Trigger point dry needling, manual therapy and exercise versus manual therapy and exercise for the management of Achilles tendinopathy: a feasibility study

J Man Manip Ther. 2020 Sep;28(4):212-221. doi: 10.1080/10669817.2020.1719299. Epub 2020 Feb 12.


Objectives: The effects of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy (AT) are unknown. We conducted a study to test the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to MT and exercise in a patient population with AT.

Methods: Twenty-two subjects were randomly assigned to a control (MT+Ex) or experimental group (TDN+MT+Ex) and completed eight treatment sessions over 4 weeks with follow up at 3 months. TDN was performed to MTPs in the gastrocnemius, soleus or tibialis posterior each session. The same MT and exercise program was conducted in both groups.

Results: Two of three criteria for feasibility were met. The attrition rate at 4-week and 3-month follow-up was 18.1% and 68%, respectively. Significant differences (p < .05) reported for within group analysis for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 3 months. The GROC was significant for MT + Ex at 3 months. No between group differences were found. The MCID for the FAAM, GROC was surpassed in both groups at 4 weeks and 3 months and NPRS for the MT + Ex group at 4 weeks.

Discussion: A large RCT to investigate the effects of TDN on MTP in AT is not feasible without modifications due to low recruitment and high attrition rate. Modifications to study design should give consideration for closed or national health-care system for access to large patient populations and reduced financial burden to subjects.

Trial registration: identifier: NCT03261504F.

Trial registration: NCT02532595.

Keywords: Achilles; Trigger point dry needling; eccentric; feasibility; myofascial trigger points.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Achilles Tendon / physiopathology*
  • Adult
  • Aged
  • Combined Modality Therapy
  • Dry Needling / methods*
  • Exercise Therapy / methods*
  • Feasibility Studies
  • Humans
  • Middle Aged
  • Musculoskeletal Manipulations / methods*
  • Tendinopathy / physiopathology
  • Tendinopathy / therapy*
  • Young Adult

Associated data