This is a comparative study to determine if there is a difference in pain reduction and
disability between dry needling and manual therapy for patients with low back pain. Subjects
will be seen two times per week for 3 weeks (6 visits) and will receive either dry needling
or manual mobilizations along with patient education and a home exercise program.
Subjects will sign the informed consent prior to any examination procedures. Eligibility
assessment will be performed by the treating physical therapist and will include the subject
filling out the demographic / health history questionnaire, outcome measures, and a clinical
examination. The treating physical therapist will use 2 components of the examination for
eligibility criteria into the study. The treating therapist will press on the subject's
joints in their back to try to elicit their chief complaint. The treating physical therapist
will also press on the muscles of the subject's back to check for any trigger points. A
trigger point would include recreation of their chief complaint, tenderness,
hypersensitivity, or referred pain. The treating physical therapist will then draw an X on
the patient's back where the trigger point (myofascial trigger point or MTrP) exists. This
point will be used by the data collecting physical therapist in order to collect pain
pressure threshold of the trigger point.
The data collecting physical therapist will have the subject complete an Oswestry Disability
Index(ODI), gather a measure of the pain from the patient ,and the pain pressure threshold.
Each subject will then be allocated to either the manual therapy group or the dry needling
Once a subject is assigned to a group, they will receive either trigger point dry needling
or manual therapy mobilizations by the treating therapist. Each subject will remain in the
assigned group as long as they are continuing in the study up to 3 weeks. In addition to the
treatments under investigation, a standardized home exercise program will be assigned to
each of the subjects by the treating physical therapist. This program will be given to and
reviewed with each subject to ensure they understand the exercises and will perform the
exercise program 2x/day for the duration they are under the care of the physical therapist
for the study. Subjects will be treated on day 1 of their plan of care and subsequent
treatments will occur 2x/week for a total of 3 weeks, unless discharge occurs earlier than
the 3 week data point. Early discharge will occur if the subject achieves resolution of
symptoms or if they decide they no longer wish to be a research participant.
Subsequent sessions will involve the collection of outcome data by the data-collecting
therapist followed by treatment performed by the treating physical therapist. No adjustments
will be made to the treatment protocol in any of the sessions. Subjects will only be
scheduled with and treated by the same treating physical therapist each session. In the
event that a treating physical therapist is unable to see a subject participating in the
study, the subject will be rescheduled for a different time to receive care.
- There will be 100 subjects participating in this study that present with mechanical
low back pain, ranging from 18-70 years old.
- Subjects will be excluded if the examining therapist cannot provoke either active or
latent MTrPs of the subject's low back muscles and/or elicit symptoms with manual
passive movement of the spine at the joints of the low back. Exclusion criteria will
also consist of the presence of any red flags revealed in the patient history (i.e.,
tumor, metabolic diseases, RA, osteoporosis, prolonged history of steroid use, prior
lumbar surgery, current pregnancy, etc.) or examination (i.e. signs consistent with
significant nerve root compression). Subjects will be excluded if they demonstrate
signs of Chronic Regional Pain Syndrome (CRPS), are currently seeking litigation, are
unable to speak English, and/or have been diagnosed with a condition that can cause
prolonged MTrPs such as fibromyalgia, hypothyroidism, or iron deficiency. In
addition, no patients who have a transmittable blood disease will be included.