Effects of Dry Needling in Patients With Upper Cross Syndrome

Effects of Dry Needling on Pain, Range of Motion and Function in Patient With Upper Cross Syndrome

The study will be done to evaluate the effectiveness of dry needling of muscles involved in Upper Cross Syndrome. Muscles involved in upper cross syndrome are tight upper trap, Levator Scapulae, Sternocledomastoid , Pectorals major and minor and rhomboids. Physical assessment of trigger points will locate the target area for dry needling. After pre treatment measurements, dry needling will be performed to treatment group and stretching, hot pack and tens will be apply in control group. Study design will be randomized controlled trial and sample size will be 34 participants. Data will be collected from Riphah Rehabilitation Center. Patients of 20-50 years old with UCS diagnosed through observation and physical examination will be included. Patients with systemic soft tissue and bony diseases will be excluded. Intervention duration will be two session of DNT with two weeks routine management. Basic tools will be Visual analog scale (VAS), Neck Disability Index (NDI) and Goniometry

Study Overview

• Status: Completed
• Conditions: Neck Syndrome
• Intervention / Treatment: Other: Dry Needling; Other: Hot pack , TENS , Stretching

Detailed Description

Dry needling is relatively new method for the management of musculoskeletal pain.Different methods of dry needling, its effectiveness, and physiologic and adverse effects are discussed. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn with appropriate training, and carries a low risk. The deep method of dry needling has been shown to be more effective than the superficial one for the treatment of pain associated with myofascial trigger points. However, over areas with potential risk of significant adverse events, such as lungs and large blood vessels, we suggest using the superficial technique, which has also been shown to be effective. Questionnaire for assessing the improvement in quality of life is by NDI and ranges like neck flexion/extension, side bending and rotation will be measured by standard goniometry. Neck disability index will use to check the patient's ability to perform his ADL before and after the treatment/control. Data will be collected from Riphah rehab center. Assessed patients of UCS of age 20 to 50 will be the targeted population of this study. Patients with systematic and bony disease excluded from the study. Population having stiff upper back, tight trap and stiff upper thoracic spine have UCS. Ethical guidelines will be followed for both treatment and control group. SPSS version 21 will be use for data analysis with sample size of 34 participants, 17 participants each group that will randomly allocated in treatment/control group.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Rahim Yar Khan, Punjab, Pakistan
      • Sheikh Zaid Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 50 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Stiffness and gradual pain in neck and shoulder
• Pain due to Postural Dysfunction
• Trauma or insidious onset

Exclusion Criteria:

• Any systemic soft tissue and bony disease.
• Patient with spinal tuberculosis, spinal fractures, pregnancy, cancer.
• Any recent surgery.
• Patient with any cervical or thoracic problem.
• Patients with any other serious pathology/red flags

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A; Dry Needling	Other: Dry Needling; Dry needling on Upper trapezius, Levator Scapulae, Sternocledomastoid , Pectorals major and minor and rhomboids for 10 min
Active Comparator: Group B; Hot pack , TENS , Stretching	Other: Hot pack , TENS , Stretching; Treatments are; Hot Pack for 15 minutes; TENS for 10 minutes; Stretching The third treatment which is Stretching will be given one time on each muscle (tight upper trap, Levator Scapulae, Sternocledomastoid , Pectorals major and minor and rhomboids) of upper spine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual Analogue Scale	A Visual Analogue Scale (VAS) is a measurement instrument that tries to measure a characteristic or attitude that is believed to range across a continuum of values and cannot easily be directly measured	2nd Week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neck Disability Index Questionnaire	Neck disability index is a self report questionnaire use to determine how neck pain effects the patients daily life and to assess the self rated disability of patients with neck pain. Area of assessment are activities of daily life, attention ,work memory ,functional mobility ,pain ,occupational performance ,quality of life and sleep. Totally based on patient reported outcome	2nd Week

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Goniometer	Goniometer is an instrument particularly useful when measuring the spine where you can use it to measure flexion, extension, side bending and rotation quickly and easily	2nd Week

Collaborators and Investigators

• Sponsor: Riphah International University

Publications and helpful links

General Publications

• Liu L, Huang QM, Liu QG, Ye G, Bo CZ, Chen MJ, Li P. Effectiveness of dry needling for myofascial trigger points associated with neck and shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2015 May;96(5):944-55. doi: 10.1016/j.apmr.2014.12.015. Epub 2015 Jan 7.
• Gerber LH, Shah J, Rosenberger W, Armstrong K, Turo D, Otto P, Heimur J, Thaker N, Sikdar S. Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain. PM R. 2015 Jul;7(7):711-718. doi: 10.1016/j.pmrj.2015.01.020. Epub 2015 Feb 4.
• Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: a systematic review and meta-analysis of randomised controlled trials. Eur J Pain. 2009 Jan;13(1):3-10. doi: 10.1016/j.ejpain.2008.02.006. Epub 2008 Apr 18.
• Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Phys Ther Rev. 2014 Aug;19(4):252-265. doi: 10.1179/108331913X13844245102034.
• Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010 Sep-Oct;23(5):640-6. doi: 10.3122/jabfm.2010.05.090296.
• Gonzalez-Perez LM, Infante-Cossio P, Granados-Nuñez M, Urresti-Lopez FJ. Treatment of temporomandibular myofascial pain with deep dry needling. Med Oral Patol Oral Cir Bucal. 2012 Sep 1;17(5):e781-5.
• Ahmad Z, ur Rehman S, Ahmad S, Afzal MF. Effects of combined manual postural correction technique in patient with upper cross syndrome. Rawal Medical Journal. 2019;44(3):486-9.
• Thacker D, Jameson J, Baker J, Divine J, Unfried A. Management of upper cross syndrome through the use of active release technique and prescribed exercises. Logan College of Chiropractic. 2011 Apr
• Yeganeh Lari A, Okhovatian F, Naimi Ss, Baghban AA. The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females. Man Ther. 2016 Feb;21:204-9. doi: 10.1016/j.math.2015.08.004. Epub 2015 Aug 14.

Study record dates

Study Major Dates

• Study Start (Actual): March 30, 2020
• Primary Completion (Actual): December 30, 2020
• Study Completion (Actual): January 30, 2021

Study Registration Dates

• First Submitted: December 16, 2020
• First Submitted That Met QC Criteria: December 16, 2020
• First Posted (Actual): December 19, 2020

Study Record Updates

• Last Update Posted (Actual): March 8, 2021
• Last Update Submitted That Met QC Criteria: March 4, 2021
• Last Verified: March 1, 2021

More Information

Terms related to this study

• Keywords: Dry needling, upper cross syndrome, VAS, NDI, goniometry
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Syndrome
• Other Study ID Numbers: REC/LHR/20/1049 Komal Arooj

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No