Comparative effects of static, classical, and sham dry needling on muscle properties and autonomic nervous system activity in cervical myofascial pain syndrome.

BACKGROUND

Dry needling is frequently used for managing myofascial pain, yet the influence of needle manipulation technique on physiological responses remains uncertain.

OBJECTIVE

To compare the short-term effects of classical dynamic (pistoning) dry needling (CDN), static dry needling (SDN), and sham needling (shamN) on mechanical and microcirculatory properties of the upper trapezius muscle.

METHODS

In this randomized, single-blind, sham-controlled trial, 45 participants with upper-trapezius myofascial trigger points were allocated to CDN (n = 15), SDN (n = 15), or shamN (n = 15). CDN involved multiple fast in-out needle insertions to elicit local twitch responses, SDN consisted of a single needle insertion retained for 60 s without manipulation, and shamN simulated insertion without skin penetration. Outcomes included pressure pain threshold (PPT, N/m²), muscle stiffness (N/m), tone (Hz), elasticity (D), and perfusion (PU), recorded at baseline, immediately, 60 min, 24 h, and 7 days post-intervention. Data were analyzed with mixed (Group × Time) ANCOVA models using baseline as covariate.

RESULTS

A significant main effect of time was observed for PPT (p = 0.039, η²ₚ = 0.071) and a significant Time × Group interaction for elasticity (p < 0.001, η²ₚ = 0.974) and perfusion (p < 0.001, η²ₚ = 0.483). Post hoc comparisons showed higher PPT and perfusion and lower stiffness and tone in CDN compared with SDN and shamN across most time points (p < 0.05). No significant differences were found between SDN and shamN.

CONCLUSIONS

CDN induced greater short-term improvements in mechanical and perfusion outcomes of the upper trapezius than static or sham procedures, suggesting that needle manipulation intensity modulates physiological responses. Long-term studies are warranted to confirm sustained clinical relevance.

TRIAL REGISTRATION: ISRCTN16484644.