Galley Proof 8/03/2019; 11:33 File: bmr–1-bmr181289.tex; BOKCTP/xjm p. 1 Journal of Back and Musculoskeletal Rehabilitation -1 (2019) 1–8 1 DOI 10.3233/BMR-181289 IOS Press The effects of shock wave and dry needling on active trigger points of upper trapezius muscle in patients with non-specific neck pain: A randomized clinical trial Javad Manafnezhad a , Zahra Salahzadeh a,∗ , Mehdi Salami a , Fariba Ghader a and Morteza Ghojazadeh b a Physiotherapy Department, Faculty of Rehabilitation, Tabriz University of Medical Science, Tabriz, Iran b Physiology Department, Faculty of Medical, Tabriz University of Technology, Tabriz, Iran Abstract. BACKGROUND: Chronic neck pain is associated with various myofascial trigger points (MTrPs). OBJECTIVE: A single-blind randomized clinical trial was designed to compare the effects of extracorporeal shock wave therapy (ESWT) with dry needling (DN) techniques on the upper trapezius muscle trigger point in patients with non-specific neck pain (NSNP). METHODS: Seventy patients with NSNP and active MTrPs of the upper trapezius muscle were randomly divided into two groups: an ESWT group (n = 35) and a DN group (n = 35). Treatment sessions were performed for three weeks and all participants received related intervention once a week. The outcome measures were pain intensity, measured by a numeric pain rating scale (NPRS), pain pressure threshold (PPT), measured with a digital algometer, and functional disability, evaluated by using the neck disability index (NDI). RESULTS: NPRS and NDI were significantly decreased in the DN group and ESWT group (P< 0.05). Also, the PPT was significantly increased in the DN group and ESWT. However, there was no significant difference in pain intensity, NDI, and the PPT between the two groups (P  0.05). CONCLUSION: Both ESWT and DN can be employed to treat MTrPs of the upper trapezius muscle in patients with NSNP. Keywords: Neck pain, myofascial trigger point, dry needling, extracorporeal shock wave 1. Introduction 1 Non-specific neck pain (NSNP) is a common type 2 of cervical spine disorder with a prevalence of 30–50% 3 in the general population and about 10% of these pa- 4 tients experience chronic neck pain [1]. Some chronic 5 neck pain related to the myofascial systemstems from 6 local muscle fiber contractions referred to “myofascial 7 * Corresponding author: Zahra Salahzadeh, Physiotherapy Depart- ment, Faculty of Rehabilitation, Tabriz University of Medical Sci- ence, Valiasr Blvd., Tavanir St., Tabriz, Iran. Tel.: +98 9144173640; Fax: +98 4133375359; E-mail: salahzadeh@tbzmed.ac.ir. trigger points” (MTrPs) [2]. MTrPs are highly sensitive 8 spots that lie in the skeletal muscle, and are diagnosed 9 with mechanical pressure; they can also develop as re- 10 ferral pain in a specific pattern [3,4]. Although MTrPs 11 are found in all muscle groups, they are more prevalent 12 in the upper quarter postural muscles, especially the 13 upper trapezius muscle [5,6]. Forasmuch as the impor- 14 tance of upper trapezius muscle in the mobility and sta- 15 bility of the neck and shoulder girdle [7], active MTrPs 16 in the upper trapezius muscle cause local pain and may 17 distribute the neck and shoulder girdle function in pa- 18 tients with chronic neck pain [8]. Therefore the diagno- 19 sis and treatment of MTrPs in muscle around the neck 20 ISSN 1053-8127/19/$35.00 c  2019 – IOS Press and the authors. All rights reserved uncorrected proof version