ARTICLE IN PRESS

Effects of Dry Needling on Biomechanical

Properties of the Myofascial Trigger Points
Measured by Myotonometry: A Randomized
Controlled Trial
Carolina Jim
enez-S
anchez, PhD, PT, a Julio G

omez-Soriano, PhD, PT, b, c
Elisabeth Bravo-Esteban, PhD, PT, b Orlando Mayoral-del Moral, PhD, PT, d
Pablo Herrero-G
allego, PhD, PT, a Diego Serrano-Mu~noz, PhD, PT, b, c and Mar
ıa Ortiz-Lucas, PhD, PT a
ABSTRACT

Objective: The purpose of the present study was to examine the effect of dry needling (DN) on the biomechanical
properties of a latent medial myofascial trigger point (MTrP) of the soleus muscle compared with an adjacent point
within the taut band (TB) measured by myotonometry.
Methods: Fifty asymptomatic volunteers were randomly assigned to an intervention group (n = 26) or control group
(n = 24). One session of DN was performed in every group as follows: 10 needle insertions into the MTrP area
(intervention group) or TB area (control group). Myotonometric measurements (frequency, decrement, and stiffness)
were performed at baseline (pre-intervention) and after the intervention (post-intervention) in both locations (MTrP
and TB areas).
Results: The results showed that stiffness outcome significantly decreased with a large effect size after DN in the
MTrP when measured in the MTrP location (P = .002; d = 0.928) but not when measured in the TB location. In
contrast, no significant changes were observed in any location when the TB was needled (P > .05).
Conclusions: The findings suggest that only DN into the MTrP area was effective in decreasing stiffness outcome,
therefore a specific puncture was needed to modify myofascial muscle stiffness. (J Manipulative Physiol Ther
2021;00;1-8)
Key Indexing Terms: Trigger Points; Dry Needling; Muscle Tonus

TAGEDH1INTRODUCTIONTAGEDEN pain during different kinds of stimulation, such as

compression.1,2
A myofascial trigger point (MTrP) is defined as a hyper-
Dry needling (DN) is an effective, safe, and invasive
irritable spot in a palpable taut band (TB) within a skeletal
technique frequently used to treat MTrPs in myofascial
muscle. MTrPs can be distinguished clinically as active or
pain syndrome (MPS). A filiform needle is inserted into the
latent. An active MTrP causes either or both spontaneous
MTrP in order to obtain local twitch responses (LTRs),
local and referred pain, whereas a latent MTrP only causes
defined as a brisk contraction of muscle fibers in or around
the MTrP as a consequence of a spinal reflex.3-5 Previous
research has highlighted the need of eliciting LTRs as an
a
iPhysio Research Group, Universidad San Jorge, Zaragoza, essential component of the DN technique,4 with emphasis
Spain. on inserting the needle into the exact site of the MTrP
b
Toledo Physiotherapy Research Group, Facultad de Fisioter- area.6,7
apia de Toledo, Universidad Castilla La Mancha, Toledo, Castilla
La Mancha, Spain.
The traditional assessment of MTrPs involves manual
c
Sensorimotor Function Group, Hospital Nacional de Para- palpation and the reproduction of the patient’s symptoms
pl
ejicos, Toledo, Castilla La Mancha, Spain. in the case of active MTrPs.8 However, this is a subjective
d
Physical Therapy Unit, Hospital Provincial, Toledo, Spain. diagnostic method that is influenced by the experience
Corresponding author: Julio G
omez-Soriano, PhD, PT, Facul- level, training, and skills of the examiner.9,10 Thus, objec-
tad de Fisioterapia y Enfermería de Toledo, Despacho 1.12 Edif,
Sabatini, Avda, Carlos III s/n 45071, Toledo, Spain.
tive noninvasive techniques currently are being used to
(e-mail: Julio.Soriano@uclm.es). quantify MTrP characteristics.9,11-14 Within these charac-
Paper submitted September 27, 2019; in revised form Septem- teristics, muscle stiffness must be considered, including
ber 2, 2020; accepted June 15, 2021. both active stiffness (considering reflex response and vol-
0161-4754 untary muscle contraction) and passive stiffness (mechani-
© 2021 by National University of Health Sciences.
https://doi.org/10.1016/j.jmpt.2021.06.002
cal or viscoelastic properties).13,15,16
 ARTICLE IN PRESS
2 Jim
enez-S
anchez et al
Dry Needling on Biomechanical Properties
Myotonometry is a simple, noninvasive, portable, and
painless tool for assessing the mechanical properties of
skeletal muscles and requires low user-level skills. This
device exerts a short mechanical pulse on the tested muscle,
producing a transverse muscle belly displacement recorded
by an acceleration transducer on the testing end.17-20 Some
studies have revealed the validity of myotonometry in
assessing changes in neurologic populations,21-23 muscle
disorders,24 athletes,14,25 and healthy participants.17 A
recent publication showed that myotonometry, specifically
the “stiffness” parameter, is a reliable method to measure
MTrP and can discriminate the MTrP point from an adja-
cent point in the same TB.13 In addition, to the best of the
authors’ knowledge, only a prior noncontrolled clinical trial
has examined the effect of DN on the pre- and post-changes
in muscle stiffness of the MTrP using a myotonometer after
anterior cruciate ligament reconstruction, concluding that
passive mechanical properties can be modified by DN.24
Furthermore, no data from controlled trials have reported
the effect of DN on muscle stiffness quantified by myoton-
ometry.
Therefore, the purpose of the present study was to mea-
sure the effect of DN on the biomechanical properties of a
latent medial MTrP of the soleus muscle compared with an
adjacent point within the TB measured by myotonometry.
The authors hypothesized that participants receiving DN
application into the MTrP area of the soleus muscle would
exhibit a higher reduction of passive stiffness than those
receiving DN application into the TB area.
TAGEDH1MATERIAL AND METHODSTAGEDEN
Study Design
This study was a randomized, double-blinded, con-
trolled clinical trial conducted at the Hospital Nacional de
Parapl
ejicos in Toledo, Spain, from December 2015 to July
2017. The local ethics committee of the Complejo Hospi-
talario de Toledo approved the study design (reference:
134). The trial was registered at the ClinicalTrials.gov Pro-
tocol Registration System (NCT02952053) following the
CONSORT guidelines.
Participants
Fifty non-injured volunteers ranging in age between 18
and 55 years were recruited via a non-probabilistic conve-
nience sampling. All volunteers were required to present a
latent medial MTrP of the right soleus muscle following
the essential criteria proposed by Simons as follows: (1)
the presence of a tender spot in a TB or nodules of skeletal
muscle, (2) focal spot muscle tenderness, and (3) pressure-
elicited referred pain pattern.2,8 The following exclusion
criteria were applied: (1) any history of ipsilateral lower
limb surgery, (2) pain or musculoskeletal injury in the
Journal of Manipulative and Physiological Therapeutics
2021
ipsilateral lower limb for 6 months previous to the interven-
tion, (3) peripheral or central nervous system neurologic
disease, (4) altered sensitivity in the intervention area, (5)
treatment of MTrPs in the triceps surae muscle during the 6
months previous to the study, (6) changes in physical activ-
ity that would have affected muscle tone during the study,
(7) needle phobia, (8) intolerance to pain caused by DN, or
(9) no continuance commitment. Volunteers who met all
inclusion and exclusion criteria and consented to participate
in the study signed the informed consent.
The sample size was calculated previously to detect a
between-group difference of 46 Nm (percentage of change
of 15%) on the stiffness parameter. A standard deviation of
48 Nm was assumed for each group based on the variability
obtained in a previous study using the same protocol.13 The
desired statistical power was established at 0.8 and an alpha
level of 0.05. Although the hypothesis was that the MTrP
group would obtain a greater reduction of passive stiffness,
a 2-tailed analysis was performed to also consider a higher
reduction in the control group. A minimum of 19 partici-
pants for each group was calculated using SigmaPlot soft-
ware (Systat Software, Inc, San Jose, CA). However, to
cover possible losses, the sample size was increased by
another 6 participants (n = 25).
Randomization and Blinding
An external researcher used a web page (www.random
izer.org) to randomly assign the participants to receive DN
to either the MTrP area (intervention group [IG]) or the TB
area (control group [CG]). Random assignment was placed
in numbered, sealed, and opaque envelopes. Outcome
measures were taken by an assessor blinded to intervention
allocation. Furthermore, the participants also were blinded
to their group allocation.
Procedures
Demographic data, including age, sex, height, weight,
and body mass index (BMI), were recorded at the begin-
ning of the data collection session. Each participant was
seated comfortably on a chair with the seat-back tilted at 55
degrees, the right hip joint at 90 degrees of flexion, the right
knee slightly flexed at 10 degrees, and the right ankle in a
neutral position. Throughout all procedures, the partici-
pants were requested to completely relax.13
A physiotherapist with more than 15 years of clinical
experience on DN technique performed manual palpation
to identify the latent medial MTrP of the soleus muscle and
its TB area, following the criteria by Simons et al1 and
marked the relevant areas on the skin. To date, palpation
represents the key process for identifying an MTrP during
a diagnostic process if at least 2 of the following criteria
are present for an MTrP diagnosis: a taut band, a hypersen-
sitive spot, and referred pain.26 A blinded assessor applied
 ARTICLE IN PRESS
Journal of Manipulative and Physiological Therapeutics
Volume 00, Number 00
myotonometry to measure the 2 marked locations (the
medial MTrP of the soleus muscle and its TB) before and
after DN application in order to record the outcome meas-
ures. Although soleus muscle is largely covered by the gas-
trocnemius, the authors of the present study selected the
aforementioned muscle due its monoarticular condition and
because this setup was used in previous studies performed
by the authors’ group. The medial MTrPs of the soleus
muscle are accessible directly through a medial approach
and are easily palpated and needled.27
Intervention
The physiotherapist always performed the same DN pro-
cedure in order to blind the participants also who wore an
eye mask to avoid knowing their group allocation. Ten nee-
dle insertions were performed in both groups.6,28-30
A headless 0.25 mm £ 40 mm needle (Agupunt, Barce-
lona, Spain) was inserted perpendicularly directly into the
assigned area, depending on the group allocation. Partici-
pants allocated to the IG received a single session of multi-
ple, rapid needle insertions into the latent medial MTrP of
the soleus muscle, whereas those assigned to the CG
received a single session of DN into a point within its TB,
1 cm distal to that MTrP, where the needle was slowly
inserted to minimize the chance of eliciting LTRs.6,7,30-32
The 10-point Visual Analogue Scale was used to record
the level of pain (range between 0, no pain, and 10, worst
imaginable pain) that participants experienced during the
intervention.11,33,34 The number of LTRs also was
registered.35
Participants were asked to report any adverse events that
they experienced.
Outcome Measures
Myotonometric parameters were evaluated using the
MyotonPRO device (M€ uomeetria AS, Tallinn, Estonia).
The device provides a controlled pre-load of 0.18 N for ini-
tial compression of the tissue and then releases an addi-
tional 15-ms impulse of 0.40 N of mechanical force, which
induces a damped natural oscillation of the tissue.13,36,37
The recorded parameters are as follows: (1) oscillation fre-
quency (Hz) as an indicator of muscle tone, which charac-
terizes the resting level of tension in the tissue; (2)
logarithmic decrement (arbitrary unit), which is considered
as the ability of the muscle to restore its initial shape after
being deformed (is inversely proportional to elasticity); and
(3) stiffness (N/m), which reflects the resistance of the tis-
sue to the force that changes its shape.13,14,23
A measurement set of 10 consecutive impulses (multi-
scan mode) with a 1-s interval was completed in all partici-
pants at the MTrP location and the 1-cm distal point within
its TB. Mean data of each series were accepted if the coeffi-
cient of variation of the measurement set was inferior to
Jim
enez-S
anchez et al 3
Dry Needling on Biomechanical Properties
3%.38,39 Every outcome was measured by a blinded asses-
sor, trained in the use of MyotonPRO technology, before
(pre-intervention) and immediately after the assigned inter-
vention (post-intervention) in both the MTrP and TB area,
respectively.
Data Analysis
Statistical analysis was conducted using SPSS, Version
21 (IMB Corp, Armonk, NY) and SigmaPlot version 11.0
(Systat Software, Inc). Comparison of baseline characteris-
tics (age, sex, height, weight, and BMI) was made between
the groups after randomization.
The normality of the data distribution was checked with
the Shapiro-Wilk test. All calculations were performed
after checking the underlying assumptions for parametric
or nonparametric testing. Differences between groups (IG
vs CG) were analyzed using the independent Student t or
Mann−Whitney U test. Frequencies between groups were
compared using the chi-square test. The Student t test for
paired samples or Wilcoxon test was applied to highlight
the within-group differences (between post- and pre-inter-
vention data measurements).
Between-group and within-group effect sizes (95% con-
fidence intervals), depending on parametric or nonparamet-
ric data distribution (Cohen’s d or r), were calculated with
the difference between the data of “post-intervention”
minus “pre-intervention.” An effect size of <0.2 reflects a
negligible mean difference; between 0.2 and 0.5, a small
difference; between 0.5 and 0.8, a moderate mean differ-
ence; and >0.8, a large difference.40 The statistical analysis
was conducted at a 95% confidence level. Statistical signifi-
cance was set at P < .05.
TAGEDH1RESULTSTAGEDEN
Fifty volunteers completed the study and were randomly
assigned to the following 2 groups: the IG (n = 26) or the
CG (n = 24) (Fig 1). There were no statistically significant
differences in age, sex, height, weight, and BMI between
the 2 groups (Table 1).
Table 2 shows the descriptive values at pre- and post-
intervention in both groups when measured at MTrP and
TB, respectively. No differences were found between
groups before the intervention (P > .05). Table 3 shows the
within- and between-groups differences in both measuring
points (MTrP and TB). There were statistical differences
with a large effect size between groups at post-intervention
for stiffness outcome when measured in the MTrP area
(P = .002; d = 0.928). Nevertheless, only a nonsignificant
small effect size, near to moderate, was found when mea-
sured in the TB area when comparing both groups
(P = .131; d = 0.432). Furthermore, in the within-group
analysis, the stiffness value of MTrP decreased
 ARTICLE IN PRESS
4 Jim
enez-S
anchez et al Journal of Manipulative and Physiological Therapeutics
Dry Needling on Biomechanical Properties 2021

Fig 1. Flow chart of the study.

significantly after DN in the IG (P < .001) with a small

Table 1. Baseline Characteristics (n = 50). effect size (d = 0.207), whereas there were no significant
Intervention Control differences in the CG (P = .435; d = 0.050). There were no
Group Group significant changes between pre- and post-intervention
(n = 26) (n = 24) P Value when measured in the TB area for any group (see Table 3).
Age (y) 24.13 § 7.71 23.65 § 6.11 .630 Regarding the decrement parameter, there were no sig-
nificant differences for any intergroup comparisons (MTrP
Sex, male (%) 65.38% 54.16% .263
area: P = .127; TB area: P = .530), with the finding of a
Height (m) 1.72 § 0.08 1.69 § 0.08 .319 small effect in the MTrP area (d = −0.217). The decrement
value in the MTrP area decreased significantly in the IG
Weight (kg) 70.67 § 11.25 67.45 § 16.35 .481 (P = .005; d = −0.228), whereas no significant differences
were found in the CG (P =.753; d = 0.029). No significant
Body mass index (kg/m2) 20.93 § 8.17 23.73 § 4.75 .135
differences were observed in the TB area among all groups
NOTE. Data are presented as mean § standard deviation. over time (see Table 3).
 ARTICLE IN PRESS
Journal of Manipulative and Physiological Therapeutics Jim
enez-S
anchez et al 5
Volume 00, Number 00 Dry Needling on Biomechanical Properties

Table 2. Descriptive Values of Myotonometric Outcomes at Pre-Intervention and Post-Intervention

Intervention Group (n = 26) Control Group (n = 24)
Variable Pre-Intervention Post-Intervention Pre-Intervention Post-Intervention
Stiffness (Nm)

MTrP area 308.35 § 51.56 297.58 § 52.58 301.04 § 46.35 303.42 § 48.79

TB area 333.58 § 60.84 336.50 § 58.00 323.13 § 44.19 320.13 § 50.18

Decrement

MTrP area 1.17 § 0.18 1.13 § 0.20 1.21 § 0.24 1.20 § 0.27

TB area 1.13 § 0.17 1.12 § 0.17 1.23 § 0.27 1.20 § 0.27

Frequency (Hz)

MTrP area 15.90 § 1.73 15.71 § 1.68 15.83 § 1.73 15.73 § 1.80

TB area 16.64 § 2.10 16.64 § 1.98 16.18 § 1.72 16.02 § 1.80

NOTE. Data are presented as mean § standard deviation.
MTrP, medial myofascial trigger point of soleus muscle; TB, taut band of the MTrP.

Table 3. Within- and Between-Groups Comparison of Myotonometric Outcomes

Comparison Within Groups Comparison Between Groups
Mean Difference Effect Size Effect Size
Variable (95% CI) (95% CI) Mean Difference (95% CI) (95% CI)
Stiffness (Nm) MTrP IG −10.77* (−16.42 to −5.12) −0.207 (−1.06 to 1.48) −13.14y (−21.28 to −5.00) −0.928 (−0.93 to 2.49)
(post-intervention area CG 2.38 (−3.80 to 8.55) 0.050 (−0.58 to 0.68)
minus pre-
intervention) TB IG 2.92 (1.72 to 7.56) 0.050 (−0.58 to 0.68) 5.92 (−1.83 to 13.67) 0.432 (−0.43 to 1.30)
area CG −3.00 (−9.60 to 3.60) −0.063 (−0.60 to 0.73)

Decrement (Nm) MTrP IG −0.05y (−0.08 to −0.02) −0.240 (−0.30 to 0.78) −0.04 (−0.09 to 0.02) −0.217 (−0.26 to 0.95)
(post-intervention area CG −0.008 (−0.06 to 0.04) −0.029 (−0.54 to 0.60)
minus pre-
intervention) TB IG 0.01 (−0.04 to 0.01) 0.081 (−0.46 to 0.63) 0.01 (−0.03 to 0.05) 0.179 (−0.38 to 0.73)
area CG −0.03 (−0.05 to 0.004) −0.029 (−0.54 to 0.59)

Frequency (Hz) MTrP IG −0.20 (−0.36 to 0.05) −0.268 (−0.43 to 0.66) −0.11 (−0.48 to 0.27) −0.263 (−0.39 to 0.72)
(post-intervention area CG 0.09 (−0.46 to 0.27) 0.052 (−0.51 to 0.62)
minus pre-
intervention) TB IG −0.004 (−0.21 to 0.20) −0.002 (−0.54 to 0.55) 0.15 (−0.14 to 0.44) 0.296 (−0.26 to 0.85)
area CG −0.15 (−0.37 to 0.08) −0.087 (−0.46 to 0.63)
CG, control group; CI, confidence interval; IG, intervention group; MTrP, medial myofascial trigger point of soleus muscle; TB, taut band of the MTrP.
*
P < .001. Statistically significant differences and relevant effect sizes are in bold.
y
P < .05.

Analyzing changes in the frequency parameter between Adverse Effects

and within groups revealed no significant differences in
any area (P > .05), with the finding of a trivial effect size
(0.2> d <0.5) (see Table 3).
Finally, the proportion of participants who recorded
LTRs was 92.30% in the IG (number of evoked LTRs:
2.58 § 1.48) and 20.83% in the CG (number of evoked
LTRs: 0.32 § 0.72; P < .001). The Visual Analogue Scale
score was 3.60 (2.02) for the IG and 1.76 (1.60) for the CG
(P < .001).
No adverse side-effects were reported in any of the par-
ticipants, except post-needling soreness.
TAGEDH1DISCUSSIONTAGEDEN
The current study examined the effect of DN on the bio-
mechanical parameters of myofascial tissue using myoton-
ometry. The present study’s findings showed that needling
 ARTICLE IN PRESS
6 Jim
enez-S
anchez et al
Dry Needling on Biomechanical Properties
the MTrP of the soleus muscle specifically decreased the
stiffness variable when measured at the MTrP area, but no
changes were detected at an adjacent point within the same
TB. Furthermore, when DN was applied to the adjacent
TB, no effects were found in the MTrP nor the adjacent TB
in any of the measured outcomes. These results indicate the
importance of applying puncture, specifically over the
MTrP area, to modify muscle stiffness. However, the
effects are not substantial enough to evidence changes in
the adjacent point of the same TB. Regarding the decre-
ment variable, although no differences between groups
were determined, the IG showed a reduction after DN
application in the MTrP only when measured in the MTrP
area. These phenomena suggest that muscle elasticity of
this specific area could increase when the MTrP is specifi-
cally needled. The frequency parameter did not change
after needling and, therefore, the muscle tension was not
modified in any myofascial area.
In a recent study, no differences between needling the
MTrP and the TB were reported on mechanical or neuro-
physiological parameters associated with muscle tone mea-
sured by an isokinetic dynamometry and soleus H-reflex
assessment, respectively. It was suggested that there was a
need to use more sensitive tools in order to detect small
muscle stiffness changes after DN technique.30 Another
previous study concluded that myotonometry could be a
reliable stiffness assessment and that the MyotonPRO
device is sensitive to detect changes in the stiffness parame-
ter between the MTrP and its TB, but differences were not
seen in decrement nor frequency parameters.13 Although
the MTrP is less stiff than its surrounding area, as reported
by Jim
enez-S
anchez et al,13 in the present study, a decrease
in the stiffness parameter after DN appeared exclusively in
the MTrP area of the IG and therefore there were no
changes in its TB area. Likewise, other non-myofascial
studies have claimed that the myotonometer device is
highly sensitive relative to the point from which it is regis-
tered.41 All these findings and several other literature
data6,7,34 reinforce the importance of a localized and tar-
geted puncture into the MTrP area and the elicitation of
LTRs that contribute to modifying local tissue milieu and
the MTrP circuit.2,32,42,43 However, a recent narrative
review stated that eliciting LTRs by DN could show no
greater clinical benefits than DN without LTRs, concluding
that more research is needed to address this issue.44 For the
aforementioned reasons, future studies are necessary to
establish myotonometric assessment protocols and refer-
ence values in different myofascial areas that can provide
diagnostic and therapeutic criteria. In addition, the effect of
DN treatment on muscle stiffness with and without eliciting
LTRs should be studied.
From previous data investigating the effect of DN on
muscle stiffness assessed by myotonometry, Ortega-
Cebrian et al24 evidenced a significant reduction in the dec-
rement parameter after DN in the vastus medialis MTrP of
Journal of Manipulative and Physiological Therapeutics
2021
anterior cruciate ligament−reconstructed patients, but stiff-
ness and frequency parameters were unchanged. The pres-
ent study’s results are only in concordance with the effect
observed in the decrement parameter of the MTrP group. It
must be emphasized that the data published by Ortega-
Cebrian et al24 are the result of a noncontrolled trial. More-
over, the type, the location of the treated MTrP, and the site
of the myotonometric measurement are unclear. Additional
studies are required to assess muscle stiffness modifications
after DN is applied over myofascial and non-myofascial tis-
sues in participants with muscle tone disorders.
Regarding the effect of other myofascial therapies on
muscle stiffness assessed by myotonometry, Kisilewicz et
al,14 as in the present study, found a reduction in the stiff-
ness parameter of an active upper trapezius MTrP in elite
basketball players after a unique session of local ischemic
compression. In contrast, there were no changes in the
MTrPs of the middle and lower trapezius. Additional
research is needed to compare different interventions
applied over various areas of myofascial tissues to assess
mechanical property changes.
The findings in the present study concur with some stud-
ies that also assessed the effectiveness of the DN technique
on muscle stiffness using other assessment methods.45,46 In
a single case study, muscle stiffness quantified by tensio-
myography in a stroke patient was reduced after DN for
hypertonia and spasticity was applied on 7 MTrPs for 1 ses-
sion.45 In addition, Maher et al46 recorded a significant
reduction in trapezius tissue stiffness assessed by ultrasound
shear-wave elastography after DN in 7 females, but a control
point was not included. In contrast to the present study’s
results, a recent study using elastography showed that the
application of DN over latent MTrPs of the gastrocnemius
medialis muscle increased muscle stiffness immediately after
the puncture but decreased 1 hour after the needling proce-
dure.34 The authors34 suggested that their findings might be
justified by the presence of intramuscular edema in the punc-
tured area after DN and a different response of the medial
gastrocnemius muscle relative to other muscles. Further-
more, in an upper trapezius MPS study, Aridici et al47 identi-
fied a decrease in tissue stiffness by sonoelastography after
the application of high-power pain threshold ultrasound but
not after DN technique. Comparing muscle stiffness mea-
surement methods should be considered in future research.
Limitations and Future Research
This study was performed in asymptomatic participants,
and clinical implications should be interpreted with cau-
tion. More extensive studies in muscle tone disorder popu-
lations are necessary to assess the effect of DN on muscle
stiffness.
Myotonometric measures were taken from a latent
medial MTrP of the soleus muscle. Additional extensive
research is required to assess the effect of DN in non-
 ARTICLE IN PRESS
Journal of Manipulative and Physiological Therapeutics
Volume 00, Number 00
myofascial tissue and other muscles. Moreover, it would be
interesting to take a follow-up period into account to assess
DN efficacy. Follow-up periods may be necessary to con-
firm the medium- and long-term stiffness reductions.
Finally, the proportion of LTRs was greater in the IG,
which can indirectly affect the achievement of the results
because the elicitation of LTRs can contribute to deactivate
the vicious cycle of the MTrP circuit in the spinal cord.6,7
Future research should focus on assessing changes in
muscle stiffness in MPS and neurologic conditions after
DN application.
TAGEDH1CONCLUSIONTAGEDEN
The present study’s findings show that needling the
MTrP of the soleus muscle specifically decreased stiffness
measured at the MTrP but without any changes at an adja-
cent point within the same TB. However, when the TB was
needled, no changes were observed in the TB or the MTrP.
Such findings emphasize the importance of needling preci-
sion into the MTrP area to modify myofascial mechanical
properties, although real effectiveness and effect are
unknown in a clinical context.
TAGEDH1FUNDING SOURCES AND POTENTIAL CONFLICTS OF
INTERESTAGEDNTE
No funding sources or conflicts of interest were reported
for this study. Pablo Herrero-Gallego owns the register of
Dry Needling for Hypertonia and Spasticity mark. For the
remaining authors, there are no conflicts of interest.
TAGEDH1CONTRIBUTORSHIP INFORMATIONTAGEDEN
Concept development (provided idea for the research):
M.O.L., J.G.S.
Design (planned the methods to generate the results):
M.O.L., J.G.S.
Supervision (provided oversight, responsible for organiza-
tion and implementation, writing of the manuscript):
M.O.L., J.G.S., C.J.S.
Data collection/processing (responsible for experiments,
patient management, organization, or reporting data):
M.O.L., E.B.E., O.M.d.M.
Analysis/interpretation (responsible for statistical analysis,
evaluation, and presentation of the results): C.J.S.
Literature search (performed the literature search): C.J.S.,
M.O.L., J.G.S.
Writing (responsible for writing a substantive part of the
manuscript): C.J.S.
Critical review (revised manuscript for intellectual content,
this does not relate to spelling and grammar checking):
P.H.G., D.S.M.
Jim
enez-S
anchez et al 7
Dry Needling on Biomechanical Properties
Practical Applications
 There was insufficient evidence on dry nee-
dling effectiveness for muscle stiffness
changes of myofascial tissues.
 Myotonometry could be used for the assess-
ment of biomechanical properties of myofas-
cial trigger points after dry needling
technique.
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