10.5958/0973-5674.2019.00160.6 The Effectivity of Dry Needling and Friction Massage Application on Pain Scale Changes in Upper Trapezius Myalgia Patients Djohan Aras1, Ibtisam Mangputri Al-Ihsan1, Erfan Sutono1 1Department of Physiotherapy, Faculty of Nursing, Hasanuddin University Abstract Background: Upper trapezius myalgia is one of the most common symptoms in adults. This can be treated by using dry needling and friction massage. Objective. This study aims to determine the effectivity of dry needling and friction massage to improve pain in upper trapezius myalgia patients. Method. The study was conducted at Inco Hospital, Sorowako, South Sulawesi, Indonesia, involving 20 subject who meet the inclusion and exclusion criteria of having upper trapezius myalgia and 20 – 65 years old. Pain was measured using NPRS at baseline and after 3 times therapy for 5 weeks. Result. At the end of therapy (3 times), both of groups showed decrease of pain scale compared to baseline. The pain was improved significantly better in the dry needling with friction group compared to friction alone. Keywords: Dry needling, friction massage, upper trapezius myalgia, pain. Introduction A case study shows that the application of deep friction to muscles will help eliminate muscle pain caused Myalgia or muscle pain is the pain that originates by spasm and prevent symptoms from reoccurring5. In a from one of the muscles of the body which can be caused study conducted by Ramos et al in patients with chronic by injury, overuse, soft tissue infection or inflammation1. neck pain, it is showed that a decrease in pain and Clinical research has shown that neck/shoulder pain increase in function and range of motion of the cervical that is common in computer users is related to muscle joints after the application of friction.30 Friction, either pain, commonly known as myalgia. About 20% of the deep friction massage or cross fiber massage is applied European population reports severe chronic pain, with a to remove adhesion or minimize rough surfaces on high prevalence in women and people with low economic tendon. It is also used to increase the mobility of muscle levels. The most common chronic pain conditions are scar tissue when healing process occurs6. neck/shoulder pain including trapezius myalgia2. Dry needling is a method used by inserting needles Andersen et.al stated that from the clinical in the areas that have problems. Unlike acupuncture that examination of 653 study participants, 198 office uses Eastern science (Traditional Chinese Medicine) by workers were reported neck/shoulder pain, and more focusing on “chi” and “meridians”, dry needling uses than 2/3 of these workers experienced tenderness in the Western science with neuromusculoskeletal sciences7. upper trapezius muscle3. One of the common symptoms of myalgia is pain Material and Method for several days or even weeks. This pain is associated This study was conducted at Inco Hospital, with stiffness, muscle spasm, headaches, trigger points, Sorowako, South Sulawesi, Indonesia, from January to and tenderness in the suffered area. Other symptoms June 2018. Patients with upper trapezius myalgia were that can emerge are nausea, vomiting, fever, anxiety, invited to take part in a randomized, controlled study. A depression, vertigo, numbness and tingling. The clinical total of 40 patients were randomly divided equally into 2 presentations include pain, spasm, and upper trapezius groups. One group was given dry needling and friction, 4 tenderness . and the other group was given friction only. Both groups were given intervention three times a week for 5 weeks. Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 199 Measurement of pain was using Numeric Pain Discussion Rating Scale (NPRS). Measurement were made twice; The distribution of respondents based on the at baseline and after 5 weeks of the interventions. Pre characteristics of age and sex in table 1 shows that and post treatment was analyzed using paired sample t women aged 40-49 years were more than men. This is test. Comparison between groups was analyzed using consistent with what was stated by Dannecker et al. That independent sample t test. Significance value was set as women are more likely to experience muscle pain than 0.05. Ethical approval for this study was obtained from men. In addition, women have a higher pain response The Ethics Committee for Health Research, Hasanuddin to muscle pressure than men with the exception of a University, Makassar, Indonesia. certain point11. Research conducted by Wang et al Results states that the prevalence of gender ratios shows a higher prevalence of pain in women for headache, migraine, General characteristics of the subjects are presented temporomandibular pain, burning mouth pain, neck in the Table 1, pain, shoulder pain, back pain, knee pain, abdominal pain, and fibromyalgia. It was also said that women Table 1: Characteristics Subjects showed a perception of pain with a low threshold that 8 Age /Gender n % was more likely to be sensitive to pain . Female 4 20 This study is in line with the research conducted by 20–29 Male 0 0 Begovic et al who find that friction massages, especially Female 4 20 deep transverse massage can reduce pain. This is due to 30–39 a decrease in neuromotor excitability and a decrease in Male 3 15 muscle stiffness monitored using ultrasonography. This Female 5 25 40–49 decrease can be caused by afferent Ia type of muscle Male 2 10 spindles and slowly decreases the excitability of alpha- Female 1 5 motor neurons. This can be caused by a central inhibitor 50≤ Male 1 5 from a higher motor center. Therefore, friction massage 9 Total 20 100 can help reduce pain . Based on Table 2, there were significant differences Table 2. Comparison between Dry needling with between the groups. The dry needling and friction group Friction and friction on decreasing pain in patients experienced a decrease in the pain measurement with the with myalgia upper trapezius average of 6.1. As a comparison, the friction only group Group n Mean Std. independent experienced a decrease of 4.05 in pain improvement. Deviation sample t-test This is because dry needling has the local twitch response Dry needling + 10 6,10 1,564 0,004 (LTR) effect, resulting in a decrease in inflammation Friction and nociceptive concentration. The results of this study Friction 10 4,05 1,075 are consistent with the research conducted by Ramos et al and Kietrys et al which showed a reduction in pain Table 2 describes the statistical analysis which after the application of dry needling.23,30 In a study shows that there are significant differences in the dry conducted by Ramos et al., The number of subjects needling and friction group compared with friction alone studied was 94 people, 47 people were included in the group. The decrease in pain after 3 times of dry needling dry needling group and 47 people were included in the and friction for 5 weeks in subject of upper trapezius manual therapy group10. myalgia was 6.10. While the decrease in the pain in the friction alone group was 4.05. The statistical results The dry needling procedure is conducted by inserting obtained p <0.05 which means that the combination of a needle at the point of pain (trigger point) using the dry needling and friction massage were more effective in deep dry needling technique so that the needle is moved improving pain in patients with upper trapezius myalgia and pulled pushing until the twitch response is felt to compared to friction only. the trigger point or LTR. Some studies have concluded that if this LTR is achieved at the time of dry needling, the effect of reducing pain and increasing ROM tends 200 Indian Journal of Physiotherapy and Occupational Therapy, October-December 2019, Vol. 13, No. 4 to be greater. This LTR can reduce pain because when muscle tenderness in adults with nonspecific neck/ the trigger point is punctured by a needle, stimulation shoulder pain. BMC Musculoskeletal Disorders. of type A-delta nerve fibers occurs which then activates 2011;12(1):169. the enkephalin interneuron inhibitor dorsal horn cell 4. Bron C, Dommerholt JD. Etiology of myofascial which causes pain suppression. This is closely related trigger points. Current pain and headache reports. to the gate control theory by Melzack and Wall which 2012;16(5):439-44. was later developed by Furlan et al in its journal entitled 5. Warpenburg MJ. Deep friction massage in treatment Acupuncture and dry-needling for low back pain: an of radiation-induced fibrosis: rehabilitative care for updated systematic review within the framework of breast-cancer survivors. Integr Med (Encinitas). the co-collaboration. It was explained that dry needling 2014;13(5):32-6. inhibits type C nerve fibers that deliver muscle band myofascial trigger point pain impulses11. 6. Kisner et.al. Therapeutic exercise: foundations and techniques: Fa Davis; 2017. Conclusion 7. Kietrys DM PK, Azzaretto E. Effectiveness of dry needling for upper-quarter myofascial pain: The combination of dry needling and friction is a systematic review and meta-analysis. J Orthop more effective on improving pain in upper trapezius Sports Phys Ther. 2013;43(09):620-34. myalgia patients compared to friction alone. 8. Wáng YXJ, Wáng J-Q, Káplár Z. Increased low Conflict of Interest : The authors certify that they back pain prevalence in females than in males have no affiliation with organization that may benefit after menopause age: evidences based on synthetic from the subject discussed in this study literature review. Quantitative imaging in medicine and surgery. 2016;6(2):199. Source of Funding: This study was funded by the Physiotherapy Department, Faculty of Nursing, 9. Begovic H, Zhou G-Q, Schuster S, Zheng Y-P.