The effects of dry needling and radial extracorporeal shockwave therapy on latent trigger point sensitivity in the quadriceps: A randomised control pilot study

J Bodyw Mov Ther. 2019 Jan;23(1):82-88. doi: 10.1016/j.jbmt.2018.02.010. Epub 2018 Feb 11.


Objectives: Latent myofascial trigger points (TrP) can alter joint kinematics, reduce strength and alter activation patterns, affecting athletic performance. TrP sensitivity can be measured with the pressure pain threshold (PPT). Dry needling (DN) has been used to treat latent TrPs, but may cause post-needling soreness. Radial extracorporeal shockwave therapy (rESWT) could be used as an alternative to DN during heavy training or competition.

Methods: After baseline measures, 21 recreational athletes were split into three groups: DN, rESWT or control group, and were treated for three sessions in one week. Follow-up outcome sessions were conducted two to four and seven days after the last treatment. TrP sensitivity was measured using the PPT.

Results: There was a groupXtime interaction for the PPT (p < 0.05). After a decrease in PPT during treating, there was a significant increase (p < 0.05) in PPT for the DN group (12.92%). The rESWT group also significantly (p < 0.05) increased (13.26%), but did not show any post-treatment soreness during the treatment phase. There was no difference in the PPT in the control group during any session.

Conclusion: DN is effective for increasing PPT of latent TrPs, but can be associated with post-treatment soreness. rESWT is as effective, but without the post-treatment soreness. Future studies should include treating multiple TrPs in the lower kinetic chain as well as measuring muscle activation and joint function. Furthermore, consideration for the current training load and up-coming competition is needed. Optimum timing and longer follow-up periods of such interventions should be explored.

Level of evidence: 2b.

Summary: Treating latent TrPs in the lower kinetic chain may improve muscle activation. Unlike DN, rESWT does not cause post- treatment soreness. Consideration of training load and up-coming competition is needed to deliver the optimum treatment strategy for athletes with latent TrPs.

Keywords: Dry needling; Pressure pain threshold; Radial extracorporeal shockwave therapy; Trigger points.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Athletes
  • Extracorporeal Shockwave Therapy / methods*
  • Fascia / physiopathology
  • Female
  • Humans
  • Male
  • Needles / adverse effects*
  • Pain Measurement
  • Pain Threshold
  • Pilot Projects
  • Quadriceps Muscle / physiopathology*
  • Therapy, Soft Tissue / adverse effects
  • Therapy, Soft Tissue / methods*
  • Trigger Points / physiopathology*
  • Young Adult