Dry Needling Combined With a Therapeutic Exercise Program in Myofascial Pain Syndrome: Sonographic Evaluation of Cervical Muscles

The Effect of Dry Needling of the Upper Trapezius Muscle Added to Therapeutic Exercise Therapy on the Thickness of the Cervical Muscles in Myofascial Pain Syndrome

Patients between the ages of 20-65 years who present to the Physical Medicine and Rehabilitation outpatient clinics of our hospital with complaints of back and neck pain and are diagnosed with myofascial pain syndrome will be referred to the physicians responsible for the study to be included in the study. Exclusion criteria will be reviewed, and patients with chronic pain for more than 3 months and an active trigger point in the unilateral upper trapezius muscle will be included in the study. Patients will be randomly divided into two groups; the first group will receive only exercise therapy (including cervical range of motion and trapezius stretching), and the second group will receive exercise and dry needling therapy (1 time per week, 3 sessions in total). Demographic data (age, gender, body mass index, occupation) of all patients included in the study will be recorded. The relationship between pain and loss of function according to the Visual Analog Scale (VAS), Short Form 36 (SF-36), and Neck Disability Index (NDI) scales will be recorded. Bilateral upper trapezius, sternocleidomastoideus, and total cervical extensor muscle thickness (upper trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus) and longus colli muscle thickness measurements will be made with the ultrasonography device in our clinic. The first group will receive only exercise therapy after the measurements. Patients in the second group will receive a total of 3 sessions of dry needling treatment to the trapezius muscle for active trigger points at 0, 1, and 2 weeks in addition to exercise therapy. After the initial examination, control VAS, SF-36, NDI, and control ultrasonographic measurements will be performed in all patients at the 3rd week and 6th week. Using data analysis methods, the effect of dry needling treatment for active trigger points in the trapezius muscle on pain and functionality as well as the thickness of the cervical muscles will be investigated.

Study Overview

• Status: Completed
• Conditions: Myofascial Pain Syndrome - Neck; Myofascial Pain of Upper Trapezius Muscle
• Intervention / Treatment: Behavioral: Therapeutic Exercise Program; Procedure: Dry Needling

• Study Type: Interventional
• Enrollment (Actual): 73
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Fatih
    • Istanbul, Fatih, Turkey, 34093
      • Istanbul Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients aged 20-65 years with neck pain for more than 12 weeks
• Active trigger point in the unilateral upper trapezius muscle on physical examination
• Who agreed not to receive anti-inflammatory and myorelaxant treatment during the study period

Exclusion Criteria:

• Patients diagnosed with rheumatologic diseases
• Patients with radiculopathy
• Patients with a history of previous surgery in the shoulder, back, and neck region
• Patients with polyneuropathy
• Patients with severe cervical spondylosis
• Patients with cerebrovascular events
• Patients with malignancies
• Those with cognitive impairment
• Those with bleeding disorders
• Patients diagnosed with fibromyalgia
• Patients with thyroidectomy
• Anti-inflammatory-analgesic or myorelaxant treatment within the last 1 month
• Patients with a history of injection into the upper trapezius muscle or cervical region within the last 3 months

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
Active Comparator: Group 1: Therapeutic Exercise	Behavioral: Therapeutic Exercise Program; Participants in this group will receive a therapeutic exercise program (including cervical range of motion and trapezius stretching) during the study period.
Active Comparator: Group 2: Therapeutic Exercise and Dry Needling	Behavioral: Therapeutic Exercise Program; Participants in this group will receive a therapeutic exercise program (including cervical range of motion and trapezius stretching) during the study period.; Procedure: Dry Needling; Participants in this group will receive dry needling treatment for active trigger points in addition to the therapeutic exercise program. Dry needling treatment will be applied in a total of 3 sessions at 0, 1, and 2. weeks, one week apart.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ultrasonographic evaluation for muscle thickness assessment	Bilateral upper trapezius, sternocleidomastoid, total cervical extensor muscle thickness (upper trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus), and longus colli muscle thickness measurements will be made with the ultrasonography device.	It will be evaluated in the baseline, third, and sixth weeks.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain will be assessed with Visual Analog Scale.	Visual Analog Scale (VAS) score ranges from 0 to 10. High scores describe more pain, and low scores describe less pain.	It will be evaluated in the baseline, third, and sixth weeks.
Functional status will be assessed with the Neck Disability Index.	Neck Disability Index (NDI) consists of 10 questions in total. Each question receives a score ranging from 0 to 5. Totals can have a minimum score of 0 and a maximum score of 50. Higher scores indicate more severe disability.	It will be evaluated in the baseline, third, and sixth weeks.
General health status will be assessed with Short Form 36.	Short Form 36 (SF-36) is a 36-item patient-reported questionnaire that covers eight health domains: physical functioning (10 items), bodily pain (2 items), role limitations due to physical health problems (4 items), role limitations due to personal or emotional problems (4 items), emotional well-being (5 items), social functioning (2 items), energy/fatigue (4 items), and general health perceptions (5 items). Scores for each domain range from 0 to 100, with a higher score defining a more favorable health state.	It will be evaluated in the baseline, third, and sixth weeks.

Collaborators and Investigators

• Sponsor: Istanbul Training and Research Hospital
• Investigators: Principal Investigator: Muhammed Oğuz, Istanbul Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Actual): February 9, 2025
• Primary Completion (Actual): July 25, 2025
• Study Completion (Actual): August 15, 2025

Study Registration Dates

• First Submitted: January 26, 2025
• First Submitted That Met QC Criteria: January 30, 2025
• First Posted (Actual): February 5, 2025

Study Record Updates

• Last Update Posted (Actual): August 19, 2025
• Last Update Submitted That Met QC Criteria: August 18, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: myofascial pain syndrome; dry needling; trigger point; Therapeutic Exercise; upper trapezius muscle
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Nervous System Diseases; Muscular Diseases; Mental Disorders; Pathologic Processes; Neuromuscular Diseases; Rheumatic Diseases; Disease; Somatoform Disorders; Syndrome; Fibromyalgia; Myofascial Pain Syndromes
• Other Study ID Numbers: 18/09/2024;2024-KAEK-30;114

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No