Muscle Position and Dry Needling Efficacy

The Importance of Muscle Position in the Effectiveness of Dry Needling Technique

Currently, no previous studies have investigated how the position of a muscle before dry needling may influence the outcome and effectiveness of the treatment.

This study aims to demonstrate whether the position of the upper trapezius muscle during dry needling treatment influences the outcome of that treatment in subjects with neck pain.

A total of 46 participants with chronic neck pain will be recruited and randomly assigned to two groups: a dry needling group with the muscle in a stretched position and a dry needling group with the muscle in a shortened position. A total of two treatment sessions will be performed, separated by a 7-day interval. The primary outcome measure will be the intensity of neck and head pain, measured using the visual analog scale (VAS). Other variables to be measured include the cervical disability index, kinesiophobia, and catastrophizing (using a self-completion questionnaire), as well as participants' expectations and post-needling pain.

Study Overview

• Status: Not yet recruiting
• Conditions: Neck Pain; Headache
• Intervention / Treatment: Other: Dry needling technique with the shoulder in full adduction.; Other: Dry needling technique with the shoulder in 90° abduction.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Daniel Pecos-Martin, PhD; Phone Number: 34918855142; Email: daniel.pecos@uah.es

Study Locations

• Spain
  • Madrid
    • Alcalá de Henares, Madrid, Spain, 28805
      • Physioterapy and Pain center research
    • Alcalá de Henares, Madrid, Spain, 2805
      • Clinical University Physiotherapy and pain

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age between 18 and 65 years
• Neck pain lasting more than 3 months
• Current neck pain greater than 3/10 on the VAS (Visual Analog Scale)
• Presence of active trigger points in the upper trapezius muscle, meeting the following criteria: Painful point within a taut band whose palpation reproduces the patient's symptoms.

Exclusion Criteria:

• Neck pain with a medical diagnosis (fractures, arthritis, fibromyalgia, etc.)
• Radicular pain (paresthesia, burning, electric shocks)
• Whiplash or any recent trauma
• Previous surgery
• Treatment by another physiotherapist within the last 3 months
• Infections
• Needle phobia
• Use of anticoagulant medications
• Pregnancy
• Fibromyalgia
• Metal allergies
• Cognitive deficits or communication problems

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Upper trapezius dry needling with adduction shoulder; The dry needling technique will be applied to the trapezius muscle while the subject lies prone, with the upper limb at the side of the body, shoulder lowered, in adduction and cervical region in a neutral position. The dry needling technique will be applied using a pincer grasp, inserting the needle from the posterior to the anterior portion of the upper trapezius muscle.	Other: Dry needling technique with the shoulder in full adduction.; Ten incisions will be made in a posteroanterior direction while the patient lies prone and the muscle is grasped with a pincer grip between the first three fingers. The technique will be applied to the area that is mechanically most hyperalgesic and related to the reproduction of the patient's pain.
Experimental: Upper trapezius dry needling with 90º abduction shoulder; The dry needling technique will be applied to the trapezius muscle while the subject lies prone, with the upper limb separated from the body, shoulder at 90 degrees of abduction and cervical region in a neutral position. The dry needling technique will be applied using a pincer grasp, inserting the needle from the posterior to the anterior portion of the upper trapezius muscle.	Other: Dry needling technique with the shoulder in 90° abduction.; Ten incisions will be made in a posteroanterior direction while the patient lies prone and the muscle is grasped with a pincer grip between the first three fingers. The technique will be applied to the area that is mechanically most hyperalgesic and related to the reproduction of the patient's pain.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The visual analog scale (VAS)	Intensity of neck and head pain: This was measured using the visual analog scale (VAS). It consists of a 10 cm horizontal line, where 0 cm on the left side represents "no pain" and 10 cm on the right side represents "maximum pain." The subject marks a perpendicular line at the point they consider to represent their pain intensity. The examiner then places a millimeter ruler on the scale, assigning a numerical value to the line drawn by the patient. The VAS has proven to be a valid and reliable tool (intraclass correlation coefficient [ICC] 0.71-0.99).	Change from baseline at 3 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Disability Associated with Neck Pain	The degree of disability associated with neck pain will be measured using the Neck Disability Index (NDI) questionnaire in its Spanish version. The NDI is a 10-item questionnaire, and each item is scored on a scale of 0 to 5 points, with a range of 0 to 50 points. The higher the score, the greater the degree of disability. The NDI has proven to be a reliable tool (ICC 0.98).	Change from baseline at 3 months
Kinesiophobia with the Tampa Kinesiophobia Scale (TSK-11)	The Tampa Kinesiophobia Scale (TSK-11) short version will be used to assess fear of movement. It is an 11-item scale rated on a four-point scale ranging from "strongly agree" to "strongly disagree." Scores range from 11 to 44, with higher scores indicating greater fear of movement and/or (re)injury. This questionnaire has demonstrated similar properties to the original TSK scale, proving to be a valid and reliable instrument.	Change from baseline at 3 months
Catastrophizing with the Pain Catastrophizing Scale (PCS)	Catastrophizing Scale (PCS). The PCS has 13 items scored from 0 to 4 and is composed of three subscales: rumination, magnification, and helplessness. The overall score ranges from 0 to 52. Higher scores indicate a greater degree of pain catastrophizing. A total score >30 represents a clinically significant level of pain catastrophizing. This questionnaire has been shown to be reliable (ICC 0.94).	Change from baseline at 3 months
Local twitch response (LTRs)	Local twitch response (LTRs). The LTRs produced by needle insertion during dry needling will be counted. LTRs are generally associated with better treatment outcomes. A higher number of LTRs indicates better results, and a lower number of LTRs indicates worse results.	Change from baseline at 3 months
Cervical joint Range	Flexion, inclination, extension and rotational movement ranges will be measured with a cervical goniometer	Change from baseline mobility at one week after intervention

Collaborators and Investigators

• Sponsor: University of Alcala

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2026
• Primary Completion (Estimated): September 15, 2026
• Study Completion (Estimated): December 15, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Musculoskeletal Pain; dry needling
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Muscular Diseases; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Musculoskeletal Pain; Headache; Neck Pain
• Other Study ID Numbers: CEEI22/199

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