DRY NEEDLING VS INSTRUMENT ASSISTED SOFT TISSUE MOBILIZATION FOR MYOFASCIAL TRIGGER POINTS IN UPPER TRAPEZIUS.: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Myofascial trigger points (MTrPs) in the upper trapezius are a common cause of neck pain, functional disability, and impaired quality of life. Dry needling (DN) and instrument-assisted soft tissue mobilization (IASTM) are widely used interventions, yet direct comparative evidence regarding their effectiveness remains limited, particularly in South Asian clinical contexts.

Objective: To compare the efficacy of DN versus IASTM in reducing pain, improving pressure pain threshold (PPT), cervical range of motion (ROM), and functional disability in patients with upper trapezius MTrPs.

Methods: This single-center, parallel-group, assessor-blinded randomized controlled trial enrolled 60 participants aged 18–50 years with active upper trapezius MTrPs. Participants were randomly allocated to DN (n=30) or IASTM (n=30) groups, receiving three sessions per week for four weeks. The primary outcome was pain intensity measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included PPT, cervical ROM, and the Neck Disability Index (NDI). Baseline and post-intervention assessments were conducted by blinded evaluators. Data were analyzed using paired t-tests, independent t-tests, and repeated-measures ANOVA, with significance set at p < 0.05.

Results: Both interventions produced statistically and clinically significant improvements in all outcome measures (p < 0.001). DN resulted in greater reductions in NPRS (−4.7 ± 1.2) compared to IASTM (−2.8 ± 1.1; p < 0.001, Cohen’s d = 0.92), higher increases in PPT (DN: +1.9 ± 0.7 vs IASTM: +0.9 ± 0.6 kg/cm²; p = 0.002), and superior improvements in NDI (DN: −16.3 ± 4.5 vs IASTM: −9.4 ± 5.2; p = 0.01). Cervical ROM improved in both groups (DN: +12.3°; IASTM: +8.4°), with no statistically significant between-group difference (p = 0.08). No serious adverse events were reported; minor post-needling soreness and erythema were transient.

Conclusion: Both DN and IASTM are effective for managing upper trapezius MTrPs. Dry needling, however, demonstrates superior efficacy in pain reduction, pressure pain threshold, and functional disability. These findings support the use of DN as a primary intervention while recognizing IASTM as a viable non-invasive alternative or adjunct.