Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials

Abstract

BackgroundPlantar heel pain can be managed with dry needling of myofascial trigger points (MTrPs); however, whether MTrP needling is effective remains controversial. Thus, we conducted this meta-analysis to evaluate the effect of MTrP needling in patients with plantar heel pain.Materials and methodsPubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People’s Republic of China), and CNKI (National Knowledge Infrastructure, People’s Republic of China) databases were systematically reviewed for randomized controlled trials (RCTs) that assessed the effects of MTrP needling. Pooled weighted mean difference (WMD) with 95% CIs were calculated for change in visual analog scale (VAS) score, and pooled risk ratio (RR) with 95% CIs were calculated for success rate for pain and incidence of adverse events. A fixed-effects model or random-effects model was used to pool the estimates, depending on the heterogeneity among the included studies.ResultsExtensive literature search yielded 1,941 articles, of which only seven RCTs met the inclusion criteria and were included in this meta-analysis. The pooled results showed that MTrP needling significantly reduced the VAS score (WMD =−15.50, 95% CI: −19.48, −11.53; P<0.001) compared with control, but it had a similar success rate for pain with control (risk ratio [RR] =1.15, 95% CI: 0.87, 1.51; P=0.320). Moreover, MTrP needling was associated with a similar incidence of adverse events with control (RR =1.89, 95% CI: 0.38, 9.39; P=0.438).ConclusionMTrP needling effectively reduced the heel pain due to plantar fasciitis. However, considering the potential limitations in this study, more large-scale, adequately powered, good-quality placebo-controlled trials are needed to provide more trustworthy evidence in this area.

Electrical dry needling as an adjunct to exercise, manual therapy and ultrasound for plantar fasciitis: A multi-center randomized clinical trial

“…In addition to manual therapy, exercise and ultrasound, patients allocated to the dry needling group also received up to 8 sessions of electrical dry needling at a frequency of 1–2 times per week for 4 weeks using a standardized protocol of 8 points for 20 minutes. [ 39 – 41 , 59 , 60 ]. Within both groups, fewer treatment sessions could be delivered by the treating therapist if symptom resolution occured sooner.…”

“…Although the 2014 APTA clinical practice guidelines[ 22 ] concluded that “the use trigger point dry needling cannot be recommended for individuauls with PF,” a recent meta-analysis of seven trials concluded that trigger point dry needling is effective in patients with PF with a pooled estimate effect size of -15.5 points for pain reduction. [ 39 ] Needling therapies[ 11 , 39 – 41 ] may be a reasonable non-pharmacologic adjunct therapy for the reduction of pain in individuals with PF who are already receiving manual therapy,[ 6 , 28 , 40 , 42 ] exercise,[ 29 , 43 ] and/or electrophysical agents. [ 30 ] Needling therapy refers to the insertion of thin monofilament needles without the use of injectate.…”

“…In the absence of high quality evidence for any one treatment modality,[ 23 ] it may still be possible to achieve a high success rate with a combination of the treatments for PF. [ 8 , 19 ] Electrical dry needling,[ 11 , 39 – 41 ] manual therapy,[ 6 , 28 , 42 ] exercise[ 29 , 43 ] and ultrasound,[ 30 , 50 ] when applied separately, have each been found to be effective for PF. However, no previous study has investigated the combination of the effectiveness of electrical dry needling in addition to manual therapy, exercise and ultrasound in patients with PF.…”

Postneedling Soreness and Tenderness After Different Dosages of Dry Needling of an Active Myofascial Trigger Point in Patients With Neck Pain: A Randomized Controlled Trial

“…Deep dry needling (DDN) is a minimally invasive therapy frequently included in the treatment of multiple pain conditions. Previous research has investigated its effectiveness in patients presenting with disorders such as nonspecific low back [1], neck, or shoulder pain [2]; lateral epicondylalgia [3]; temporomandibular disorders [4]; plantar heel pain [5]; or patellofemoral pain [6]. A recent meta‐analysis has concluded that very low‐to‐moderate evidence supports its effectiveness against no treatment or placebo improving pain in the short and medium term [7].…”

<p>Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm</p>

“…The effectiveness of dry needling for the management of patients with plantar heel pain has been also investigated in a recent meta-analysis including seven clinical trials 62. He and Ma concluded that TrP-DN was effective for reducing pain intensity (SMD −15.5, −19.48 to −11.53) compared with a control intervention.…”