OBJECTIVES:To identify the modalities most commonly used by outpatient physical therapists in the United States for the treatment of myofascial trigger points (MTrPs), determine how frequently those modalities are used, and examine the factors influencing modality selection. METHODS:A descriptive, exploratory, cross-sectional internet survey was administered through Qualtrics to a convenience sample of licensed physical therapists practicing in outpatient settings in the United States between 17 March 2025, and 7 April 2025. Participants were recruited through the Tennessee Physical Therapy Association and two multistate outpatient orthopedic networks. Responses were analyzed using descriptive statistics, including frequencies and percentages. RESULTS:Fifty-nine outpatient physical therapists completed the survey. Manual release (93.2%) and dry needling (88.1%) were the most commonly reported modalities for MTrP management, and manual release was the most frequently used intervention overall (55.9%). The most commonly endorsed reasons for selecting a modality were the ability to provide precise treatment (100%), rapidly reduce symptoms (98.1%), and achieve long-lasting results (90.7%). Cost-effectiveness was endorsed by 59.3% of respondents, while ultrasound was reported by only 5.1%. DISCUSSION:In this exploratory sample, outpatient physical therapists favored hands-on and needling-based approaches for the management of MTrPs, with treatment precision and perceived clinical effectiveness appearing to drive decision-making more strongly than cost. These findings support the continued clinical use of manual therapy and dry needling in contemporary outpatient practice while suggesting a diminished role for ultrasound as a stand-alone modality; because the sample was a convenience sample drawn from a single state association and two multistate networks, findings should not be generalized beyond this sample without further study.
Introduction Manual therapy (MT) is widely recommended for musculoskeletal disorders, yet its biological mechanisms remain poorly synthesized, with existing evidence often aggregating distinct techniques and outcome domains. This systematic review and meta-analysis evaluates the neurophysiological and metabolic effects of MT, exploring differences between technique characteristics (high-velocity low-amplitude [HVLA] vs. non-HVLA) and anatomical regions. Methods Registered prospectively (PROSPERO CRD42024497251), five databases (MEDLINE, CINAHL, Web of Science, Scopus and CENTRAL) were searched through 14 July 2025. Randomized controlled trials and controlled clinical trials evaluating neurophysiological or metabolic outcomes following MT in adults, with or without musculoskeletal pain, were included. Risk of bias was assessed using Cochrane RoB 2.0. Meta-analyses used random-effects models; certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Fifty studies (2,147 participants) were included. Meta-analyses showed that joint mobilization significantly increased skin conductance (sympathetic marker) versus sham in healthy cohorts. Conversely, non-HVLA MT, particularly soft tissue techniques, was associated with reduced heart rate and increased RMSSD (parasympathetic marker). No consistent effects were observed for blood pressure, skin temperature, or frequency-domain HRV. Narrative synthesis indicated that HVLA manipulation may attenuate somatosensory evoked potentials and increase muscle conduction velocity, while soft tissue approaches were linked to increased oxytocin and reduced adrenocorticotropic hormone levels. Overall, certainty of evidence ranged from low to moderate due to methodological heterogeneity and imprecision. Conclusion Manual therapy is associated with short-term modulation of neurophysiological regulation, characterized by technique-specific response profiles. Joint mobilization primarily induces sympathetic-driven responses, whereas soft tissue techniques are more frequently associated with parasympathetic-driven markers. The overall pattern of findings suggests that MT interacts with regulatory systems in a technique-dependent manner rather than producing uniform systemic physiological effects.
BACKGROUND:Road Traffic Injuries affect more than 50 million people each year. Whiplash-associated disorders (WAD) are among the most common musculoskeletal conditions resulting from these injuries, affecting up to 83% of individuals exposed to this type of trauma. Approximately 50% of affected individuals experience incomplete recovery. Although specific neck exercises are recommended, the effectiveness of device-guided craniocervical training administered via telerehabilitation for subacute grade I-II WAD remains unknown. OBJECTIVE:To evaluate the preliminary effectiveness and feasibility of a device-guided craniocervical exercise program delivered via telerehabilitation on pain and disability in individuals with subacute grade I-II WAD. METHODS:A multicentre, assessor-blinded, randomized pilot feasibility trial with a 1:1:1 allocation ratio was conducted. Thirty-three participants were randomized into three groups: device-guided training, active exercise or usual care. The exercise groups received 12 supervised online sessions over a 6-week period. Disability, pain, and eight self-reported outcome measures were assessed at baseline, 6 weeks, and 12 weeks. RESULTS:Statistical analysis showed significant between-group differences in disability and pain intensity at T1 and T2 in favor of the device-guided training group (p < 0.05). No statistically significant between-group differences were found for secondary outcomes. Recruitment rate was 3.3 participants per month, adherence was 77%, and 16 mild transient adverse events were reported (27%). The estimated sample size for a future definitive trial was 94 participants. CONCLUSIONS:A device-guided craniocervical exercise program delivered via telerehabilitation appears feasible, safe, and associated with greater reductions in disability and pain than conventional specific neck exercise and usual care in subacute WAD. While findings are preliminary, they support progression to a definitive multicentre randomized controlled trial currently underway to confirm effectiveness.Registration: ClinicalTrials.gov - NCT06580990.
INTRODUCTION:Forward head posture (FHP) is a common postural disorder. The aim of this study was to compare diaphragmatic endurance, trunk muscle endurance, and respiratory function in individuals with and without forward head posture (FHP). METHODS:The study included individuals with (FHP group, n = 32) and without (control group, n = 35) FHP. FHP was determined by craniovertebral angle. Diaphragmatic endurance was assessed using the Maximum Phonation Time (A/I phonation test), trunk muscle endurance using McGill Trunk Endurance Muscle tests (trunk flexion endurance test, trunk extension endurance test, trunk lateral flexion endurance test), and respiratory function using spirometry. Independent Sample T-test and Mann Whitney U test were used for analysis. RESULTS:Individuals with FHP had lower mean A (p = 0.006, d = 0.69), I (p = 0.015, d = 0.61) phonation durations, and significantly all trunk muscle endurance across all tests (p < 0.001, d = 1.31-1.73) compared to control group. No significant between-group differences were found in respiratory parameters (p > 0.05). CONCLUSION:Individuals with FHP demonstrated significantly reduced A/I phonation duration-suggestive of impaired diaphragmatic endurance and reduced trunk muscle endurance compared to individuals without FHP, while respiratory function remained similar between groups. These findings suggest that diaphragmatic and trunk muscle function should be considered in the clinical management of FHP.
OBJECTIVES:Neck pain is common and generally benign, but in rare cases it may be the early symptom of vertebral artery dissection (VAD). To date, no published secondary analysis addressing red flags for VADs in patients whose primary complaint is neck pain, nor any describing the typical clinical presentation, demographic characteristics, and common risk factors of VAD, has been published. Therefore, this scoping review addresses that gap by systematically mapping available evidence on red flags, predisposing risk factors, clinical features at presentation, and demographic profiles in patients presenting primarily with neck pain due to extracranial vertebral artery dissection. METHODS:A systematic search was conducted in MEDLINE, Embase, Web of Science, and CINAHL. Primary studies on adults with extracranial VAD and neck pain were included. Two authors independently selected studies and extracted data on clinical predictors. RESULTS:Forty-six studies (38 case reports, 8 case series) involving 58 patients were included. Most patients (63.8%) were female, with a mean age of 36.8 years. Neck pain was typically unilateral, severe, and poorly responsive to analgesics, often radiating to the head, upper limb, or shoulder; in half of the cases no identifiable cause of onset could be determined, while trauma or sudden neck movements accounted for another third. Risk factors were inconsistently reported, with current smoking and hypertension the most commonly documented. Neurological symptoms were present in two-thirds of cases, most frequently upper limb weakness and dizziness, while systemic symptoms (mainly nausea and vomiting) occurred in 24.1%. Physical examination findings were also inconsistently reported: motor deficits, sensory loss, and reflex abnormalities were each documented in roughly 40-47% of cases, and cranial nerve examination was described in only 25.9% of cases and was unremarkable in most of these. CONCLUSION:Symptoms and demographic features in extracranial VAD cases with neck pain are highly variable. Due to limited diagnostic accuracy data and inconsistent reporting, the clinical utility of red flags remains uncertain. Until more robust evidence becomes available, clinicians should adhere to expert recommendations for screening for VAD while maintaining a high level of vigilance. Further large-scale observational studies are needed to assess the diagnostic value of red flags in this context.
OBJECTIVE:The Posterior Talar Glide Test (PTGT) assesses ankle arthrokinematics and is recommended in the International Ankle Consortium's Rehabilitation-Oriented Assessment guidelines. This systematic review evaluated its intra-rater and inter-rater reproducibility in individuals with and without ankle sprain conditions. METHODS:Following the PRISMA 2020 guidelines, a systematic search was conducted in PubMed, CINAHL, and Embase up to 11 July 2025. The protocol was prospectively registered in PROSPERO (CRD420251084281). Studies were eligible if they reported reproducibility metrics of the PTGT, including intraclass correlation coefficients (ICC), standard error of measurement, or minimal detectable change (MDC). Two independent reviewers screened, extracted, and appraised studies using the QAREL tool. A random-effects meta-analysis pooled intra-rater ICCs, while inter-rater reproducibility was summarized narratively. Certainty of evidence for each reproducibility outcome was assessed using the GRADE framework. RESULTS:Six studies were included. Pooled intra-rater reliability was excellent (ICC = 0.93, 95% CI 0.80-0.97; I2 = 89.2%), with moderate-certainty evidence. Inter-rater reliability ranged from poor to good (ICC 0.46-0.81) across two studies, with low-certainty evidence. Mean MDC values were 4.0° for intra-rater and 4.2° for inter-rater reproducibility, representing the smallest changes exceeding PTGT measurement error. . CONCLUSIONS:The PTGT demonstrates excellent intra-rater and poor-to-good inter-rater reliability. Further validation is needed to determine whether the PTGT measures posterior talar glide range of motion, detects positional fault, or both.
OBJECTIVES:To examine associations among cervical radiographic morphology, degeneration severity, demographic characteristics, primary clinical presentation, pain intensity, and neck-related patient-reported outcomes. METHODS:This retrospective cross-sectional review included 250 cervical radiographic examinations obtained from outpatient chiropractic teaching clinics from 10 May 2021 through 11 March 2024. Every fifth eligible examination was sampled in reverse chronological order. Demographic, clinical, and radiographic variables were abstracted from de-identified records and radiology reports. Pain scores were available for 238 examinations. Because four non-equivalent outcome instruments were used, scores were not pooled; the main patient-reported outcome analyses were restricted to the Neck Bournemouth Questionnaire (NBQ; n = 90). Spearman correlations, Kruskal-Wallis tests, chi-square tests, and multivariable logistic regression were used. RESULTS:The sample included 132 females and 118 males (mean age, 38.2 ± 16.3 years). Age was strongly associated with degeneration severity (ρ = 0.783; 95% CI, 0.725-0.829; p < 0.001). Degeneration was weakly associated with pain (ρ = 0.232; 95% CI, 0.107-0.356; p < 0.001) and NBQ score (ρ = 0.230; 95% CI, 0.017-0.436; p = 0.030). Pain differed across degeneration categories, with a small effect (H(3) = 12.76; p = 0.005; ε2 = 0.042), but not across lateral morphology categories (p = 0.672). In the adjusted model, a one-category increase in degeneration severity had a positive but imprecise association with radiculopathy (OR = 1.56; 95% CI, 0.93-2.62; p = 0.089); age, sex, and morphology variables were not independently associated with radiculopathy. DISCUSSION/CONCLUSION:Age was the dominant correlate of radiographic degeneration. Associations of degeneration with pain, NBQ score, and radiculopathy were weak or imprecise, whereas static morphology showed limited independent associations with clinical presentation. Cervical radiographs should be interpreted alongside history, examination, neurological findings, and patient-reported function, not as isolated explanations for symptoms.
INTRODUCTION:Despite the growing clinical use of dry needling, the anatomical accuracy and safety of ultrasound-unguided approaches to the soleus remain insufficiently standardized and validated. This study aimed to evaluate (i) the anatomical accuracy and safety of a standardized ultrasound-unguided dry needling protocol targeting the mid-third of the soleus, (ii) intra- and inter-rater reliability of key procedural outcomes, and (iii) agreement between ultrasound imaging and cadaveric dissection as validation methods for needle placement. METHODS:An experimental cross-sectional cadaveric study was conducted on five fresh-frozen human cadavers (10 lower limbs), yielding 24 dry needling events. Two physiotherapists with different levels of dry needling experience (intermediate: 5 years; advanced: >10 years) performed the protocol independently. A blinded sonographer assessed needle tip location and quantitative safety margins using high-resolution ultrasound. Anatomical dissection was subsequently performed to confirm final needle placement in a subset of approaches. Outcomes included soleus placement accuracy, septum puncture (lateral and posterior/deep), and neurovascular/vascular compromise. Reliability was assessed using percentage agreement and Cohen's kappa. RESULTS:Accurate needle placement within the soleus was achieved in 22/24 procedures (91.7%), with 2 failures (8.3%), both performed by the intermediate-experience physiotherapist. Lateral septum puncture occurred in 5/24 cases (20.8%), and posterior/deep septum puncture in 3/24 cases (12.5%). No puncture of the tibial neurovascular bundle or vascular structures was observed (0%). Intra-rater agreement for the advanced physiotherapist was 100% across dichotomous outcomes. Inter-rater agreement was 80% for soleus accuracy and overall procedural success. Ultrasound imaging and cadaveric dissection demonstrated 100% agreement across accuracy and safety outcomes in the advanced physiotherapist approaches. CONCLUSIONS:In this cadaveric model, a standardized ultrasound-unguided dry needling protocol targeting the soleus achieved high anatomical accuracy with no neurovascular injury, and showed excellent agreement between ultrasound and dissection for the advanced operator.
OBJECTIVE:To compare the addition of Mulligan manual therapy (MMT) or sham MMT to neck exercise for the management of people with episodic migraine. METHODS:Ninety-nine adult patients (mean 41.5 years, SD 13.3) with episodic migraine were allocated to six sessions of neck exercise alone, exercise + MMT, or exercise + sham MMT. Migraine frequency was the primary outcome measure. Headache intensity and duration, medication, disability, upper cervical range of motion (CROM), pressure-pain thresholds of cervical and tibialis anterior muscle areas, as well as patient satisfaction score were secondary outcome measures evaluated at baseline, 4, 13, and 26 weeks. RESULTS:Headache frequency was not significantly improved when comparing exercise + MMT to exercise alone (4-week MD: 0.57, 95%CI: -0.30 to 1.43; 13-week MD: 0.90, 95%CI: 0.01 to 1.79; 26-week MD: 0.66, 95%CI: -0.31 to 1.62) and to exercise + sham MMT (4-week MD: -2.28, 95%CI: -1.35 to 0.79; 13-week MD: -0.88, 95%CI: -1.81 to 0.06; 26-week MD: -0.81, 95%CI: -1.77 to 0.15). For secondary outcome of disability, a statistically significant improvement was observed for exercise + MMT only at 4-week over exercise alone (MD: 5.59, 95%CI: 3.06 to 8.11) and over exercise + sham MMT (MD: -3.57, 95%CI: -6.12 to -1.03) but not at 13 and 26 weeks. Statistically significant improvement in CROM was observed at 13‑ and 26-week follow-up over the other two groups. CONCLUSION:MMT combined with exercise did not result in a significant reduction in headache frequency compared to exercise alone or exercise with sham. The results could be attributed to the lack of subgrouping migraine subjects based on the presence of articular impairments.
OBJECTIVES:Conservative management of shoulder adhesive capsulitis primarily relies on physical therapy, with non-thrust joint mobilization representing a fundamental component. This systematic review compared the clinical effects of different non-thrust joint mobilization approaches on objective and subjective outcomes among individuals with shoulder adhesive capsulitis. METHODS:English-language randomized controlled trials published between January 1, 2000, and November 30, 2025, were identified by systematically searching PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and ScienceDirect. Eligible trials evaluated the clinical effects of different non-thrust joint mobilization approaches, delivered alone or in combination with other interventions, on objective and subjective outcomes in individuals with shoulder adhesive capsulitis. RESULTS:The Mulligan mobilization approach, compared with the Maitland mobilization approach, was more effective in restoring ranges of shoulder abduction and external rotation and decreasing shoulder pain and disability, with mean differences of 1.49 (95% CI: 0.91 to 2.07), 1.26 (95% CI: 0.85 to 1.67), and -1.23 (95% CI: -2.39 to -0.07), respectively. In addition, the random-effects model exhibited a statistically significant difference between posterior and anterior Kaltenborn mobilization techniques in the range of shoulder external rotation, with a mean difference of 2.56 (95% CI: 1.92 to 3.19). CONCLUSIONS:The comparative effects of non-thrust joint mobilization techniques in adhesive capsulitis appear to be technique-specific and outcome-dependent. Although Mulligan and posterior Kaltenborn mobilization showed favorable effects for selected outcomes, the certainty of evidence was very low. Therefore, no single mobilization technique can currently be recommended as universally superior.
BACKGROUND:Patients with upper extremity pain often have concurrent spine dysfunction, which may be a primary source of their symptoms. This case series describes three patients receiving physical therapy treatment for upper extremity pain. CASE DESCRIPTIONS:Patient A presented with primary complaints of elbow and shoulder pain. Patient B was presented with posterior shoulder pain. Patient C was presented with bilateral wrist pain. All patients were treated with spine mobilization or manipulation techniques. At discharge, they all had clinically significant improvements in self-reported disability and were able to complete necessary daily activities without pain. CONCLUSION:Each patient's symptoms presented in locations that do not correspond with typical pain referral patterns from the spine. Clinical examination of upper extremity conditions should include screening of spinal structures to account for central nervous system changes, which may facilitate pain in remote regions from the site of pathology.
INTRODUCTION:Thoracic hyperkyphosis (THK) may affect the autonomic nervous system (ANS) as the thoracolumbar outflow governs the sympathetic nervous system, but there is a paucity of literature on the effect of postural correction on ANS functions. Therefore, the study was conducted to examine the effects of postural correction exercises and thoracic manipulation on ANS function in thoracic hyperkyphosis. METHODS:The study employed a pretest-posttest, active-comparator group design. A total of 80 adults aged 18-40 years with a kyphosis angle >45° and a numeric pain rating scale score >3 were randomly allocated to the experimental and active-comparator groups in a 1:1 ratio. Participants in the active-comparator group underwent postural correction exercise, whereas those in the experimental group received thoracic manipulation in addition to postural correction for 3 weeks. Pain, kyphosis angle, root mean square of successive differences (RMSSD) of R-R intervals, and Sympathetic Skin Response (SSR) are the outcome variables measured at baseline and after 3 weeks of the intervention. RESULTS:Analysis of Covariance (ANCOVA) revealed significant group effects for HRV and SSR amplitude (p < 0.001, partial η2 = 0.22 to 0.49) after adjusting for kyphosis angle and pain, whereas SSR latency remained non-significant. Additionally, kyphosis angle and pain were found significant covariates (p < 0.01), indicating a significant association with change in autonomic functions. DISCUSSION:Postural correction exercise, along with thoracic manipulation, may improve autonomic functions among symptomatic individuals with THK. However, future studies employing advanced autonomic assessment tools and long-term follow-up are necessary to validate and generalize these findings. CTRI REGISTRATION NUMBER:CTRI/2024/04/066057.
BACKGROUND:Lumbar disc herniation (LDH) is a leading causes of low back pain (LBP). Conservative approaches, such as the McKenzie Method of Mechanical Diagnosis and Therapy (MDT), are widely used as first-line treatments. MDT is based on patients' symptomatic and mechanical responses to repeated movements and sustained postures. Although not pathology-specific, it is commonly applied to LDH. However, the association between radiological and mechanical characteristics remains unclear. OBJECTIVES:To examine the association between MRI-based LDH classification and directional preference (DP) identified using MDT. METHOD:This cross-sectional study included 120 individuals with LBP lasting more than four weeks and confirmed LDH. Data collection included demographic and clinical variables MRI findings, and MDT assessment to determine DP through repetitive lumbar movements. Disc herniations were classified as bulging, protrusion, extrusion, or sequestration.Association between disc tyoe and DP were analyzed using Pearson's chi-square test. RESULTS:In total, 120 participants (59 females, 61 males; mean (SD) age = 44.14 (10.80) years) were enrolled. Protrusion was the most prevalent disc type (54.17%), and extension was the most frequently identified DP (49.16%). The results of this study demonstrated a significant association between disc type and DP (p < 0.001), with a strong effect size (Cramér's V = 0.51). CONCLUSIONS:A significant association exists between radiological and mechanical features in LDH. Extension DP was more common in milder cases, whereas many severe cases lacked a clear DP, suggesting MDT may be more responsive in less severe LDH. Further longitudinal studies are warranted.
OBJECTIVE:This case describes the upper cervical chiropractic management of a patient with neck pain and headaches with a history of cervical artery compromise following a motor vehicle accident. BACKGROUND:A 54-year-old male with neck pain and headaches was seen in a chiropractic office. Eight months prior to his initial visit, the patient was involved in a motor vehicle accident (MVA) which resulted in partial dissection of his left internal carotid artery. The patient reported severe cervicalgia, headaches and painful restricted cervical motion. Physical exam and cervical imaging assessed acceptable risk for treatment and indicated altered axis of motion in the first cervical vertebrae (C1) relative to the occiput (Co). OUTCOMES:The patient was examined over a 6 month period and received a total of 5 Blair upper cervical chiropractic adjustments. Physical exam findings, the Numerical Rating Scale (NRS), the Neck Pain Disability Index (NDI) and the RAND-36 outcomes were used to track progress. The NRS, NDI and RAND-36 demonstrated positive changes in presenting symptoms. CONCLUSION:More investigation is needed to understand the relationship between a history of traumatic cervical artery compromise and the effectiveness and safety of upper cervical chiropractic care utilizing Blair protocol to manage latent symptoms.
OBJECTIVE:Valid, reliable, and low-cost tools to assess pain can enhance quantitative pain assessment in multiple settings. Therefore, we assessed the technical validity, concurrent validity, reliability, and treatment sensitivity of the Egyptian algometer, which is a low-cost pain assessment tool. We also examined clinicians' inter- and intra-rater reliability with this device. METHODS:Technical validity of the algometer was tested by comparing the algometer to German standard weights. We tested (concurrent validity and reliability of the algometer in young healthy participants (n = 20, 27.31 ± 4.13 years), treatment sensitivity in 9 participants with discogenic sciatica (45.11 ± 14.77 years), and inter- and intra-rater reliability of 3 physical therapists who conducted all the tests. A combination of intra-class correlation coefficients (ICC(2,1) and ICC (2,3)) and Bland-Altman plots were used for all the analyses. RESULTS:The Egyptian algometer (i) demonstrated a force bias of ≤ ±3% versus standard German weights; (ii) showed excellent concurrent validity and reliability (ICC > 0.9) versus Wagner algometer, and (iii) inter-and intra-rater reliability (r > 0.9) for the standard acupuncture points. The Egyptian algorithm was sensitive to capture treatment changes across different body acupuncture points in patients with discogenic sciatica (range SEM = 0.22 to 0.41; p = 0.008 to 0.021; and 95% CI = -0.176 to -2.275; Cohen's d = 0.29-0.39). DISCUSSION:The Egyptian algorithm is a low-cost, valid, and reliable device to assess pain in healthy young adults. Additionally, the Egyptian algorithm can effectively capture pain treatment response in individuals with discogenic sciatica.
INTRODUCTION:Forward head posture (FHP) is one of the most frequently reported postural deviations in contemporary populations. Therapeutic exercise has been associated with improvements in FHP, rounded shoulders, and thoracic kyphosis. However, it remains unclear whether exercise programs targeting the neck region differ in their effects from those that also include the thoracic spine compared with control conditions. METHODS:A systematic review with meta-analysis was conducted following a comprehensive search of the Cochrane Library, PubMed, PEDro, and Web of Science databases from inception to 9 February 2026. Eligible studies were randomized controlled trials investigating therapeutic exercise interventions in patients with FHP. The intervention had to be based on therapeutic exercise. Studies were required to compare the intervention with a control group. Methodological quality was assessed using the PEDro scale, and the certainty of the evidence was evaluated according to the GRADE guidelines. RESULTS:Thirteen randomized controlled trials involving 819 participants were included in qualitative synthesis and meta-analysis. Both neck-focused exercise and combined neck - thoracic exercise programs showed statistically significant short-term improvements in craniovertebral angle and neck disability compared with control conditions. Combined neck - thoracic exercise programs demonstrated significant reductions in pain intensity post-intervention. The certainty of the evidence ranged from low to very low. CONCLUSION:Therapeutic exercise programs targeting the neck region, alone or combined with thoracic exercises, may improve craniovertebral angle and neck-related outcomes in individuals with FHP. However, the certainty of the evidence ranged from low to very low and the findings should be interpreted with caution. PROTOCOL REGISTRATION:PROSPERO registration ID CRD420261304664.
OBJECTIVES:To systematically evaluate the effects of dry needling on myofascial mechanical properties in adults with active or latent myofascial trigger points through a systematic review including randomized controlled trials comparing dry needling with sham or noninvasive treatments. METHODS:Searches in MEDLINE, PubMed, Embase, Scopus, and Web of Science databases were conducted up to July 2025. The primary outcome was stiffness, whereas tone and elasticity were secondary, measured with shear-wave elastography or myotonometry. The meta-analysis was conducted under random-effects models with restricted maximum likelihood. The risk of bias was assessed with RoB 2.0, and certainty with the GRADE scale (PROSPERO: CRD420251081108). RESULTS:Eleven randomized controlled trials encompassing 612 participants were included, of which 10 contributed to meta-analysis. Dry needling reduced stiffness in the short term (SMD -0.37, -0.64 to -0.11; I2 = 36%). No immediate or mid-term effects emerged. Subgroup analyses suggested greater benefits in healthy participants (SMD -0.33, -0.58 to -0.07; I2 = 49.9%). Shear-wave elastography and myotonometry showed comparable patterns, though heterogeneity was higher in elastography. The certainty of outcomes ranged from very low to low. CONCLUSION:Dry needling reduces myofascial short-term stiffness, particularly in latent myofascial trigger points. Beyond estimating treatment effects, the present findings highlight the potential role of device-based measurements in supporting and refining the clinical assessment of myofascial trigger points. Future well-designed and standardized trials with longer follow-up are needed to clarify whether objectively measured changes in stiffness correspond to clinician-perceived palpatory findings and to determine their relevance within multimodal clinical decision-making.
