY
Instrumentation and Evaluation Method: A group of specialized physiotherapists will
evaluate each participant for MTrPs in muscles related to NSLBP. Identified MTrPs
will be included in the study.
Variables: For this initial RCT, only the main variables will be considered (NSLBP,
pain during treatment, and post-needling pain). These will be evaluated using the
Numeric Pain Rating Scale (NPRS).
Intervention: Participants will be randomized into two groups: DN (without
vibration, considered the control group) and DN+V (vibration for 10 minutes).
Follow-up: NSLBP will be evaluated before and after the intervention, and at 24 and
48 hours. Pain during treatment will be recorded immediately after the intervention.
Post-treatment pain will be evaluated 48 hours later, asking each participant how
long post-needling pain lasted if it occurred.
TRANSFER AND DISSEMINATION OF RESULTS The development of this treatment technique for
MTrPs will involve creating a "know-how" that encompasses all knowledge and application
methodology related to DN+V. This dissertation will demonstrate the effectiveness and
cost-effectiveness of DN+V, but this will only be the starting point of the "know-how,"
as further research will be necessary to address current uncertainties (e.g., does the
entire population and all musculature respond the same way?) and to refine the
application methodology (optimal dose of time/intensity/frequency of vibration, possible
combination with physical exercise, etc.).
Once the "know-how" has been validated and scientifically supported, efforts will be made
to disseminate it. Through presentations, courses, and training sessions, the DN+V
technique will be promoted to advance clinical practice among physiotherapists. An
example of a successfully implemented "know-how" in physiotherapy is the "DNHS" technique
(www.dnhs.es), a dry needling technique specifically developed for neurological patients
by Dr. Pablo Herrero, the director of the doctoral thesis in which this study is
included.
When the "know-how" of the DN+V technique gains popularity among health professionals,
its economic potential will be exploited. Similar to other treatment techniques like PE,
specific devices for DN+V application will be developed, and training sessions will be
conducted to ensure proper use of the technique. This will generate economic returns for
the researchers and promoters involved in the development of the DN+V technique.
