Review of dry needling for trigger points of the lower extremity and low back

Study Type: Systematic review
OE Level of Evidence: 2
Journal Level of Evidence: N/A
6 randomized controlled trials analyzing the effect of dry needling in the lower extremity and/or lumbar region on patients with painful muscular trigger points, were included in this systematic review. The purpose of this study was to qualitatively assess the body of evidence regarding the effect of dry needling on clinically important outcomes in patients with lower quarter trigger points. The results displayed Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
Why was this study needed now?
Trigger points are highly localized, hyperirritable locations in a taut band of muscle, that are often classified as active or latent. Latent trigger points require manual palpation to elicit pain. The prevalence of trigger points has not been well studied, however, it is believed that they are underdiagnosed. Many treatments exist for trigger points and include stretching, massage, laser therapy, thermotherapy, and ultrasound, however, no clear standard intervention has been elucidated. Dry needling (or medical acupuncture) has garnered interest in trigger point therapy. However, no reviews of the effectiveness of this treatment in alleviating trigger points in the lower quarter (lumbar spine + lower extremity) had been conducted, thus the present study was prudent.
What was the principal research question?
How effective was dry needling as an intervention for lower quarter trigger points in patients with various orthopedic conditions?
Data Source: An electronic database search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States National Library of Medicine (NLM) at the National Institutes of Health (Pubmed), Physiotherapy Evidence Database (PEDro), SPORTDiscus, Cochrane Library, and the American Physical Therapy Association's (APTA) PTNow. Manual searches of reference lists were also conducted.The latest search was conducted in February 2015.
Index Terms: Search terms included: (dry needling OR acupuncture OR intramuscular stimulation) AND (trigger point OR myofascial pain).
Study Selection: Inclusion criteria were clinical trials or reviews (randomized controlled trials [RCTs]) published in English, analyzing the effect of dry needling in the lower extremity and/or lumbar region for various conditions, in patients with muscular trigger points in the lower quarter, in comparison to another intervention (sham or no intervention). Four independent reviewers assessed articles for adherence to inclusion criteria, any disagreements were resolved through discussion. 6 RCTs were selected for inclusion (4 'high' quality, 2 'fair' quality).
Data Extraction: One reviewer extracted data and the other three reviewers verified this data. Outcomes included pain (visual analogue scale [VAS], FHSQ pain subscale, SFMPQ, WOMAC, pressure-pain threshold [PPT]) and impairment measures (range of motion [ROM], peak isometric strength).
Data Synthesis: Meta-analyses were not performed as the studies were clinically heterogeneous. Methodological quality of included studies was assessed using the PEDro scale.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.