Exercises and Dry Needling for Subacromial Pain Syndrome: a Randomized Parallel- Group Trial.

Abstract

This randomized clinical trial investigated the effectiveness of exercise vs. exercise plus trigger point dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise +TrP-DN. Participants in both groups were asked to perform an exercise program of the rotator cuff muscles twice daily for 5 weeks. Further, patients allocated to the exercise +TrP-DN group also received dry needling to active TrPs in the muscles reproducing shoulder symptoms during the 2nd and 4th sessions. The primary outcome was pain-related disability assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes included mean current pain and the worst pain experienced in the shoulder during the previous week. They were assessed at baseline, one week, and 3, 6, and 12 months after the end of treatment. Analysis was by intention to treat with mixed ANCOVA adjusted for baseline outcomes. At 12 months, 47 (94%) patients completed follow-up. Statistically larger improvements (all, P<0.01) in shoulder disability was found for the exercise +TrP-DN group at all follow up periods [post: Δ -20.6 (-23.8 to -17.4); 3 months: Δ -23.2 (-28.3 to -18.1); 6 months: Δ -23.6 (-28.9 to -18.3); 12 months: Δ -13.9 (-17.5 to -10.3). Both groups exhibited similar improvements in shoulder pain outcomes at all follow-up periods. The inclusion of TrP-DN to an exercise program was effective for improving disability in subacromial pain syndrome. No greater improvements in shoulder pain were observed.