The effects of dry needling and radial extracorporeal shockwave therapy on the sensitivity of trigger points in the quadriceps and jump performance: A randomised control trial
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Background: Trigger points (TrPs) can reduce strength. Thus, may reduce jump height. Dry needling (DN) is an effective treatment for TrPs but can cause post-needling soreness, potentially reducing jump performance. Radial extracorporeal shockwave therapy (rESWT) is an emerging treatment for TrPs that may not cause post-needling soreness. The post-needing soreness from DN may prevent an athlete training maximally. rESWT may be a possible alternative treatment for TrPs during periods of high-intensity training. Methods: A mixed absolute intra-class coefficient (ICC[3:1]) was conducted to determine the reliability of the researcher at measuring the pressure pain threshold (PPT), anatomical landmark system (ALS) to locate TrPs. Bland-Altman plots were created to visualise the data. The ICC(3:1) of the countermovement jump (CMJ-JH), jump height of the depth jump (DJ-JH) and components of the DJ was established. Twenty-one subjects with latent TrPs in the vastus lateralis (VL) and vastus medialis (VM) were treated with DN, rESWT or acted as a control. The outcome measures were the PPT, CMJ-JH and DJ-JH. After a Baseline session (B-line), there were three treatment sessions and two follow-up sessions (FU) at 3-4 days and seven days after the final treatment. A 2-way ANOVA was conducted to determine the effects of DN and rESWT on the PPT of TrPs, in the VL and VM. A 3-way ANOCVA (factoring for PPT) was conducted to analyse the effects of DN and rESWT on CMJ-JH. A 2-way ANOCVA (factoring for PPT and body mass index [BMI]) was carried out to analyse the effects of DN and rESWT on DJ-JH. Results: The ICC(3:1) for the PPT ranged from 0.637 to 0.875. The ICC(3:1) for the ALS was 0.643 to 0.886 for the X-line and 0.603 to 0.745 for the Y-line. The ICC(3:1) for the CMJ-JH was 0.928 to 0.961. The ICC(3:1) for the DJ-JH was 0.919 to 0.956. The mean PPT of the DN group increased from 28.25 N to 31.68 N between B-line and FU2. In the rESWT group, the mean PPT increased from 22.08 N to 24.07 N between B-line and FU2. Results from a 2-way ANOVA reported a statistically significant interaction between group and time (p=0.003) for the PPT. The mean CMJ-JH for the DN group increased from 27.43 cm at the Baseline to 28.07 cm between B-line and FU2; whereas, the rESWT group increased from 23.24 cm to 24.71 cm during the same period. Results from a 3-way ANOCVA (factoring for the PPT) reported a statistically significant interaction between group and time for the CMJ-JH (p=0.007). The mean DJ-JH for the DN group decreased from 22.71 cm to 20.86 cm between B-line and FU2. The rESWT group also decreased, from 21.38 cm at Baseline to 20.21 cm at Follow-up 2. A 3-way ANOCVA (factoring for the PPT and BMI) reported a statistically significant interaction between group and time for the DJ-JH (p=0.001). Conclusion: The investigator is reliable at measuring the PPT, ALS, CMJ-JH, DJ-JH. DN appears to have a positive effect on the mean PPT after one week once the post-needling soreness had subsided. rESWT shows a gradual improvement in PPT and CMJ-JH throughout the treatment phase and follow-up phase, which suggests that rESWT does not cause post-treatment soreness. Treating subjects with DN may not be the most appropriate action if they are engaging in competition or high-intensity concentric strength training in the following week. DN and rESWT can impede reactive strength for up to four days, possibly due to reducing the elastic property of the taut bands associated with TrPs. Further studies should include treating multiple TrPs in multiple muscles involved in triple extension and measuring muscle activation. Future research in this area should also consider using a longer post-treatment follow-up period.
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