| Summary: | Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2011. === Background: Myofascial Pain Syndrome is a condition characterized by the
development of hyperirritable foci in muscle. Treatments include modalities such as
cryotherapy, electrotherapy, ultrasound, ischeamic compression and dry-needling,
the latter of which is reported to be the most effective. A side-effect of dry-needling is
post-needling soreness which results from bleeding in the area of needle insertion.
The application of heat as a therapy to an injured area has been reported to
decrease pain by blocking nociceptors, decreasing muscle spasm, and increasing
connective tissue extensibility.
Objectives: To determine the relative effectiveness of heat therapy immediately
after dry-needling versus dry-needling alone on post-needling soreness in the deltoid
muscle of asymptomatic subjects. This was done in terms of subjective and objective
clinical findings.
Methodology: This study was designed as a randomised, parallel-controlled clinicaltrial.
Thirty asymptomatic subjects were used. Each subject acted as their own
control in that both the left and right arms of each subject were dry-needled. One of
the arms received heat therapy after the dry-needling procedure while the other arm
acted as a control. Algometer readings, a Numerical Pain Rating Scale-101 (NRS-
101) and a 24 Hour Pain Diary were used as assessment tools.
Algometer and NRS-101 readings were taken before and after the dry-needling
procedure and during the 24 hour follow up visit. Subjects used a 24 hour pain diary
which was filled out at 3 hour intervals, to record the development of post-needling
soreness.
Independent samples t-test and Pearson’s chi square test were used to compare
age and gender between the treatment groups. Repeated measures ANOVA testing
was used to compare the effect of heat treatment with no heat treatment in the 60
arms over the three time periods of assessment for the outcomes which were
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measured as continuous variables (NRS-101 and algometer). For binary outcomes
such as the presence or absence of pain at any time point, Fisher’s exact tests were
used to compare the heat treated with the control arms in the left and right arms
separately. A p value of less than 0.05 was considered as statistically significant.
Results: Both the objective and subjective measurements from the heat intervention
and control groups revealed the development of post-needling soreness. There was
a slight trend of heat therapy decreasing post-needling soreness in terms of
subjective (NRS-101 and pain diary) and objective (algometer) findings which was
however, not found to be statistically significant.
Conclusion: Although the results of the study revealed no statistical evidence of a
beneficial effect of heat therapy on objective or subjective findings clinical
significance could not be excluded due to the observed trend of heat therapy
decreasing post-needling soreness in terms of subjective (NRS-101 and pain diary)
and objective (algometer) findings. Further investigation is recommended.
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