The association between dry needling-induced twitch response and change in pain and muscle function in patients with low back pain: a quasi-experimental study.
OBJECTIVE
To investigate the relationship between dry needling-induced twitch response and change in pain, disability, nociceptive sensitivity, and lumbar multifidus muscle function, in patients with low back pain (LBP).


METHODS
Quasi-experimental study.


METHODS
Department of Defense Academic Institution.


METHODS
Sixty-six patients with mechanical LBP (38 men, 28 women, age: 41.3 [9.2] years).


METHODS
Dry needling treatment to the lumbar multifidus muscles between L3 and L5 bilaterally.


METHODS
Examination procedures included numeric pain rating, the Modified Oswestry Disability Index, pressure algometry, and real-time ultrasound imaging assessment of lumbar multifidus muscle function before and after dry needling treatment. Pain pressure threshold (PPT) was used to measure nocioceptive sensitivity. The percent change in muscle thickness from rest to contraction was calculated to represent muscle function. Participants were dichotomized and compared based on whether or not they experienced at least one twitch response on the most painful side and spinal level during dry needling.


RESULTS
Participants experiencing local twitch response during dry needling exhibited greater immediate improvement in lumbar multifidus muscle function than participants who did not experience a twitch (thickness change with twitch: 12.4 [6]%, thickness change without twitch: 5.7 [11]%, mean difference adjusted for baseline value, 95%CI: 4.4 [1 to 8]%). However, this difference was not present after 1-week, and there were no between-groups differences in disability, pain intensity, or nociceptive sensitivity.


CONCLUSIONS
The twitch response during dry needling might be clinically relevant, but should not be considered necessary for successful treatment.
U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, United States. Electronic address: shanekoppenhaver@mac.com.
Shane L
SL
Koppenhaver
South College Doctor of Physical Therapy Program, Knoxville, TN, United States.
Michael J
MJ
Walker
Physical Therapy Student During Study, U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, United States.
Charles
C
Rettig
Physical Therapy Student During Study, U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, United States.
Joel
J
Davis
Physical Therapy Student During Study, U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, United States.
Chenae
C
Nelson
Physical Therapy Student During Study, U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, United States.
Jonathan
J
Su
Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.
Cesar
C
Fernández-de-Las-Peñas
Associate Dean (Research), School of Psychology and Exercise Science, Murdoch University, Perth, Australia.
Jeffrey J
JJ
Hebert
D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008161:Lumbosacral Region / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009339:Needles; D064170:Paraspinal Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D016037:Single-Blind Method; D061028:Trigger Points / Q000503:physiopathology*; D014463:Ultrasonography
Dry needling; Low back pain; Muscle contraction; Paraspinal muscles; Ultrasonography