This study aims to evaluate the efficacy of a new invasive therapy for treating MTrPs: dry needling with vibratory stimulus (DN+V). The following hypotheses are proposed:
* DN+V will utilize vibration on the dry needling needles instead of an electrical stimulus like in percutaneous electrolysis (PE), which could potentially damage some tissues. The expectation is that DN+V will increase the mechanical stimulus applied to the MTrP, yielding greater benefits in terms of pain relief, functional capacity, muscle strength, and other variables of interest in individuals with NSLBP, possibly requiring less treatment time compared to DN alone.
* In DN, repeated insertions and withdrawals of the needle into the MTrP provoke a hemorrhagic and inflammatory reaction that results in hypersensitivity and microscopic tissue injury in the muscle, causing pain during treatment and post-needling pain for the next 24-32 hours. A study showed that PE caused less post-needling pain than DN, likely because PE typically involves a single puncture per needle without needle manipulation.
* DN+V will follow the same methodology as PE, with a single puncture and no needle manipulation. Thus, it is expected that DN+V, being less invasive than DN, will reduce pain during treatment and post-needling pain compared to DN. A study supports this hypothesis, concluding that needle manipulation in DN produces greater post-needling pain than DN without needle manipulation.
To test these hypotheses, a randomized clinical trial will be conducted: "RCT: Analysis of the Effectiveness on Pain in Individuals with Nonspecific Low Back Pain by Adding a Percutaneous Vibratory Stimulus to Dry Needling in the Treatment of MTrPs."
EXPECTED RESULTS This initial study will provide the first data on DN+V, focusing on whether DN+V is easy to apply, well-tolerated by patients, and shows effects similar to or better than DN in reducing NSLBP.
METHODOLOGY
* Instrumentation and Evaluation Method: A group of specialized physiotherapists will evaluate each participant for MTrPs in muscles related to NSLBP. Identified MTrPs will be included in the study.
* Variables: For this initial RCT, only the main variables will be considered (NSLBP, pain during treatment, and post-needling pain). These will be evaluated using the Numeric Pain Rating Scale (NPRS).
* Intervention: Participants will be randomized into two groups: DN (without vibration, considered the control group) and DN+V (vibration for 10 minutes).
* Follow-up: NSLBP will be evaluated before and after the intervention, and at 24 and 48 hours. Pain during treatment will be recorded immediately after the intervention. Post-treatment pain will be evaluated 48 hours later, asking each participant how long post-needling pain lasted if it occurred.
TRANSFER AND DISSEMINATION OF RESULTS The development of this treatment technique for MTrPs will involve creating a "know-how" that encompasses all knowledge and application methodology related to DN+V. This dissertation will demonstrate the effectiveness and cost-effectiveness of DN+V, but this will only be the starting point of the "know-how," as further research will be necessary to address current uncertainties (e.g., does the entire population and all musculature respond the same way?) and to refine the application methodology (optimal dose of time/intensity/frequency of vibration, possible combination with physical exercise, etc.).
Once the "know-how" has been validated and scientifically supported, efforts will be made to disseminate it. Through presentations, courses, and training sessions, the DN+V technique will be promoted to advance clinical practice among physiotherapists. An example of a successfully implemented "know-how" in physiotherapy is the "DNHS" technique (www.dnhs.es), a dry needling technique specifically developed for neurological patients by Dr. Pablo Herrero, the director of the doctoral thesis in which this study is included.
When the "know-how" of the DN+V technique gains popularity among health professionals, its economic potential will be exploited. Similar to other treatment techniques like PE, specific devices for DN+V application will be developed, and training sessions will be conducted to ensure proper use of the technique. This will generate economic returns for the researchers and promoters involved in the development of the DN+V technique.
