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The aim of this study was to analyze the effects of dry needling (DN) in upper trapezius latent trigger points (LTrPs) on muscle stiffness. A total of 51 recreational physically active subjects with LTrPs in the upper trapezius volunteered to participate and were randomly divided into a DN-group (n = 27) and a sham-DN group (n = 24). Volunteers received 1-session of DN or placebo treatment. Muscle stiffness, measured with strain and shear-wave elastography, pressure pain threshold (PPT), post-needling soreness, and muscle thickness were evaluated before treatment, and at 30-min, 24-hours, and 72-hours follow-up after treatment. The DN-group showed lower values from baseline for muscle stiffness measured with shear-wave elastrography at 24-hours (from 44.44 ± 15.97 to 35.78 ± 11.65 kpa; P Perspective This study found that one session of DN intervention in latent trigger points of the upper trapezius muscle reduced muscle stiffness and the pressure pain threshold for the dry needling group compared to the sham dry needling group.

The aim of the present study was to provide a systematic review and meta-analysis of the main biases in practical applications of the different types of elastography in assessment of the stiffness of healthy patellar tendons. A literature search on four databases (Scopus, Web of Science, Pubmed and SportDiscus) was conducted on March 25, 2020. After analysis of 1,052 resultant articles, studies were included if they met two inclusion criteria: (1) studies were observational or randomized controlled trials; (2) studies included outcomes of patellar tendon stiffness. Twenty-one studies met the inclusion criteria and were included in this meta-analysis. Four meta-analyses were performed with respect to assessment procedure and participant characteristics. This meta-analysis found a low effect of examined portion of patellar tendon (standardized mean difference [SMD] = 0.27, 95% confidence interval [CI]: 0.01-0.54, n = 379, Z = 2.01, p = 0.04) and a high effect of knee flexion angle during assessment (SMD = -2.12; 95% CI: -2.67 to -1.58, n = 97, Z = 7.68, p0.01) in stiffness outcomes. The risk of bias was generally low, but the heterogenicity of the results downgraded the level of evidence. There is evidence in the elastography assessment of patellar tendon suggesting that the knee position and patellar tendon portion evaluated influence stiffness outcomes for patellar tendon in healthy volunteers.

The objective of this study was to evaluate the validity of a short assessment MyotonPRO protocol to measure the stiffness of the superficial muscles and tendons of the lower limbs. The stiffness of the dominant lower limb vastus lateralis (VL), rectus femoris (RF) and patellar tendon (PT) was evaluated in 52 healthy participants (26.9 ± 3.4 years) with two MyotonPRO protocols: the standard protocol (10 mechanical taps) and the short protocol (five mechanical taps). The myotonometry was performed at the midpoint of the length from the upper pole of the patella to the greater trochanter for the VL, and to the anterior superior iliac spine for the RF. The PT was evaluated 1 cm caudal from the inferior pole of the patella. Pearson’s correlation coefficients were calculated to determine the relationships between protocols. The validity of the short protocol was evaluated with Student’s t-test. High positive correlations were observed between the short and standard protocols in the stiffness of the VL (r = 0.959; p < 0.001), the RF (r = 0.967; p < 0.001) and the PT (r = 0.953; p < 0.001) and no differences were found between both protocols in the stiffness assessment of the VL, RF and PT (p > 0.05). Therefore, the five-compressions protocol is a valid protocol for the assessment of lower limb mechanical properties.

The present study aimed to verify the association between adherence to the Mediterranean diet (MD) and anthropometric and health variables. Four-hundred-and-ninety-five college-aged males aged 18–25 participated in this cross-sectional research. The KIMED (Mediterranean Diet Quality Index for children and adolescents) was used to assess the adherence to MD. The following variables were also assessed: body mass (BM), height (HE), body mass index (BMI), body fat percentage (%FAT), lean mass (LEAN), abdominal girth (AG), waist-to-hip ratio (WHR), oxygen saturation (SPO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), double product (DP), and fasting blood glucose (GLU). The results showed that adherence to MD presented a strong negative correlation with most of the anthropometric parameters (BM: r = −0.571; BMI: r = −0.614; %FAT: r = −0.558; and AG: r = −0.564), a moderate or weak correlation with most of the health variables (GLU: r = −0.407; SBP: r = −0.238; DBP: r = −0.217, and DP: r = −0.265) and LEAN (r = −0.497), and a very weak correlation with WHR (r = −0.090). Many anthropometric parameters (BM, BMI, %FAT, LEAN, AG, WHR) present significant correlations with health variables (SBP, DBP, DP, and GLU). We conclude that greater adherence to Mediterranean diet is associated with healthier values of the selected anthropometric and health parameters. Since most of the anthropometric and health parameters present significant correlations among themselves, this finding could be useful in medical diagnosis, health monitoring, and risk detection. Based on the level of adherence to Mediterranean diet and the KIDMED found in the present study, and considering the prevalence of obesity in the Middle East, it is imperative to implement nutritional interventions with the target population of this research to prevent nutrition-related diseases and promote public health.

BACKGROUND: Whole-body electromyostimulation (WB-EMS) is a new tendency in training used to complement conventional training. OBJECTIVE: The aim was to analyze the effects of training with WB-EMS on body composition, strength and balance in middle-aged women. METHODS: Twenty-eight women were randomly assigned to two groups: the WB-EMS group (age = 48.1 ± 4.3 years) or the control group (CG) (age = 51.1 ± 5.4 years). All participants continued their training of 2 days⋅week-1 and 60 min⋅day-1 of endurance-dynamic strength exercises and additionally did 20 minutes more of dynamic strength exercises one day⋅week-1: the WB-EMS group did the additional training with WB-EMS and the CG did the same training but without WB-EMS. Body composition, muscle isokinetic strength of the knee flexors/extensors and postural stability were measured before and after 8 weeks of training. RESULTS: After the training program, the WB-EMS group showed lower values for the waist circumference (83.00 ± 7.37 vs. 78.50 ± 7.30 cm; p< 0.01), hip circumference (104.80 ± 8.61 vs. 101.00 ± 6.78 cm; p< 0.05) and total fat mass (37.04 ± 6.08 vs. 36.26 ± 5.78%; p< 0.05). In balance stability the WB-EMS group reduced their Fall Risk Index (1.70 ± 0.51 vs. 1.30 ± 0.38 AU; p< 0.01) and deviation (1.50 ± 0.43 vs. 1.03 ± 0.74 AU; p< 0.01) after training and showed lower values in the Fall Risk Index (p= 0.007) and deviation (p= 0.024). CONCLUSIONS: The WB-EMS training program helps reduce the risk of falling and improves body composition variables and balance results in middle-aged physically active women.

Objective: This meta-analysis evaluated the effect of dry needling alone or combined with other treatment interventions on pain, related-disability, pressure pain sensitivity, and strength in people with lateral epicondylalgia of musculoskeletal origin. Data Sources: MEDLINE, CINAHL, PubMed, PEDro, Cochrane Library, SCOPUS and Web of Science databases from their inception to 5 April 2020. Review Methods: Randomized controlled trials collecting outcomes on pain, related-disability, pressure pain thresholds, or strength where one group received dry needling for lateral epicondylalgia of musculoskeletal origin. The risk of bias was assessed by the Cochrane Guidelines, methodological quality was assessed with the PEDro score, and the quality of evidence by using the GRADE approach. Results: Seven studies including 320 patients with lateral epicondylalgia were included. The meta-analysis found that dry needling reduced pain intensity (SMD ‒1.13, 95%CI ‒1.64 to ‒0.62) and related-disability (SMD ‒2.17, 95%CI ‒3.34 to ‒1.01) with large effect sizes compared to a comparative group. Dry needling also increased pressure pain thresholds with a large effect size (SMD 0.98, 95%CI 0.30 to 1.67) and grip strength with a small size effect (SMD 0.48, 95%CI 0.16 to 0.81) when compared to a comparative group. The most significant effect was at short-term. The risk of bias was generally low, but the heterogenicity of the results downgraded the evidence level. Conclusion: Low to moderate evidence suggests a positive effect of dry needling for pain, pain-related disability, pressure pain sensitivity and strength at short-term in patients with lateral epicondylalgia of musculoskeletal origin. Level of Evidence: Therapy, level 1a. Registration number: OSF Registry - https://doi.org/10.17605/OSF.IO/ZY3E8

Objective To examine the effects of dry needling against trigger point (TrP) injections (wet needling) applied to TrPs associated with neck pain. Methods Electronic databases were searched for randomized clinical trials in which dry needling was compared with TrP injections (wet needling) applied to neck muscles and in which outcomes on pain or pain-related disability were collected. Secondary outcomes consisted of pressure pain thresholds, cervical mobility, and psychological factors. The Cochrane Risk of Bias tool, the Physiotherapy Evidence Database score, and the Grading of Recommendations Assessment, Development, and Evaluation approach were used. Results Six trials were included. TrP injection reduced pain intensity (mean difference [MD ] –2.13, 95% confidence interval [CI] –3.22 to –1.03) with a large effect size (standardized mean difference [SMD] –1.46, 95% CI –2.27 to –0.65) as compared with dry needling. No differences between TrP injection and dry needling were found for pain-related disability (MD 0.9, 95% CI –3.09 to 4.89), pressure pain thresholds (MD 25.78 kPa, 95% CI –6.43 to 57.99 kPa), cervical lateral-flexion (MD 2.02°, 95% CI –0.19° to 4.24°), or depression (SMD –0.22, 95% CI –0.85 to 0.41). The risk of bias was low, but the heterogenicity and imprecision of results downgraded the evidence level. Conclusion Low evidence suggests a superior effect of TrP injection (wet needling) for decreasing pain of cervical muscle TrPs in the short term as compared with dry needling. No significant effects on other outcomes (very low-quality evidence) were observed. Level of Evidence Therapy, level 1a.

The present study aimed to determine the epidemiology of sport-related injuries in amateur and professional adolescent athletes and the incidence of different risk factors on those injuries. Four hundred ninety-eight athletes aged 14 to 21 voluntarily participated in this prospective injury surveillance, conducted from 1 January 2019 to 31 December 2019. The information collected included: personal data, sports aspects, characteristics of the injuries, and lifestyle. Forty point four percent of the participants suffered an injury in 2019 (39% of them in a previously injured area). The average injury rate was 2.64 per 1000 h. Soccer presented the highest rate (7.21). The most common injuries were: lumbar muscle strains (12.24%), ankle sprains (11.98%), and bone fractures (9.31%). Ankles (36.12%), knees (19.32%), and shoulders (6.47%) concentrated the highest number of injuries. Fifty-nine point twenty-eight percent of the injuries occurred during practices, and 40.72% during competition or peri-competition. Higher injury rates were associated (in this order) with the following factors: (a) Greater number of hours of practice per week. (b) Not performing warm-ups. (c) Using inadequate sports facilities. (d) Being aged 14–17. (e) Not performing physical preparation. (f) Inappropriate training load. (g) Not performing injury-preventive activities. (h) Performing sports technique without the supervision of one sports coach. (i) Inadequate sports equipment. In conclusion, since most injury risk factors are modifiable, it is imperative to implement strategies to reduce amateur and professional adolescent athletes’ injury rates.

Objective. To evaluate the effects of combining dry needling with other physical therapy interventions versus the application of the other interventions or dry needling alone applied over trigger points (TrPs) associated to neck pain. Databases and Data Treatment. Electronic databases were searched for randomized controlled trials where at least one group received dry needling combined with other interventions for TrPs associated with neck pain. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool, methodological quality was assessed with PEDro score, and the quality of evidence was assessed by using the GRADE approach. Between-groups mean differences (MD) and standardized mean difference (SMD) were calculated. Results. Eight trials were included. Dry needling combined with other interventions reduced pain intensity at short-term (SMD −1.46, 95% CI −2.25 to −0.67) and midterm (SMD −0.38, 95% CI −0.74 to −0.03) but not immediately after or at long-term compared with the other interventions alone. A small effect on pain-related disability was observed at short-term (SMD −0.45, 95% CI −0.87 to −0.03) but not at midterm or long-term. The inclusion of dry needling was also effective for improving pressure pain thresholds only at short-term (MD 112.02 kPa, 95% CI 27.99 to 196.06). No significant effects on cervical range of motion or pain catastrophism were observed. Conclusion. Low-to-moderate evidence suggests a positive effect to the combination of dry needling with other interventions for improving pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion in people with neck pain associated with TrPs at short-term. No midterm or long-term effects were observed.

Objective: The aim of this study was to evaluate the effect of acupuncture/electroacupuncture, alone or combined with other interventions, on pain intensity, pain-related disability, and strength in lateral epicondylalgia (LE) of musculoskeletal origin. Databases and data treatment: Electronic databases were searched for randomized clinical trials, where at least one group received acupuncture or electroacupuncture for LE of musculoskeletal origin. To be eligible, trials had to include humans and collect outcomes on pain intensity or pain-related disability in LE. Data were extracted by two reviewers. The risk of bias (RoB) of the trials was assessed using the Cochrane RoB tool, methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) score, and the level of evidence was summarized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) using random effects were calculated. Results: A total of 14 trials (10 acupuncture) were included. The meta-analysis found a moderate effect size of acupuncture (SMD = −0.66, 95% confidence interval (CI) = −1.22 to −0.10), but not electroacupuncture (SMD = −0.08, 95% CI = −0.99 to 0.83), in the reduction of elbow pain as compared to a comparative group. Acupuncture exhibited a significant moderate effect size (SMD = −0.51, 95% CI = −0.91 to −0.11) in the improvement of related-disability. Acupuncture (SMD = 0.36, 95% CI = 0.16 to 0.57), but not electroacupuncture (SMD = 0.34, 95% CI = −0.29 to 0.98), exhibited a significant but small effect size on strength. Most significant effects were in the short term. The RoB was low but the heterogeneity of trial results led to a downgrading of the GRADE evidence level. Conclusion: Low-level evidence suggests positive effects of acupuncture, but not electroacupuncture, for pain, related-disability, and strength, in LE of musculoskeletal origin, in the short term.

Volleyball players and gymnasts need strength training to achieve their optimum sport performance. The aims of this study were to describe body composition, strength, performance, and characteristics of trunk muscle activation in volleyball players and gymnasts, and to analyze the differences between the sports. The sample consisted of 40 female athletes: rhythmic gymnasts (n = 24, age 13.95 &plusmn, 2.77 years) and volleyball players (n = 16, age 19.81 &plusmn, 5.55 years). Body composition, maximum voluntary contraction (MVC) of isometric tests in an isokinetic dynamometer, McGill core endurance test, and surface electromyography (EMGrms) of the trunk muscle during the McGill test and isometric tests were recorded. Rhythmic gymnasts presented lower body composition values than volleyball players (p &lt, 0.05). The volleyball players presented higher isometric strength than rhythmic gymnasts in terms of MVC in trunk flexion (p &lt, 0.05, d = 1.3) and trunk extension (p &lt, 0.001, d = 1.3). EMGrms from the rhythmic gymnasts were greater for trunk flexor muscles (p &lt, 0.01, d = 0.7) and trunk extensor muscles (p &lt, 0.001, d = 1.3) during McGill endurance tests compared to the volleyball players. In the isometric test, EMGrms from the rhythmic gymnasts were greater for trunk flexor muscles in flexion (p &lt, 0.01, d = 0.9) and extension tests (p &lt, 0.05, d = 0.7). In conclusion, the volleyball players exhibited higher peak strength, despite the fact that the gymnasts showed greater muscle activity during the maximum voluntary contraction.

Our aim was to evaluate the effect of dry needling alone as compared to sham needling, no intervention, or other physical interventions applied over trigger points (TrPs) related with neck pain symptoms. Randomized controlled trials including one group receiving dry needling for TrPs associated with neck pain were identified in electronic databases. Outcomes included pain intensity, pain-related disability, pressure pain thresholds, and cervical range of motion. The Cochrane risk of bias tool and the Physiotherapy Evidence Database (PEDro) score were used to assessed risk of bias (RoB) and methodological quality of the trials. The quality of evidence was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Between-groups mean differences (MD) and standardized mean differences (SMD) were calculated (3) Twenty-eight trials were finally included. Dry needling reduced pain immediately after (MD −1.53, 95% CI −2.29 to −0.76) and at short-term (MD −2.31, 95% CI −3.64 to −0.99) when compared with sham/placebo/waiting list/other form of dry needling and, also, at short-term (MD −0.51, 95% CI −0.95 to −0.06) compared with manual therapy. No differences in comparison with other physical therapy interventions were observed. An effect on pain-related disability at the short-term was found when comparing dry needing with sham/placebo/waiting list/other form of dry needling (SMD −0.87, 95% CI −1.60 to −0.14) but not with manual therapy or other interventions. Dry needling was effective for improving pressure pain thresholds immediately after the intervention (MD 55.48 kPa, 95% CI 27.03 to 83.93). No effect on cervical range of motion of dry needling against either comparative group was found. No between-treatment effect was observed in any outcome at mid-term. Low to moderate evidence suggests that dry needling can be effective for improving pain intensity and pain-related disability in individuals with neck pain symptoms associated with TrPs at the short-term. No significant effects on pressure pain sensitivity or cervical range of motion were observed. Registration number: OSF Registry—https://doi.org/10.17605/OSF.IO/P2UWD.

Objective The main objective of this systematic review and meta-analysis was to determine the short-, medium-, and long-term effectiveness of dry needling (DN) applied by physical therapists to myofascial trigger points for the treatment of pain. Methods PubMed, Scopus, SportDiscus, and Web of Science databases were searched from their inception to February 2020. Randomized controlled trials that compared DN with other treatments or placebo and measured pain with a visual analog Scale or another numerical pain rating scale were included. Two authors used a personalized form to collect the following data relevant to the objectives of the review from each article independently: study design, purpose, sample size, diagnosis, characteristics of DN intervention, characteristics of placebo intervention, outcome measures, period of assessment, body region, DN technique, and number of sessions. The initial search identified 1771 articles. After the selection, 102 articles were assessed for eligibility; 42 of these articles measuring pain were used for the meta-analysis. Four meta-analyses were performed according to the follow-up period from the last reported treatment. Results This meta-analysis found a large effect to decrease pain within 72 hours (standardized mean difference [SMD] = −0.81; 95% CI = −1.21 to −0.40), a moderate effect in 1 to 3 weeks (SMD = −0.69; 95% CI = −1.02 to −0.35), a large effect in 4 to 12 weeks (SMD = −0.85; 95% CI = −1.30 to −0.40), and a large effect in 13 to 24 weeks (SMD = −0.81; 95% CI = −1.64 to −0.03). The risk of bias was generally low; however, the heterogeneity of the results downgraded the level of evidence. Conclusions Low-quality evidence that the immediate to 72-hour (large) effect, 4- to 12-week (large) effect, 13- to 24-week (large) effect, and moderate-quality 1- to 3-week (moderate) effect suggested that DN performed by physical therapists was more effective than no treatment, sham DN, and other therapies for reducing pain. Impact DN is commonly used by physical therapists to treat musculoskeletal pain, and it is very important for physical therapists to know the clinical conditions and time periods for which DN is effective in reducing pain in their patients.

Objective: This study aimed to compare the acute effects of a full squat (SQ) or hip thrust (HT) with two different loading intensities (60% and 85% 1 RM) on sprint ability in junior male tennis players. Methods: Nineteen tennis players were included in this research. They underwent four different experimental conditions: HT at 60% 1 RM, HT at 85% 1 RM, SQ at 60% 1 RM, or SQ at 85%. The force–velocity (F–V) profile was used to assess tennis players’ sprint acceleration ability before and after applying the conditioning stimulus. The variables registered were as follows: 5 m test (5 m), 10 m test (10 m), maximum theoretical force (F0), maximum power (Pmax), and the maximal ratio of horizontal-to-resultant force (RFpeak). Results: Significant improvements in 5 m, Pmax, and RFpeak were observed when the conditioning stimulus was performing one set of seven reps of HT at 60% 1 RM. When the activation protocol was one set of seven reps of SQ at 60% 1 RM, significant improvements in 5 m, 10 m, F0, Pmax (N), and RFpeak were detected. Additionally, performing one set of three reps of SQ at 85% 1 RM as an activation protocol provided significant improvements in F0. Conclusion: The use of HT and SQ with a load of 60% 1 RM improved the sprint F–V profile components related to the acceleration phase of the sprint in junior tennis players. Using intensity loads of 85% 1 RM is not adequate to increase acute sprint performance in this population. HT presents a higher transferability to sprinting in the first 5 m of sprinting, whereas SQ provides acute improvements in different sprinting phases.

Background Latent trigger point (LTrP) can cause motor dysfunction and disturb normal patterns of motor recruitment. Objective To analyze the effects of DN in the upper trapezius (UT) LTrP on pain and the mechanical and contractile properties of the muscle. Design A randomized, double-blinded, parallel-group-trial. Methods Fifty healthy volunteers with LTrPs in the UT were randomly divided into a DN-group (n = 26) and a Sham-DN-group (n = 24) and received one session of DN or placebo treatment. Mechanical and contractile properties of the muscle and pressure pain perception (PPP) were evaluated before treatment and in a 30min, 24 h and 72 h follow-up after treatment. Results In the mechanical properties, the DN-group showed lower values than the Sham-DN-group for dynamic stiffness at 72 h (p = 0.04). The DN-group showed lower values for dynamic stiffness at 72 h from baseline (278.74 ± 38.40 to 261.54 ± 33.64 N/m; p = 0.01) and for tone at 72 h from 30min (16.62 ± 1.27 to 15.88 ± 1.31 Hz; p = 0.01). In the contractile properties, the DN-group showed higher values for maximal radial displacement (Dm) of the muscle belly at 72 h from baseline (5.38 ± 1.67 to 6.13 ± 1.70 mm; p = 0.04), higher values for contraction time at 30min (28.53 ± 8.80 s; p = 0.03) and lower ones at 72 h (24.74 ± 4.36 s; p = 0.04) from baseline (26.97 ± 6.63 s). The DN-group showed a decrease of PPP from baseline to 72 h after treatment (5.16 ± 1.33 to 4.02 ± 0.97 mm; p Conclusion The application of DN in healthy volunteers over LTrPs in the UT decreased dynamic stiffness, tone and contraction time and increased Dm at 72 h after treatment. Additionally, the PPP showed a decrease at 72 h after needling. CLINICALTRIALS.GOV: NCT04466813.