Journal Name: Brazilian Journal of Physical Therapy
Year: 2021
Impact Factor: Not explicitly mentioned but recognized for publishing
impactful rehabilitation studies.
SJR Score: Not provided in the document.
IH Index: Not provided in the document.
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Authors:
Carlos Murillo: Department of Rehabilitation Sciences, Ghent University,
Belgium.
Julia Treleaven: University of Queensland, Australia; specialized in
sensorimotor function.
Barbara Cagnie: Rehabilitation Sciences, Ghent University, Belgium;
expert in dry needling research.
Javier Peral: Physical Therapy Department, University of Alcala, Spain.
Deborah Falla: University of Birmingham, UK; renowned for spinal pain
research.
Enrique Lluch: University of Valencia, Spain; focused on pain rehabilitation
strategies.
---
Introduction:
Persistent neck pain often affects sensorimotor control, including head
and eye movement coordination and postural stability. This dysfunction is
commonly linked to altered proprioceptive input from the cervical spine.
The upper cervical spine, particularly the obliquus capitis inferior (OCI)
muscle, plays a pivotal role in sensorimotor integration due to its high
density of muscle spindles. Impairments in the OCI can contribute to neck
pain, reduced mobility, and proprioceptive deficits. Dry needling (DN) has
been proposed as an effective intervention to restore muscle function and
improve cervical afferent input.
This study focuses on evaluating the short-term effects of DN on OCI,
assessing its impact on cervical sensorimotor control, mobility, and
postural stability.
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Research Gap:
Although DN has been studied for pain relief and muscle function
improvement, its role in enhancing cervical sensorimotor function remains
underexplored. Few studies have targeted deep muscles like OCI, which
are difficult to access with conventional therapies.
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Hypothesis:
DN applied to the OCI improves cervical sensorimotor control, upper
cervical mobility, and postural stability in individuals with neck pain.
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Aim:
To assess the short-term impact of DN on head and eye movement
control, cervical joint position error (JPE), and cervical mobility.
Additionally, to determine its effect on global and upper cervical rotation.
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Population:
Participants were adults aged 18-65 years with neck pain persisting for at
least three months. All participants exhibited cervical JPE impairment
exceeding 4.5°, indicating proprioceptive dysfunction.
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Study Design:
This was a double-blind, parallel-group, randomized sham-controlled trial
conducted following CONSORT and STRICTA guidelines. It aimed to
minimize bias and ensure methodological rigor.
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Sampling Method:
Participants were recruited through posters and advertisements in the
metropolitan area of Valencia, Spain. Eligibility screening was conducted
via phone before baseline assessment.
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Sample Size:
The study enrolled 40 participants, randomly divided into:
Dry Needling Group (n=20): Received DN targeting the OCI muscle.
Sham Group (n=20): Received simulated needling with a blunt, non-
penetrating device.
Sample size calculation, based on detecting a 2° difference in JPE, ensured
80% power at a significance level of 0.05.
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Participants' Characteristics:
Age: DN group: 37.6 ± 11.88 years; Sham group: 36.85 ± 11.05 years.
Gender: DN group: 40% male; Sham group: 25% male.
Pain Intensity (VAS): DN group: 53.2 ± 11.00; Sham group: 48.00 ± 15.00.
Neck Disability Index (NDI): DN group: 33.5 ± 8.32; Sham group: 31.8 ±
7.81.
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Randomization and Allocation:
Randomization was achieved using a computer-generated sequence, with
allocation concealed in opaque envelopes. Participants were randomly
assigned to receive either DN or sham intervention.
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Blinding:
Double blinding was implemented:
1. Participants were unaware of their group assignment.
2. Outcome assessors were blinded to the intervention type.
Blinding effectiveness was evaluated using Bang’s Blinding Index.
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Inclusion Criteria:
1. Adults aged 18-65 years with neck pain lasting ≥3 months.
2. Cervical JPE exceeding 4.5°.
3. Neck pain intensity ≥30/100 mm on the Visual Analog Scale (VAS).
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Exclusion Criteria:
1. History of cervical trauma, surgery, or neurological deficits.
2. Needle phobia, anticoagulant therapy, or pregnancy.
3. Prior DN treatment targeting the cervical region.
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Trial Registration:
Registered at ClinicalTrials.gov (ID: NCT03838224).
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Intervention:
Dry Needling Group: DN was performed bilaterally on the OCI using a
validated approach. The fast-in-and-fast-out technique was applied to
induce local twitch responses.
Sham Group: Sham needling involved a non-penetrating, blunted needle
device mimicking DN procedures.
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Outcome Measures:
1. Primary Outcome:
Cervical JPE (measured with a laser pointer and headband setup).
2. Secondary Outcomes:
Cervical movement sense (zigzag pattern tracing).
Standing balance (firm and soft surfaces with eyes open/closed).
Cervical range of motion (ROM) using the Flexion-Rotation Test (FRT).
Pain intensity (VAS).
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Statistical Analysis:
Linear mixed models were used to evaluate group and time interactions.
Bonferroni corrections were applied for post-hoc analyses. Missing data
were handled using restricted maximum likelihood estimations.
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Results:
Cervical JPE: DN significantly reduced JPE immediately post-intervention
(mean difference -0.93°) and at one-week follow-up (-1.64°) compared to
sham.
Cervical Mobility: The DN group showed significant improvements in upper
cervical mobility (measured by FRT) at one week (mean difference
+6.98°).
Pain Intensity: DN reduced pain intensity by 15.83 mm on the VAS,
approaching clinical significance.
No significant changes in standing balance or cervical movement sense
were observed in either group.
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Discussion:
The results confirm that DN of the OCI improves cervical proprioception
and mobility in the short term. The absence of significant postural stability
improvements suggests that tailored exercises may be required for these
outcomes. Future research should explore combining DN with
sensorimotor training for comprehensive rehabilitation.
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Limitations:
1. Short-term outcomes were assessed; long-term effects remain
unknown.
2. The focus on the OCI limits the generalizability of findings to other
cervical muscles.
3. Post-needling soreness may have influenced immediate outcome
measurements.
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Conclusion:
DN targeting the OCI is an effective short-term intervention for improving
cervical proprioception and mobility. Integrating DN into multimodal
rehabilitation programs may offer enhanced benefits for managing neck
pain.
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Concluding Points for Critical Appraisal:
DN of the OCI offers a promising, evidence-based approach for enhancing
sensorimotor function in individuals with neck pain, emphasizing the
importance of precise muscle targeting.
