Issue 24-4, 2025

Original article

https://doi.org/10.38025/2078-1962-2025-24-4-44-53

Comparative Effectivenesss of Dry Needling and Deep Friction Massage in Myofascial Pain Syndrome: an Original Research

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ORCID Dies I. Qonita, ORCID Aryadi Arsyad*, ORCIDAndi Ariyandy, Meutiah M. Abdullah, ORCID Andi R.A. Hasyar

Hasanuddin University, Makassar, Indonesia


ABSTRACT

INTRODUCTION.  Myofascial Pain Syndrome (MPS) is a common condition that limits mobility and causes chronic pain. While myofascial trigger points are recognized as key contributors, the most effective treatments remain debated. Dry Needling (DN) and Deep Friction Massage (DFM) are commonly used, but direct comparisons of their effectiveness in pain reduction, range of motion (ROM) improvement, and trigger point size changes are scarce. Research often assesses these treatments separately, leaving a gap in understanding their comparative efficacy.

AIM.  To evaluate the comparative effectiveness of DN and DFM on MPS.

MATERIALS AND METHODS.  Thirty-six participants were divided into DN and DFM groups. Evaluations were conducted before and 30 minutes after treatment, assessing pain levels with Visual Analogue Scale (VAS), Range of Motion (ROM) with a goniometer, and trigger point size using ultrasonography.

RESULTS AND DISCUSSION.  Both groups exhibited significant reductions in pain levels (p < 0.05). The DFM group demonstrated more substantial delta change in pain reduction (31.81 ± 7.6) compared to the DN group (18.19 ± 8.8). Both groups showed significant improvements in ROM (p < 0.05), with DFM having a greater impact on flexion, extension, and lateral flexion. No significant difference was observed in rotational movements between the two groups. Regarding trigger point size, only the DFM group showed significant changes (p < 0.05); however, the delta change between DN (0.38 ± 0.5) and DFM (0.35 ± 0.3) were not statistically significant (p > 0.05).

CONCLUSION.  Both DN and DFM effectively reduce pain and increase ROM, although neither of them significantly changed trigger point size. DFM provided better results in pain reduction 30 minutes post-treatment compared to DN.

REGISTRATION:   UMIN Clinical Trials Registry (UMIN-CTR) identifier No. UMIN000057060, registered 22.02.2025.


KEYWORDS: dry needling, deep friction massage, neck pain, myofascial pain syndrome, trigger point

FOR CITATION:

Qonita D.I., Arsyad A., Ariyandy A., Abdullah M.M., Hasyar A.R.A. Comparative Effectiveness of Dry Needling and Deep Friction Massage in Myofascial Pain Syndrome: an Original Research. Bulletin of Rehabilitation Medicine. 2025; 24(4):44–53. https://doi.org/10.38025/2078-1962-2025-24-4-44-53 https://doi.org/10.38025/2078-1962-2025-24-4-44-53  

FOR CORRESPONDENCE:

Aryadi Arsyad, Е-mail: aryadi.arsyad@med.unhas.ac.id


References:

  1. Konior K., Bitenc-Jasiejko A., Lietz-Kijak D., et al. Multimodal programmes in the treatment of myofascial pain syndrome (MPS) — a two-step review. Fizjoterapia Pol. 2023; 1(23): 188–203. http://dx.doi.org/10.56984/8ZG07B914
  2. Gerwin R.D. Diagnosis of myofascial pain syndrome. Phys Med Rehabil Clin N Am. 2014; 25(2): 341–355. https://doi.org/10.1016/j.pmr.2014.01.011
  3. Gerwin R.D. A New Unified Theory of Trigger Point Formation: Failure of Pre- and Post-Synaptic Feedback Control Mechanisms. Int J Mol Sci. 2023; 24(8142): 1–14. https://doi.org/10.3390/ijms24098142
  4. Gálvez L.A., Cuervo Pulgarín J.L., Castellanos Ramelli D., et al. Trapezius-rhomboid plane block for myofascial pain syndrome. Description of a new intervention. Interv Pain Med. 2024; 3(2): 3–6. https://doi.org/10.1016/j.inpm.2024.100410
  5. Wu W.T., Chang K.V., Ricci V., Özçakar L. Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review. J Yeungnam Med Sci. 2024; 41(87): 179–187. https://doi.org/10.12701/jyms.2024.00416
  6. Hung C.Y., Wang B., Chang H.C., et al. Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome. Life. 2024; 14(449): 1–29. https://doi.org/10.3390/ life14040499
  7. Zhang X.F., Liu L., Wang B.B., et al. Evidence for kinesio taping in management of myofascial pain syndrome: a systematic review and meta-analysis. Clin Rehabil. 2019; 33(5): 865–874. https://doi.org/10.1177/0269215519826267
  8. Shahzad H., Chaudhary W.A., Baig M.I., et al. Effectiveness of Dry Needling versus Cupping Therapy for Pain in Piriformis Syndrome. J Heal Rehabil Res. 2024; 4(2): 1090–1094. https://doi.org/10.61919/jhrr.v4i2.935
  9. Navarro-Santana M.J., Sánchez-Infante J., Gómez-Chiguano G.F., et al. Effects of Trigger Point Dry Needling on Lateral Epicondylalgia of Musculoskeletal Origin: A Systematic Review and Meta-Analysis. Clin Rehabil. 2020; 34(11): 1327–1340. https://doi.org/10.1177/0269215520937468
  10. Roy S.D., Sur M., Nath P., Roy B. Exploring the potential of dry needling as a targeted approach for tennis elbow relief and recovery. Int J Orthop Sci Physiother. 2024; 6(1): 21–24. https://doi.org/10.33545/26648989.2024.v6.i1a.21
  11. Munoz M., Dommerholt J., Perez-Palomares S., et al. Dry Needling and Antithrombotic Drugs. Hindawi. 2022; 2022: 1–10. https://doi.org/10.1155/2022/1363477
  12. Kaur J., Kapila T. To Compare the Efficacy of Deep Transverse Friction Massage and Ultrasound in Patients with Upper Trapezius Trigger Points. Int J Trend Sci Res Dev. 2017; 1: 197–202. https://doi.org/10.31142/ijtsrd2263
  13. Mohamadi M., Piroozi S., Rashidi I., Hosseinifard S. Friction massage versus kinesiotaping for short-term management of latent trigger points in the upper trapezius: A randomized controlled trial. Chiropr Man Ther. 2017; 25(1): 1–6. https://doi.org/10.1186/s12998-017-0156-9
  14. Hassan S.M., Hafez A.R., Seif H.E., Kachanathu S.J. The Effect of Deep Friction Massage versus Stretching of Wrist Extensor Muscles in the Treatment of Patients with Tennis Elbow. Open J Ther Rehabil. 2016; 04(01): 48–54. https://doi.org/10.4236/ojtr.2016.41004
  15. Kamali F., Mohamadi M., Fakheri L., Mohammadnejad F. Dry needling versus friction massage to treat tension type headache: A randomized clinical trial. J Bodyw Mov Ther. 2019; 23(1): 89–93. https://doi.org/10.1016/j.jbmt.2018.01.009
  16. Stieven F.F., Ferreira G.E., de Araújo F.X., et al. Immediate Effects of Dry Needling and Myofascial Release on Local and Widespread Pressure Pain Threshold in Individuals With Active Upper Trapezius Trigger Points: A Randomized Clinical Trial. J Manip Physiol Ther. 2021; 44(2): 95–102. https://doi.org/10.1016/j.jmpt.2020.07.003
  17. Rayegani S.M., Bayat M., Bahrami M.H., et al. Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clin Rheumatol. 2014; 33(6): 859–864. https://doi.org/10.1007/s10067-013-2448-3
  18. Kaljić E., Trtak N., Avdić D., et al. The role of a dry needling technique in pain reduction. J Heal Sci. 2018; 8(3): 128–139. https://doi.org/10.17532/jhsci.2018.610
  19. Shah J.P., Danoff J.V., Desai M.J., et al. Biochemicals Associated with Pain and Inflammation are Elevated in Sites Near to and Remote from Active Myofascial Trigger Points. Arch Phys Med Rehabil. 2008; 89(1): 16–23. https://doi.org/10.1016/j.apmr.2007.10.018
  20. Cagnie B., Barbe T., De Ridder E., et al. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. J Manipulative Physiol Ther. 2012; 35(9): 685–691. https://doi.org/10.1016/j.jmpt.2012.10.005
  21. Badriyah Hidayat H., Oktavianti A. Dry Needling Sebagai Terapi Nyeri Miofasial Servikal. Maj Kedokt Neurosains Perhimpun Dr Spes Saraf Indones. 2020; 37(4). https://doi.org/10.52386/neurona.v37i4.177
  22. Nugraha R., Rahmatika, Sudaryanto, Hasbiah, Erawan T. Effect of Ultrasound Combined with Dry Needling on Myofascial Pain in the Upper Trapezius: a Controlled Randomised Study. Bulletin of Rehabilitation Medicine. 2024; 23(6):19–25. https://doi.org/10.38025/2078-1962-2024-23-6-19-25
  23. Hsieh Y.L., Yang S.A., Yang C.C., Chou L.W. Dry needling at myofascial trigger spots of rabbit skeletal muscles modulates the biochemicals associated with pain, inflammation, and hypoxia. Evidence-based Complement Altern Med. 2012; 2012. https://doi.org/10.1155/2012/342165
  24. Zutshi K., Verma P., Hazari A. Effectiveness of Myofascial Release in Improving Pain, Pain Pressure Threshold and Disability as Compared with Standard Care in Upper Trapezius Myofascial Trigger Points. Indian J Physiother Occup Ther — An Int J. 2021; 15(3): 37–44. https://doi.org/10.37506/ijpot.v15i3.16161
  25. Bau J.G., Wu S.K., Huang B.W., et al. Myofascial treatment for microcirculation in patients with postural neck and shoulder pain. Diagnostics. 2021; 11(12): 1–12. https://doi.org/10.3390/diagnostics11122226
  26. Yoon Y.S., Yu K.P., Lee K.J., et al. Development and application of a newly designed massage instrument for deep cross-friction massage in chronic non-specific low back pain. Ann Rehabil Med. 2012; 36(1): 55–65. https://doi.org/10.5535/arm.2012.36.1.55
  27. Kumar A., Sandeep P.K., Ramkumar S.D. Efficacy of corticosteroid injection vs deep friction massage in lateral epicondylitis. Int J Orthop Sci. 2023; 9(1): 115–118. https://doi.org/10.22271/ortho.2023.v9.i1b.3285
  28. Morhenn V., Beavin L.E., Zak P.J. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Altern Ther Health Med. 2012; 18(6): 11–18.
  29. Fernández-de-Las-Peñas C., Dommerholt J. International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: a delphi study. Pain Med. 2018; 19(1): 142–150. https://doi.org/10.1093/pm/pnx207
  30. Fernández-De-Las-Peñas C., Plaza-Manzano G., Sanchez-Infante J., et al. Is dry needling effective when combined with other therapies for myofascial. trigger points associated with neck pain symptoms? A systematic review and meta-analysis. Pain Res Manag. 2021; 2021: 8836427. https://doi.org/10.1155/2021/8836427
  31. Pantouvaki A., Velivasakis G., Kastanis G. Functional outcomes of perilunate dislocation injuries treated with deep friction massage: one year follow-up. Int J Innov Res Med Sci. 2019; 04(12): 731–734. https://doi.org/10.23958/ijirms/vol04-i12/795
  32. Moshrif A., Elwan M., Daifullah O.S. Deep friction massage versus local steroid injection for treatment of plantar fasciitis: a randomized controlled trial. Egypt Rheumatol Rehabil. 2020; 47(1). https://doi.org/10.1186/s43166-020-00013-6
  33. Fernández-de-Las-Peñas C., Nijs J. Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res. 2019; 12: 1899–1911. https://doi.org/10.2147/JPR.S154728
  34. Peter Z.B., Tiwari B. Effect of dry needling in myofascial pain syndrome: a case report. Int J Heal Sci Res. 2024; 14(5): 326–330. https://doi.org/10.52403/ijhsr.20240542
  35. Nowak Z., Chęciński M., Nitecka-Buchta A., et al. Intramuscular injections and dry needling within masticatory muscles in management of myofascial pain. Systematic review of clinical trials. Int J Environ Res Public Health. 2021; 18(18). https://doi.org/10.3390/ijerph18189552
  36. Gerber L.H., Sikdar S., Aredo J.V., et al. Beneficial effects of dry needling for treatment of chronic myofascial pain persist for 6 weeks after treatment completion. PM R. 2017; 9(2): 105–112. https://doi.org/10.1016/j.pmrj.2016.06.006
  37. Doley M., Warikoo D., Arunmozhi R. Effect of positional release therapy and deep transverse friction massage on gluteus medius trigger point — a comparative study. J Exerc Sci Physiother. 2013; 9(1): 40. https://doi.org/10.18376//2013/v9i1/67579
  38. Shu D., Wang J., Meng F., et al. Changes in inflammatory edema and fat fraction of thigh muscles following a half-marathon in recreational marathon runners. Eur J Sport Sci. 2024; 24(10): 1508–1515. https://doi.org/10.1002/ejsc.12189
  39. Choksi K., Chauhan S., Jaria S., Agrawal A. Effect of deep transverse friction massage and ischemic compression in trapezitis: a randomized controlled trial. Indian J Physiother Occup Ther — An Int J. 2021; 15(1): 47–53. https://doi.org/10.37506/ijpot.v15i1.13347



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This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.