Original article The effect of the combination of dry needling and MET on latent trigger point upper trapezius in females Ameneh Yeganeh Lari a , Farshad Okhovatian b, * , Sedigheh sadat Naimi a , Alireza Akbarzadeh Baghban c a Department of Physiotherapy, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran b Physiotherapy Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran c Proteomics Research Center, Department of Basic Sciences, Faculty of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran article info Article history: Received 16 April 2014 Received in revised form 5 August 2015 Accepted 7 August 2015 Keywords: Myofascial pain syndromes Trigger point MET Dry needling abstract Aim: The purpose of this clinical trial experiment was to compare the effects of the combination of dry needling (DN) and the muscle energy technique (MET) on the upper trapezius latent myofascial trigger point. Method: Sixty female patients, aged 18e30 with latent myofascial trigger points in the upper trapezius muscle were randomly divided into three groups: group 1 (n ¼ 20) received DN and MET, group 2 (n ¼ 20) received only MET, and group 3 (n ¼ 20) received only DN. The visual analogue scale (VAS), pressure pain threshold (PPT), and range of active contra lateral flexion (CLF) were measured before each treatment. The patients were treated for three sessions in a one-week period with at least a two-day break between each session, and in session four, an assessment of primary outcomes was conducted without any treatment. Results: All three treatment groups showed decreases in pain (p ¼ 0.001) and increases in PPT levels (p ¼ 0.001) as well as increases in CLF (p ¼ 0.001). But the group receiving trigger point DN together with MET showed more significant improvement than the other two groups in VAS, PPT and ROM. No sig- nificant differences were found between the MET-only group and the DN-only group. Conclusion: Our results indicate that all three treatments used in this study were effective for treating MTP. According to this study, DN and MET is suggested as a new method for the treatment of MTP. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction Myofascial pain syndrome (MPS) is one of the most common musculoskeletal pain diseases and is characterized by myofascial trigger points (MTPs) (Chaiamnuay et al., 1998). MTP is a hyperir- ritable nodule of tenderness in a palpable taut band of skeletal muscle that can refer pain to a distant point and also causes distant motor and autonomic effects (Simons and Travell, 1992; Simons et al., 1999a, 1999b). Studies conducted in pain clinics indicate that the incidence of MPS “Occurs in 30%e85% of patients”. A report from a clinic specializing in head and neck pain reported a myo- fascial aetiology in 55% of cases and 30% of the patients had active MTPs (Skootsky and Oye, 1989; Han and Harrison, 1997). The exact cause of MTP is still unknown, but Simons et al. (1999a, 1999b) hypothesized that some muscle fibers shorten and form taut bands in response to the release of calcium ions from damaged fibers or excessive amounts of acetylcholine from the motor end plate. In the upper quadrant, postural muscles in general and the upper trape- zius muscle in particular are most affected by MTP (Luime et al., 2004; Meleger and Krivickas, 2007; Chang et al., 2011). There are two categories of trigger points (TPs): active and latent. Active TP are spontaneously active and produce local or referred pain to remote structures. Latent TPs, however, are not spontaneously active and would not produce any symptoms unless evoked by an external stimulant (Simons et al., 1999a, 1999b; Travel and Simons, 1999; Simons, 2004a, 2004b). According to Travel and Simons Abbrevations: DN, dry needling; MET, muscle energy technique; MTP, Myo- fascialT rigger point; VAS, visual analogue scale; PPT, pressure pain threshold; IC, ischaemic compression; SCS, Strainecounter strain; INIT, integrated neuromuscular inhibition technique. * Corresponding author. Physiotherapy Research Centre, School of Rehabilitation Science, Shahid Beheshti University of Medical Sciences, Damavand Street, Opposite of Buali Hospital, Tehran, Iran. Tel.: þ98 9123277524. E-mail address: farshadokhovatian1965@gmail.com (F. Okhovatian). Contents lists available at ScienceDirect Manual Therapy journal homepage: www.elsevier.com/math http://dx.doi.org/10.1016/j.math.2015.08.004 1356-689X/© 2015 Elsevier Ltd. All rights reserved. Manual Therapy 21 (2016) 204e209