1Medical Department Wojciech Korfanty, Upper Silesian Academy, Katowice, Poland
2Physiotherapy Centre “Od Nowa” Racibórz Zamkowa, Racibórz, Poland
3Institute of Physiotherapy, Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzeszów, Rzeszów, Poland
4Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
5Provita Żory Medical Center, Żory, Poland
Correspondence: Robert Trybulski Medical Department Wojciech Korfanty, Upper Silesian Academy, Katowice 40‑659, Poland. Tel: +48-32-35-70-500 Fax: +48-32-35-70-532 E-mail: roberttrybulski@proton.me
• Received: March 31, 2025 • Revised: July 25, 2025 • Accepted: August 11, 2025
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
To compare the Hong (GH) and sustained insertion (GS) dry needling methods in patients with myofascial neck pain, this experimental study was conducted.
Methods
A randomized controlled trial included 30 participants, assigned to either the GH (n=15) or GS (n=15) group. Each group received treatment on either the right or left side, with one side receiving experimental DN and the other receiving control (sham) DN. The GS method involved a single needle insertion per myofascial trigger point for one minute, while the GH method used multiple rapid needle insertions over two minutes without needle retention. Measurements were taken before therapy, 5 minutes post-DN session (post-5min), 24 hours post-session (post-24h), and 7 days post-session (post-7d). Muscle tension (MT) and muscle stiffness (MS) were measured with a myotonometer, pressure pain threshold (PPT) with an algometer, maximum isometric strength (Fmax) with a handheld dynamometer, and transcutaneous perfusion (PU) with laser Doppler flowmetry. Power Doppler Score (PDS) and minor adverse events were also recorded.
Results
Results showed that GH led to significantly higher MT and MS values at post-24h and post-7d (p<0.001). In contrast, GS showed greater PPT and Fmax at post-5min, post-24h, and post-7d (p<0.001). Additionally, GH exhibited higher PU values at post-5min and post-7d (p<0.001), while GS showed higher PDS values at post-5min and post-24h (p<0.001).
Conclusion
The GH method resulted in less favorable outcomes in terms of MT and MS, while the GS method showed superior improvements in pain relief and functional recovery.
Myofascial pain syndrome (MPS) has garnered considerable attention in clinical practice due to its complex etiology and the challenges it presents for effective treatment [1]. Among various therapeutic approaches, dry needling (DN) has emerged as a prominent intervention to alleviate pain and restore function by targeting myofascial trigger points (MTrPs) [2]. These trigger points are palpable nodules within taut bands of muscle fibers that can cause local tenderness and referred pain patterns [3]. The effectiveness of DN is closely linked to the procedural methodology employed, including factors such as the number of insertions, the depth and technique of needling, and the specific muscle groups targeted [4].
Cervical myofascial pain, commonly referred to as neck pain, is a prevalent musculoskeletal condition characterized by the presence of MTrPs, leading to acute or chronic pain [5]. It is often associated with muscle stiffness (MS), tightness, tenderness, and a limited range of motion [6]. This condition may occur independently or alongside other musculoskeletal disorders, predominantly affecting individuals aged 27 to 50 [1]. Chronic muscle overload or injury frequently contributes to local pain that can radiate, leading to functional impairment and a reduced quality of life [4]. Recent studies underscore the physiological implications of myofascial pain, indicating that MTrPs may influence muscle performance and systemic factors such as blood perfusion and biomechanical properties [7]. For instance, laser Doppler flowmetry (LDF) studies have shown that myofascial pain significantly affects muscle elasticity and pressure pain thresholds (PPTs), revealing a complex interaction between pain perception and muscle function [8].
According to the American Physical Therapy Association, DN involves the use of fine acupuncture needles to stimulate muscle and connective tissue trigger points to treat neuromusculoskeletal disorders [9]. DN aims to relieve and normalize muscle tension (MT) and MS, modulating pain at muscle trigger points through mechanisms that are not yet fully understood [10]. The consensus is that the physiological mechanisms of DN in myofascial pain involve a complex interplay between peripheral and central sensitization, neuromuscular responses, and pain modulation systems [11]. Peripheral sensitization modulates nociceptive stimuli, often indirectly, through factors like serotonin. Central sensitization involves the activation of neural networks in the central nervous system, typically through N-methyl-D-aspartate receptor activation [12]. DN may influence these sensitization processes by mechanically disrupting trigger points, releasing pain mediators, and interrupting the pain cycle at the spinal cord level (pain gating theory) [8,13].
Establishing an effective DN methodology, including the appropriate frequency and number of insertions, is crucial for optimizing myofascial pain management outcomes [14]. Many studies describe a sustained insertion DN (GS) methodology, involving a maximum of five punctures per MTrP until a local twitch response (LTR) is elicited [13,15]. However, recent studies have questioned the reliability of LTR as a diagnostic criterion for MTrPs and the efficacy of DN therapy [8]. An alternative technique is the Hong (GH) method, which involves multiple rapid needle insertions to treat MPS pain [16,17]. This method aims to stimulate nociceptors in the MTrP region, potentially activating the descending pain inhibitory system for immediate and significant pain relief. It is effective for quickly restoring normal muscle function and achieving long-lasting therapeutic effects [18].
Comparative studies evaluating different DN techniques remain limited. One of the few available studies directly compared deep DN and the peppering technique, finding both approaches effective in managing MPS. Specifically, both methods significantly reduced pain and depressive symptoms and improved functional outcomes for up to 12 weeks post-treatment [19]. Despite comparable efficacy and adverse event profiles, deep DN was associated with lower procedural pain, suggesting it may be better tolerated [19]. However, inconsistencies in the application of DN techniques—such as variation in the number and depth of needle insertions—pose methodological challenges. Clinical observations and survey data indicate that increasing the number of insertions may heighten the risk of adverse effects, including post-treatment pain, hematomas, burning sensations, and fatigue [20]. Additionally, patients may tolerate repeated insertions poorly. A systematic review of the literature recommends DN, alone or in combination with other interventions, for treating musculoskeletal pain conditions associated with MTrPs [1]. Various DN techniques appear to be similarly effective in reducing myofascial pain intensity [14].
Despite the apparent efficacy of DN in treating myofascial pain, critical methodological issues remain unresolved. Diagnostic studies of perfusion and PPTs following GS applications support its effective use [21]. However, concerns persist regarding the optimal number of insertions and the procedural framework used in clinical practice.
Further research into standardized protocols and the integration of DN with other treatment modalities is essential to fully understand its role and maximize patient outcomes in myofascial pain management. Thus, this randomized controlled trial aimed to compare the procedural methodologies (sustained insertion and multiple DN techniques) to determine their efficacy in treating MTrPs and their effects on muscle perfusion, strength, and biomechanical properties of the trapezius muscle in individuals with neck pain. Our hypothesis is that GS therapy will demonstrate greater immediate efficacy and patient tolerance, with no significant long-term differences in the measured variables.
METHODS
The CONSORT guidelines were followed in reporting this randomized trial [22]. This research was approved by the Ethics Committee of the National Council of Physiotherapists (approval number 26/2022, dated January 12, 2023) and registered as a clinical trial (ISRCTN16484644). The study adhered to the principles outlined in the Declaration of Helsinki. Participants were informed they could withdraw at any time without providing a reason. Each signed informed consent, completed a health questionnaire, and was briefed on potential adverse effects.
Study design
In this single-masked study, participants were allocated randomly in a 1:1 ratio using simply randomization in a dedicated software to either the GH method (n=15) or the GS method (n=15). To ensure proper concealment of group allocation, randomization was conducted before baseline measurements were taken. Furthermore, each group was randomly assigned to the right or left side for the experimental (DN therapy) and control (sham dry needling [shamDN] therapy) conditions. This approach allowed participants to serve as their own control through random side assignment [23].
Participants were evaluated at four time points: rest (before therapy), 5 minutes post-DN session (post-5min), 24 hours post-session (post-24h), and 7 days post-session (post-7d).
Participants
After recruitment, the study involved 30 volunteers (n=30) with MPS and active MTrPs in the upper trapezius muscle, comprising both males and females. Participants met the following inclusion criteria: (1) bilateral neck pain persisting for over a month; (2) a neck pain score of 4 or higher on the Numeric Pain Rating Scale (NPRS); (3) a palpable tight band in the muscle; (4) a hypersensitive, tender point within the tight band; (5) local or referred neck pain triggered by pressure; and (6) restricted neck mobility. The diagnostic criteria used in this study were based on international consensus and classical literature on the subject. The diagnosis of active MTrPs was based on: the presence of a taut band, a hypersensitive point within this band, referred pain when the point is pressed, limited range of motion and pain during muscle contraction [9]. Exclusion criteria included: (1) receiving physiotherapy or pharmacological treatment within three months of pain onset; (2) radicular diseases or radicular pain; (3) neck pain linked to whiplash; (4) dizziness; (5) prior neck surgery; (6) other connective tissue diseases like systemic sclerosis or fibromyalgia; (7) cervical discopathy-induced pain; (8) nickel allergy; (9) needle phobia; (10) occlusive syndromes of the jugular and vertebral arteries and veins; and (11) pregnancy.
Interventions
Each group was randomly assigned an experienced physical therapist, one per group, to ensure the treatments were administered. In the GS, DN treatment was provided by inserting a sterile SOMA needle (0.30×0.30 mm, Acus Med Spółka z ograniczoną odpowiedzialnością) into the active, painful point along the midline of the upper trapezius muscle (Fig. 1A). The procedure followed strict safety protocols, such as disinfecting the puncture site and the therapist wearing protective gloves. DN treatment was performed with the participant in a prone position, the head supported by a special couch at a 15-degree flexion angle [7]. Each trigger point was treated with a single needle puncture, observing for a LTR. This method has been previously described in studies [4,24] that showed its effectiveness in reducing MT and improving tissue perfusion. If no LTR appeared after five punctures without skin removal, the needle was inserted as deeply as possible and left in place for one minute [25]. MTrPs were identified by palpable tenderness along a taut band in the upper trapezius muscle, generally located in the muscle’s middle region. The entire DN procedure took about two minutes, with the treatment being stopped if participants experienced severe pain or any adverse reactions. The number of adverse events was recorded.
In the GH, the same safety protocols and diagnostic criteria were followed, but the technique involved rapid, repetitive needle movements over a period of two minutes, without leaving the needle in the skin, regardless of how many LTRs appeared (an average of 40 punctures per trigger point). The GH technique with multiple (average 40) needle insertions over 2 minutes was based on previous studies [16,17] that supported the efficacy of this method in rapid pain modulation by activating the descending inhibitory system and inducing multiple LTRs.
For the control condition, a quasi-needle was used instead of the classic needle, ensuring no skin penetration. This quasi-needle, which contained a spring mechanism, was used with a technique that created a sensation similar to that of a real DN needle (telescopic needle-sham therapy) [8]. Participants could not see the needle being used due to the prone position (Fig. 1B). Throughout the experiment, participants were instructed not to engage in intensive exercise or physical labor that might strain their neck muscles. They were also instructed to avoid physiotherapy treatments, painkillers, and anti-inflammatory medications. Each participant underwent both a therapeutic session and a sham session.
Outcomes
All measurements and treatments were conducted in the Medical Center, under controlled conditions in a room set at 21°C, with monitoring via electronic sensors. The following measurements were taken at specific time points: (i) MT (Hz), (ii) MS (N/m), (iii) PPT (N/cm), (iv) maximum isometric strength (Fmax [kgf]), (v) transcutaneous perfusion response ([PU] perfusion unit – arbitrary units), (vi) Power Doppler Score (PDS) (scale 0–3), and (vii) minor adverse events (MAEs [number]). These measurements were conducted at the following moments: (i) at rest (before therapy), (ii) post-5min, (iii) post-24h, and (iv) post-7d.
MT and MS
After identifying the MTrP based on the previously mentioned criteria and marking the measurement location on the upper trapezius muscle with a marker, the biomechanical properties of the muscle, including MT and MS, were assessed using the MyotonPRO myotonometer (AS, Myoton Ltd). The MyotonPRO is a digital device featuring a body and a push-in probe (Ø 3 mm). Its reliability and repeatability have been confirmed in scientific literature [26]. The process begins by applying an initial pressure of 0.18 N to the surface via the probe, which compresses the underlying tissue. The device then delivers a mechanical impulse of 0.4 N for 15 ms, briefly deforming the tissue [27]. Resting MT is measured based on the frequency of muscle vibrations at rest, which is recorded by the silent electromyographic signal [27]. MS is calculated by evaluating the tissue’s resistance to deformation using a logarithmic scale [28].
PPT
The PPT at trigger points plays a crucial role in diagnosing and treating myofascial pain [29]. To measure the PPT, an algesimeter (FDIX; Wagner Instruments) was used. Participants underwent three pressure tests with a probe (r=4 mm) applied to the tissue area (mm). The average force value (kg) of the three measurements was calculated and displayed digitally. If any significant deviation from the measured value occurred, the device signaled the need for a retest. The pressure was gradually increased until the participant found the sensation unpleasant [29]. Pressure altimeters, a widely used tool in clinical practice, have been validated as a reliable method for diagnosing and assessing treatment in MPSs, with high reliability in repeated measures [29,30]. All measurements were taken while the participant was in the treatment position.
Isometric muscle strength assessment
Handheld dynamometers are commonly utilized for measuring isometric muscle strength due to their portability and user-friendly design. These devices are known for providing reliable and valid measurements, making them ideal for both clinical and field applications [31]. The Kinvent K-Force Push v 3 handheld dynamometer, a reliable and repeatable tool [32], was used for isometric muscle strength testing. While seated, the device was positioned on the upper arm of the tested side. The participant was instructed to lift the arm upward, engaging the upper trapezius muscle, among others (Fig. 2). Each contraction lasted for 3 seconds [33]. The test was performed twice, and the strength values were averaged.
Tissue perfusion (PU)
MTrP is often associated with altered blood flow caused by MT and local ischemia. LDF is a technique capable of detecting these changes, offering a quantitative assessment of the muscle’s physiological state. LDF is widely used for perfusion assessment and is recognized as a reliable, repeatable, and non-invasive method, making it the gold standard in this field [34,35]. Tissue perfusion was measured using a Perimed device, manufactured in Sweden in 2004. LDF measurements were taken at a skin tissue volume of 1 mm³ and a depth of 2.5 mm, with two contact laser probes placed on the marked MTrP. The technique utilizes emitted radiation that penetrates deep into the tissue, where it interacts with moving blood cells, causing a change in their oscillation frequency due to the Doppler effect [36]. A photodetection system then analyzes the returning light, and the resulting voltage is directly proportional to the speed and number of moving blood cells, enabling the evaluation of blood supply to the tissue area based on the principles outlined by [37]. The final result of this process is the PU.
PDS
The PDS is an important tool in medical imaging, particularly for evaluating vascularity and inflammation in various conditions [38]. It provides valuable insight into blood flow and changes in vascular tissue, which helps assess disease activity and severity. PDS is frequently applied in the context of musculoskeletal disorders, rheumatoid arthritis, and obstetric conditions, among others [39]. As a safe, non-invasive, and cost-effective imaging method, PDS offers a quick and sensitive approach for visualizing hyperperfusion in tissues affected by penetrating or inflammatory interventions. The effectiveness of PDS in evaluating synovitis has been validated by comparing its results with those from magnetic resonance imaging, histology, and arthroscopy, with significant positive correlations reported, further confirming its reliability and reproducibility [40,41] In this study, PDS was conducted by an experienced operator. The SonoScape P20 with a 6–15 MHz linear probe was employed. Standardized PDS settings included a pulse repetition rate of 1,200 Hz and a color mode frequency of 8 MHz. The probe was positioned over the marked MTrPs, and the measurement window was set to a depth corresponding to the needle penetration during DN therapy. A semiquantitative visual scale was used to categorize the results: 0 for standard or minimal degree, 1 for mild degree, 2 for moderate degree, and 3 for severe degree (Fig. 3) [40].
MAEs
The effects and types of adverse events were recorded in the table as part of the study, following the survey previously developed and published [20].
Sample size
Based on findings from an earlier study on DN in combat sports [7], the sample size for this investigation was established in advance. To examine both within-group and between-group interactions across four measurement points, a repeated measures ANOVA was conducted. The effect size (f) of 0.758, derived from a partial eta squared of 0.341 observed in PPT [7], was used in the analysis. With a significance level set to 0.05 and a desired power of 0.95 for two groups and 8 measurements, G*Power software calculated that a minimum of 6 participants would be required. Although the statistical minimum was 6 participants, we opted to recruit more participants to accommodate potential dropouts and ensure the study’s sample size remained adequate. As a result, we aimed to recruit 30 participants, which is often considered sufficient for the central limit theorem to apply, allowing the sampling distribution to approximate a normal distribution [42].
Randomization
The randomization process was overseen by a researcher not involved in later assessments to ensure the blinding procedure remained intact. Using a simple randomization method, participants were assigned to groups in a 1:1 ratio in a dedicated software (research randomizer). To guarantee impartial allocation, participants were allocated prior to their initial assessments.
Blinding
The participants were the only ones blinded to the experiment, while the physiotherapists and evaluators were aware of the DN protocols being applied.
Statistical methods
The Kolmogorov–Smirnov test was applied to assess the normality of the sample, yielding p-values greater than 0.05. Following this, Levene’s test was conducted to evaluate the homogeneity of variances, with p-values also exceeding 0.05. A mixed ANOVA was then performed to analyze the interaction between time (four timing points×DN therapy and shamDN therapy) and group (GS and GH). To calculate effect sizes for pre- and post-intervention comparisons, Cohen’s d was used. Effect sizes were categorized based on the thresholds [43]: small (≥0.10), moderate (≥0.30), large (≥1.2), and very large (≥2.0). Bonferroni-corrected post-hoc tests were conducted to follow up significant ANOVA findings. An independent t-test was conducted to compare baseline anthropometric data between groups, following verification of normality and homogeneity. Statistical analysis was carried out using SPSS software (version 28.0; IBM Corp), with a significance threshold of p<0.05.
RESULTS
After recruitment, 30 participants were included in the study and subsequently analyzed (Fig. 4). Among the 30 participants, 20 were males (age, 31.3±5.2 years; height, 179.7±8.1 cm; body mass, 86.6±6.9 kg; body mass index [BMI], 25.9±2.4 kg/m²) and 10 were females (age, 32.4±6.0 years; height, 167.8±7.5 cm; body mass, 64.1±10.5 kg; BMI, 24.0±2.8 kg/m²). The demographic characteristics and anthropometric data for each group are provided in Table 1. An independent t-test revealed no statistically significant differences between the GS and GH groups at baseline for age (GS, 31.9±5.1 years; GH, 31.4±5.8 years; p=0.791), body mass (GS, 79.9±13.0 kg; GH, 78.3±14.3 kg; p=0.912), height (GS, 175.9±9.1 cm; GH, 175.5±10.5 cm; p=0.761), and NPRS scores (GS, 5.13±0.99; GH, 5.53±1.06; p=0.294). However, a significant difference was observed in BMI between the groups (GS, 26.3±3.0 kg/m²; GH, 24.2±1.9 kg/m²; p=0.029). However, a significant difference was found in BMI (p=0.014), with the GS group exhibiting greater values. It is important to clarify that these are descriptive outcomes and are not part of the main analysis.
The Table 2 describes the mean and standard deviation of the outcomes across different time points and conditions in both experimental groups.
Table 3 presents the post hoc comparisons within groups (GS vs. GH) and between conditions (experimental vs. sham, depending on the condition to which each group was exposed).
Table 4 presents the post hoc comparisons between groups (GS vs. GH) in each time point.
Fig. 5 provides a descriptive illustration of the main outcome values observed across the different time points.
MT
Significant interactions (time and groups) were observed in the MT (F=75.562; p<0.001; ηp2=0.730). In the DN condition, between-group comparisons revealed that MT was significantly greater in GS than in GH at rest (F=8.168; p=0.008; ηp2=0.226). Conversely, GH showed significantly higher values at post-24h (F=255.377; p<0.001; ηp2=0.901) and post-7d (F=18.906; p<0.001; ηp2=0.403). In the shamDN condition, GS was significantly higher than GH at rest (F=15.462; p=0.001; ηp2=0.356), post-5min (F=20.371; p<0.001; ηp2=0.421), post-24h (F=25.131; p<0.001; ηp2=0.473) and post-7d (F=10.108; p=0.004; ηp2=0.265).
Within the GS group, comparisons revealed significant differences in MT (F=42.747; p<0.001; ηp2=0.932). Within the GS group under the DN condition, analysis revealed that MT was significantly higher at rest compared to post-5min (p<0.001, Bonferroni correction for 8 comparisons), post-24h (p<0.001) and post-7d (p<0.001). Additionally, MT at post-24h was significantly lower than at post-5min (p=0.004) and post-7d (p=0.012). No significant differences were observed in MT within the GS group across the time points in the shamDN condition. MT was significantly greater in the GS shamDN condition compared to the DN condition at post-5min (p<0.001), post-24h (p<0.001), and post-7d (p<0.001).
Similarly, within the GH group, comparisons revealed significant differences in MT (F=44.471; p<0.001; ηp2=0.934). In the GH group under the DN condition, MT was significantly higher at post-24h compared to rest (p<0.001, Bonferroni correction for 8 comparisons), post-5min (p<0.001) and post-7d (p<0.001). Additionally, MT at rest was significantly higher than at post-5min (p<0.001) and post-7d (p<0.001). No significant differences in MT were observed within the GH group across the time points in the shamDN condition. MT was significantly greater in the GH group under the shamDN condition compared to the DN condition at post-5min (p=0.005), but significantly lower in the shamDN condition compared to the DN condition at post-24h (p<0.001) and post-7d (p<0.001).
MS
Significant interactions (time and groups) were observed in the MS (F=20.701; p<0.001; ηp2=0.425). For MS in the DN condition, GH exhibited significantly higher values than GS at both post-24h (F=127.339; p<0.001; ηp2=0.820) and post-7d (F=14.830; p=0.001; ηp2=0.346). In terms of PPT, GS had significantly greater values than GH at post-5min (F=4.786; p=0.037; ηp2=0.146), post-24h (F=68.312; p<0.001; ηp2=0.709), and post-7d (F=16.201; p<0.001; ηp2=0.367) at DN condition. For Fmax in the DN condition, GS exhibited significantly higher values than GH at post-24h (F=6.330; p=0.018; ηp2=0.184).
Within the GS group, comparisons revealed significant differences in MS (F=56.189; p<0.001; ηp2=0.947). Within the GS group under the DN condition, analysis revealed that MS was significantly higher at rest compared to post-5min (p<0.001), post-24h (p<0.001) and post-7d (p<0.001). Additionally, MS at post-24h was significantly lower than at post-5min (p=0.009). No significant differences were observed in MS within the GS group across the time points in the shamDN condition. MS was significantly greater in the GS shamDN condition compared to the DN condition at post-5min (p=0.007), post-24h (p<0.001), and post-7d (p<0.001).
Similarly, within the GH group, comparisons revealed significant differences in MS (F=6.985; p<0.001; ηp2=0.690). In the GH group under the DN condition, MS was significantly higher at post-24h compared to rest (p=0.013), and post-5min (p<0.001). No significant differences in MS were observed within the GH group across the time points in the shamDN condition. No significant differences in MS were found between the GH group’s shamDN and DN conditions at any time point.
PPT
Significant interactions (time and groups) were observed in the PPT (F=30.638; p<0.001; ηp2=0.522).
Within the GS group, comparisons revealed significant differences in PPT (F=45.448; p<0.001; ηp2=0.935). Within the GS group under the DN condition, analysis revealed that PPT was significantly smaller at rest compared to post-5min (p<0.001), post-24h (p<0.001) and post-7d (p<0.001). Additionally, PPT at post-5min was significantly lower than at post-24h (p=0.001) and post-7d (p<0.001). Finally, PPT at post-24h was significantly lower than at post-7d (p<0.001). In the shamDN condition, PPT at rest was significantly lower than at post-5min (p<0.001) and post-24h (p<0.001). Significant smaller PPT was found in DN than in shamDN conditions in the GS group at post-24h (p=0.001) and post-7d (p=0.001).
Similarly, within the GH group, comparisons revealed significant differences in PPT (F=38.944; p<0.001; ηp2=0.925). In the GH group under the DN condition, PPT was significantly lower at post-24h compared to rest (p<0.001), and post-5min (p<0.001) and post-7d (p<0.001). Additionally, PPT at post-7d was significantly higher than at rest (p<0.001), and post-5min (p<0.001). PPT at post-5min was also significantly lower than at rest (p=0.001). Interestingly, in the shamDN condition, the GH group had significantly higher PPT at post-5min compared to rest (p<0.001). In the GH group, PPT was significantly higher in the shamDN condition compared to the DN condition at post-24h (p<0.001), whereas at post-7d, PPT was lower in the shamDN condition than in the DN condition (p<0.001).
Maximal force
Significant interactions (time and groups) were observed in the Fmax (F=4.996; p=0.016; ηp2=0.151). Within the GS group, comparisons revealed significant differences in Fmax (F=55.730; p<0.001; ηp2=0.947). Within the GS group under the DN condition, analysis revealed that Fmax was significantly greater at post-7d compared to rest (p<0.001), and post-5min (p<0.001). Additionally, PPT at post-24h was significantly greater than at post-5min (p=0.039). In the shamDN condition, Fmax at rest was significantly lower than at post-5min (p<0.001), post-24h (p<0.001), and post-7d (p<0.001). No significant differences were observed between the GS shamDN and DN conditions at any time point (p>0.05).
Similarly, within the GH group, comparisons revealed significant differences in Fmax (F=11.963; p<0.001; ηp2=0.792). In the GH group under the DN condition, Fmax was significantly lower at rest compared to post-7d (p=0.013). Additionally, Fmax at post-24h was significantly smaller than at post-7d (p<0.001). In the shamDN condition, the GH group had significantly smaller Fmax at rest compared to post-24h (p=0.036). No significant differences were observed between the GS shamDN and DN conditions at any time point (p>0.05).
Perfusion
Significant interactions (time and groups) were observed in the, PU (F=12.683; p<0.001; ηp2=0.312). For the PU variable in the DN condition, GH showed significantly higher values than GS at both post-5min (F=28.349; p<0.001; ηp2=0.503) and post-7d (F=26.961; p<0.001; ηp2=0.491).
Within the GS group, comparisons revealed significant differences in PU (F=45.715; p<0.001; ηp2=0.936). Within the GS group under the DN condition, analysis revealed that PU was significantly smaller at rest compared to post-5min (p<0.001), post-24h (p<0.001) and post-7d (p=0.007). Additionally, PU at post-24 was significantly greater than at post-5min (p=0.001) and post-7d (p<0.001). Finally, PU at post-5min was significantly greater than at post-7d (p<0.001). In the shamDN condition, PU at rest was significantly lower than at post-24 (p<0.001), while PU was significantly smaller at post-5min compared to post-24h (p=0.016). Significant smaller PU was found in shamDN than in DN conditions in the GS group at post-5min (p=0.001), post-24h (p<0.001) and post-7d (p=0.004).
Similarly, within the GH group, comparisons revealed significant differences in PU (F=40.428; p<0.001; ηp2=0.928). In the GH group under the DN condition, PU was significantly lower at rest compared to post-5min (p<0.001), post-24h (p<0.001) and post-7d (p<0.001). Additionally, PU at post-5min was significantly higher than at post-24h (p<0.001), and post-24h (p<0.001). PU at post-24h was also significantly greater than at post-7d (p=0.001). In the shamDN condition, no significant differences of PU were found comparing the different time points. In the GH group, PU was significantly higher in the DN condition compared to the shamDN condition at post-5min (p<0.001), post-24h (p<0.001) and post-24h.
PDS
Significant interactions (time and groups) were observed in the PDS (F=51.978; p<0.001; ηp2=0.650). PDS in the DN condition, GS showed significantly higher values than GH at post-5min (F=43.750; p<0.001; ηp2=0.610) and post-24h (F=68.600; p<0.001; ηp2=0.710).
Regarding the PDS variable, comparisons between time points under the DN condition for the GS group revealed that values at rest were significantly lower compared to post-5min (p<0.001) and post-24h (p<0.001). Additionally, values at post-7d were significantly lower than at post-5min (p<0.001) and post-24h (p<0.001). Comparisons of PDS between the shamDN and DN conditions in the GS group revealed significantly higher values in the DN condition at post-5min (p<0.001) and post-24h (p<0.001).
Within the GS group, comparisons revealed significant differences in PDS (F=114.091; p<0.001; ηp2=0.894). In the GH group, no significant differences in PDS were found between time points in either the DN (p>0.05) or shamDN (p>0.05) conditions. Additionally, no differences were observed between the shamDN and DN conditions at the same time points (p>0.05).
Adverse events
Table 5 summarizes the minor adverse effects reported immediately after the interventions and 24 hours later. It shows that in the GH group, 33.3% of participants reported increased pain immediately after the intervention, with this number rising to 73.3% 24 hours later. In the GS group, 6.7% reported increased pain immediately after the session, which increased to 13.3% 24 hours later.
Additionally, although no small hematomas were reported immediately after the session in both GH and GS groups, 40.0% of participants in the GH group had small hematomas 24 hours later, compared to just 13.3% in the GS group. Burning sensations were reported exclusively by participants in the GH group, affecting 20.0% of participants both immediately after the intervention and 24 hours later.
Fatigue was reported by 20.0% of GH participants 24 hours after the session, while only 6.7% of GS participants reported fatigue at the same time. Fainting was observed in GH participants 24 hours after the intervention, while no fainting was reported in the GS group.
DISCUSSION
The study revealed significant interactions between time and group across the different outcomes, indicating differential responses to GH and GS in managing myofascial neck pain. The GS group was consistently better than the GH group, showing greater reductions in MT and MS, increased PPT, and improved Fmax over time, particularly in the DN condition. In contrast, the GH group exhibited delayed or less pronounced improvements, with some measures like PU showing higher immediate responses but less sustained benefits. The shamDN condition showed minimal improvements across both groups, reinforcing the efficacy of actual DN therapy. Additionally, the GS group experienced fewer MAEs, suggesting better safety and tolerability.
MT and MS
The study showed that MT and MS significantly reduced in the GS group compared to the GH group across various time points in the DN condition. The GS method showed consistent decreases in MT and MS post-5min, post-24h, and post-7d, whereas the GH group exhibited higher MT and MS values at post-24h and post-7d, indicating less effective outcomes. Within-group comparisons highlighted that the GS method led to significant and sustained reductions in MT and MS over time, while the GH method’s improvements were less consistent. The GS method’s superior outcomes may be due to its sustained needle retention strategy, which facilitates LTRs that help release MT and improve muscle flexibility [7]. This approach likely optimizes the mechanical and neurological responses necessary for effective treatment [44]. In contrast, the GH method’s rapid needle insertions may insufficiently trigger these responses. DN’s efficacy over shamDN is supported by its ability to induce LTRs, reduce nociceptive substances, and enhance local blood flow, thereby promoting tissue repair and reducing MT and MS [45], being our results aligned with previous studies considering the effects of DN in neck pain.
PPT
The study showed that the GS method resulted in significantly higher PPT values compared to the GH method at post-5min, post-24h, and post-7d in the DN condition, indicating more effective pain relief. Within-group analysis showed that PPT improved over time in both groups, but the GS method consistently outperformed the GH method. The enhanced PPT in the GS group can be attributed to the sustained needle insertion technique, which may provide more consistent mechanical and biochemical stimulation of MTrPs, leading to better modulation of nociceptive pathways [2]. This prolonged engagement likely enhances endogenous pain inhibitory mechanisms, resulting in greater pain relief than the multiple rapid insertions used in the GH method [46]. The significant difference between DN and shamDN conditions supports the physiological effectiveness of DN in reducing pain through neuromodulation and localized muscle relaxation, which have been confirmed in previous studies in neck pain [47].
Maximal force
The study indicated that Fmax improvements were not significantly greater in the DN condition compared to the shamDN condition, being different from previous studies [48]. These results suggest that while DN may have some impact on muscle strength recovery, it was not more effective than the shamDN condition in enhancing Fmax as observed in evaluations carried out in athletes [7]. The lack of substantial differences between DN and shamDN in Fmax improvements might be due to the nature of the strength measurement, which can be influenced by multiple factors, including neural adaptation and muscle fatigue [49]. It is possible that the interventions did not sufficiently activate the neuromuscular mechanisms necessary for significant strength improvements.
Perfusion
In both the GS and GH groups, DN was associated with significant changes in PU over time. In the GS group, DN led to a transient increase in tissue perfusion, with PU being significantly higher at post-24h compared to post-5min and post-7d, and smaller than at rest. This suggests that DN might temporarily enhance blood flow, promoting tissue recovery [50]. Importantly, the DN condition showed smaller PU compared to shamDN at all time points, indicating that the mechanical effects of needling itself, rather than placebo, played a key role in these changes. In the GH group, DN consistently increased PU at all post-needling time points compared to rest, with the greatest values observed at post-5min, suggesting an immediate effect on blood flow. Between-group analysis revealed that the GH method was more effective than the GS method at post-5 minutes, but no differences were observed at the remaining time points.
The observed changes in PU in both the GS and GH groups suggest that DN influences tissue perfusion primarily through the induction of local vasodilation [51]. In the GS group, DN led to a transient increase in blood flow, with PU at post-24h being higher than post-5min and post-7d but still smaller than at rest, indicating that DN initially enhances circulation, but the effects diminish over time. The higher PU observed in the DN condition compared to shamDN across all time points underscores the mechanical effect of needling, such as needle-induced microtrauma and muscle stimulation, which likely activates local vasodilation and enhances perfusion [51]. In the GH group, DN consistently increased PU at all post-needling time points, with the greatest effect at post-5min, suggesting a stronger or more immediate vasodilatory response, potentially due to deeper tissue penetration or a different mechanical response from the GH method. This sustained increase in blood flow might contribute to better nutrient and oxygen delivery to tissues, aiding in muscle recovery [52]. However, between-group analysis revealed that the GH method showed a stronger effect at post-5min, while differences between methods became less pronounced over time, indicating that both techniques may induce similar physiological effects in the long term.
PDS
The results from the PDS indicate that the GS group experienced significant changes in tissue perfusion following DN, with a marked increase in PDS at post-24h compared to post-5min and post-7d, suggesting a transient enhancement of blood flow. This increase in perfusion may reflect the vasodilatory effects of DN, promoting improved circulation and tissue recovery [51]. The smaller PDS in the shamDN group compared to the DN group across all time points further supports the hypothesis that the mechanical stimulation from needling, rather than placebo effects, contributed to these changes. In contrast, the GH group did not exhibit significant changes in PDS at any time point, nor were there differences between DN and shamDN conditions. This lack of response could be attributed to various factors, such as the possibility that the deeper needling technique used in the GH method did not induce the expected local microvascular changes or that the time frame for observing such effects may differ. This suggests that the technique may influence the magnitude and timing of these effects, warranting further investigation into optimal parameters for maximizing vascular response.
Adverse effects
In this study, the GH group experienced a higher frequency of adverse effects compared to the GS group, both immediately post-session and 24 hours later. These differences can likely be attributed to the more intense and invasive nature of the GH method, which involves deeper needle insertions and may cause greater mechanical irritation. In contrast, the GS method, being less invasive, resulted in fewer side effects, suggesting that it may be a safer alternative for individuals who are more sensitive to discomfort or disposed to adverse reactions.
Study limitations, future research and practical applications
This study had some limitations that should be considered when interpreting the findings and planning future research. First, the sample size may limit the generalizability of the results, as larger and more diverse populations (e.g., older) could provide more robust evidence of the differential effects between the GS and GH methods. Additionally, the study focused on short- and medium-term outcomes (5 minutes, 24 hours, and 7 days post-treatment), which leaves unclear the long-term efficacy of these techniques in managing myofascial neck pain. Moreover, the relatively high number of needle insertions (averaging 40) may contribute to the observed outcome trends, potentially introducing procedural bias. Future comparative studies should standardize or account for the recommended number of insertions per technique to ensure methodological consistency and achieve a balanced evaluation. Additionally, future studies could explore the long-term effects of GS and GH methods, particularly regarding the duration of pain relief. Furthermore, while the study observed significant differences in several outcome measures, the lack of significant findings in some areas, such as Fmax improvements, suggests the need for further investigation into the physiological mechanisms underlying these outcomes, as other factors like neural adaptation or muscle fatigue may have influenced the results. Finally, the higher incidence of adverse events in the GH group suggests that the method may carry more risk, and future research should focus on refining techniques to reduce discomfort and enhance safety, potentially incorporating personalized approaches to treatment based on patient sensitivity.
Despite these limitations, the results of the current study suggest that the GS method is more effective and safer than the GH method in reducing MT and MS, improving PPT, and enhancing local tissue perfusion. This indicates that the GS method may be a better option for patients suffering from myofascial pain. Clinicians may consider adopting the GS approach, particularly for patients who experience more pronounced pain or are sensitive to deeper, more invasive needling techniques. The consistent reductions in MT and pain observed with the GS method also highlight its potential for providing longer-lasting benefits, making it a viable option for patients seeking sustained relief from chronic neck pain. Additionally, the lower incidence of adverse events in the GS group highlights its better tolerability, which could lead to improved patient compliance and satisfaction. For clinicians, this study advocates for a careful selection of the needling technique based on the patient’s condition, sensitivity, and response to treatment, which could optimize therapeutic outcomes and minimize risks.
Conclusions
The findings of this study reveal that the GS method is more effective than the GH method in managing myofascial neck pain, particularly in reducing MT and MS, improving PPT, and enhancing local tissue perfusion. The GS approach’s superior outcomes are likely due to its sustained needle retention strategy, which facilitates more consistent mechanical and neurological responses, leading to better pain relief. Additionally, the GS method was associated with fewer adverse events, highlighting its better safety profile and tolerability. While both DN techniques showed generally greater efficacy than shamDN, the GH method’s results were less consistent and more disposed to delayed improvements. These findings support the clinical use of the GS method as a safer and more effective treatment option for individuals with myofascial pain, emphasizing the importance of individualized treatment approaches based on individual patient needs. Further research is needed to explore the long-term effects and underlying mechanisms of these interventions.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING INFORMATION
None.
AUTHOR CONTRIBUTION
Conceptualization: Olaniszyn G. Data curation: Olaniszyn G, Trybulski R. Investigation: Olaniszyn G, Kużdżał A, Kawczyński A, Matuszczyk F, Gałęziok K. Methodology: Olaniszyn G, Kużdżał A, Kawczyński A, Matuszczyk F, Gałęziok K. Formal analysis: Clemente FM. Project administration: Trybulski R. Resources: Olaniszyn G. Software: Olaniszyn G. Visualization: Clemente FM, Trybulski R. Supervision: Trybulski R. Writing – original draft: Olaniszyn G, Kużdżał A, Kawczyński A, Matuszczyk F, Gałęziok K, Clemente FM, Trybulski R. Writing – review and editing: Olaniszyn G, Kużdżał A, Kawczyński A, Matuszczyk F, Gałęziok K, Clemente FM, Trybulski R. Approval of final manuscript: all authors.
Fig. 1.
(A) Traditional acupuncture needle used in dry needling. (B) Telescopic needle sham therapy.
Fig. 2.
Measurement of maximum isometric strength using the Kinvent K-Force Push v 3 handheld dynamometer.
Fig. 3.
Power Doppler Score (II degree).
Fig. 4.
Participants flowchart.
Fig. 5.
Mean and standard deviation of muscle tension (MT), muscle stiffness (MS), pressure pain threshold (PPT), muscle strength (Fmax), perfusion response (PU), and Power Doppler Score (PDS) at rest, 5 minutes post-DN session (post-5min), 24 hours post-session (post-24h), and 7 days post-session (post-7d) in both conditions (dry needling, DN; sham dry needling, shamDN) for the Hong method (GH) and sustained insertion DN (GS) groups. *Significantly different between DN and shamDN in the GH group (p<0.05), using the Bonferroni correction for multiple comparisons within the group (i.e., 6 comparisons). #Significantly different between DN and shamDN in GS group (p<0.05), using the Bonferroni correction for multiple comparisons within the group (i.e., 6 comparisons).
Table 1.
Demographic characteristics and anthropometric data of the participants
*A significant difference was observed between group, representing a between-group comparison in each time points (p<0.05).
Table 5.
Description of minor adverse effects reported immediately after the interventions and 24 hours later
GH
GH
GS
GS
Immediately after the session
After 24-h
Immediately after the session
After 24-h
Small hematoma
0
6
0
2
Increased pain
5
11
1
2
Fatigue
0
3
0
1
Burning
3
3
0
0
Fainting
0
2
0
0
Values are presented as number only.
GH, Hong method; GS, sustained insertion dry needling.
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Comparing Multiple Versus Sustained Insertion Dry Needling Therapy for Myofascial Neck Pain: A Randomized Controlled Trial
Fig. 1. (A) Traditional acupuncture needle used in dry needling. (B) Telescopic needle sham therapy.
Fig. 2. Measurement of maximum isometric strength using the Kinvent K-Force Push v 3 handheld dynamometer.
Fig. 3. Power Doppler Score (II degree).
Fig. 4. Participants flowchart.
Fig. 5. Mean and standard deviation of muscle tension (MT), muscle stiffness (MS), pressure pain threshold (PPT), muscle strength (Fmax), perfusion response (PU), and Power Doppler Score (PDS) at rest, 5 minutes post-DN session (post-5min), 24 hours post-session (post-24h), and 7 days post-session (post-7d) in both conditions (dry needling, DN; sham dry needling, shamDN) for the Hong method (GH) and sustained insertion DN (GS) groups. *Significantly different between DN and shamDN in the GH group (p<0.05), using the Bonferroni correction for multiple comparisons within the group (i.e., 6 comparisons). #Significantly different between DN and shamDN in GS group (p<0.05), using the Bonferroni correction for multiple comparisons within the group (i.e., 6 comparisons).
Graphical abstract
Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
Graphical abstract
Comparing Multiple Versus Sustained Insertion Dry Needling Therapy for Myofascial Neck Pain: A Randomized Controlled Trial
GS (n=15)
GS (n=15)
GH (n=15)
GH (n=15)
p-value
DN
ShamDN
DN
ShamDN
Male
10
10
-
Female
5
5
-
Age (yr)
31.9±5.1
31.4±5.8
0.791
Body mass (kg)
79.9±13.0
78.3±14.3
0.912
Height (cm)
175.9±9.1
175.5±10.5
0.761
Body mass index (kg/m2)
26.3±3.0
24.2±1.9
0.029*
NPRS (A.U.)
5.13±0.99
5.53±1.06
0.294
MT rest (Hz)
19.6±0.8
19.6±0.8
18.8±0.7
18.7±0.6
GS vs. GH: F=8.168; p=0.008*; =0.226
GSsham vs. GHsham: F=15.462; p=0.001*;=0.356
MS rest (N/m)
346.5±19.2
350.9±17.8
346.2±23.6
348.9±25.8
GS vs. GH: F=0.001; p=0.973; =0.001
GSsham vs. GHsham: F=0.061; p=0.807; =0.002
PPT rest (N/cm)
79.0±6.4
79.5±4.2
82.1±3.2
80.8±2.8
GS vs. GH: F=2.952; p=0.097; =0.095
GSsham vs. GHsham: F=0.977; p=0.331; =0.034
Fmax rest (kgf)
30.1±5.1
31.9±3.5
33.1±3.1
32.2±3.6
GS vs. GH: F=3.924; p=0.057; =0.123
GSsham vs. GHsham: F=0.057; p=0.812; =0.002
PU rest (A.U.)
8.2±0.7
8.0±0.8
8.5±0.7
8.3±0.6
GS vs. GH: F=1.144; p=0.294; =0.039
GSsham vs. GHsham: F=1.206; p=0.282; =0.041
PDS rest (A.U.)
0.0
0.0
0.0
0.0
-
GS (n=15)
GS (n=15)
GH (n=15)
GH (n=15)
Mixed ANOVA (time×group)
Between-group comparisons
Between-group comparisons
DN
ShamDN
DN
ShamDN
DN
ShamDN
MT (Hz)
Post-5min
17.7±0.6
19.5±0.8
17.4±0.9
18.4±0.5
F=75.562; p<0.001*; =0.730
F=0.891; p=0.353; =0.031
F=20.371; p<0.001*; =0.421
Post-24h
16.4±0.7
19.5±0.7
20.5±0.7
18.4±0.5
F=255.377; p<0.001*; =0.901
F=25.131; p<0.001*; =0.473
Post-7d
17.1±0.4
19.5±0.8
17.7±0.3
18.7±0.6
F=18.906; p<0.001*; =0.403
F=10.108; p=0.004*; =0.265
MS (N/m)
Post-5min
315.7±15.4
347.1±16.8
332.0±33.9
335.5±30.9
F=20.701; p<0.001*; =0.425
F=2.886; p=0.100; =0.093
F=1.634; p=0.212 =0.055
Post-24h
294.5±10.0
348.7±17.6
357.2±19.1
346.3±21.9
F=127.339; p<0.001*; =0.820
F=0.109; p=0.743 =0.004
Post-7d
304.1±6.8
351.0±16.5
339.3±34.8
353.1±38.7
F=14.830; p=0.001*; =0.346
F=0.036; p=0.850; =0.001
PPT (N/cm)
Post-5min
82.8±5.8
81.6±4.2
79.1±2.8
82.5±3.2
F=30.638; p<0.001*; =0.522
F=4.786; p=0.037*; =0.146
F=0.491; p=0.489; =0.017
Post-24h
88.6±6.3
82.6±3.9
72.7±3.9
83.1±3.4
F=68.312; p<0.001*; =0.709
F=0.167; p=0.686; =0.006
Post-7d
94.8±4.6
81.3±3.8
88.7±3.7
83.0±4.0
F=16.201; p<0.001*; =0.367
F=1.419; p=0.244; =0.048
Fmax (kgf)
Post-5min
32.6±4.2
33.1±3.1
33.4±3.3
32.5±3.5
F=4.996; p=0.016*; =0.151
F=0.303; p=0.586; =0.011
F=0.267; p=0.609; =0.009
Post-24h
35.1±4.5
32.8±3.3
31.5±3.1
32.6±3.8
F=6.330; p=0.018*; =0.184
F=0.021; p=0.887; =0.001
Post-7d
36.1±4.6
33.0±3.0
35.0±2.4
32.8±3.7
F=0.692; p=0.412; =0.024
F=0.017; p=0.898; =0.001
PU (A.U.)
Post-5min
10.6±1.0
8.1±0.8
12.8±1.2
8.3±0.5
F=12.683; p<0.001*; =0.312
F=28.349; p<0.001*; =0.503
F=0.803; p=0.378; =0.028
Post-24h
11.6±0.9
8.2±0.8
11.6±0.5
8.3±0.6
F=0.031; p=0.861; =0.001
F=0.058; p=0.811; =0.002
Post-7d
8.9±0.6
8.1±0.7
10.0±0.5
8.3±0.5
F=26.961; p<0.001*; =0.491
F=0.736; p=0.398; =0.026
PDS (A.U.)
F=51.978; p<0.001*; =0.650
Post-5min
1.2±0.4
0.0
0.2±0.4
0.0
F=43.750; p<0.001*; =0.610
-
Post-24h
1.6±0.5
0.0
0.2±0.4
0.0
F=68.600; p<0.001*; =0.710
-
Post-7d
0
0.0
0.0
0.0
-
-
GS
GSsham
GH
GHsham
MT (Hz)
Rest vs. post-5min
p<0.001*
p=0.374
p<0.001*
p=0.003*
Rest vs. post-24h
p<0.001*
p>0.999
p<0.001*
p=0.275
Rest vs. post-7d
p<0.001*
p>0.999
p<0.001*
p>0.999
Post-5min vs. post-24h
p=0.004*
p>0.999
p<0.001*
p>0.999
Post-5min vs. post-7d
p=0.357
p>0.999
p>0.999
p=0.110
Post-24h vs. post-7d
p=0.012*
p>0.999
p<0.001*
p=0.086
MS (N/m)
Rest vs. post-5min
p<0.001*
p>0.999
p=0.208
p=0.305
Rest vs. post-24h
p<0.001*
p>0.999
p=0.013*
p>0.999
Rest vs. post-7d
p<0.001*
p>0.999
p>0.999
p>0.999
Post-5min vs. post-24h
p=0.009*
p>0.999
p=0.001*
p=0.756
Post-5min vs. post-7d
p>0.999
p>0.999
p>0.999
p=0.347
Post-24h vs. post-7d
p>0.999
p>0.999
p=0.078
p>0.999
PPT (N/cm)
Rest vs. post-5min
p<0.001*
p<0.001*
p=0.001*
p<0.001*
Rest vs. post-24h
p<0.001*
p<0.001*
p<0.001*
p=0.022*
Rest vs. post-7d
p<0.001*
p=0.379
p<0.001*
p=0.082
Post-5min vs. post-24h
p<0.001*
p>0.999
p<0.001*
p>0.999
Post-5min vs. post-7d
p<0.001*
p>0.999
p<0.001*
p>0.999
Post-24h vs. post-7d
p<0.001*
p=0.101
p<0.001*
p>0.999
Fmax (kgf)
Rest vs. post-5min
p=0.002*
p<0.001*
p>0.999
p=0.863
Rest vs. post-24h
p<0.001*
p<0.001*
p=0.324
p=0.036*
Rest vs. post-7d
p<0.001*
p=0.001*
p=0.013*
p=0.293
Post-5min vs. post-24h
p=0.039
p=0.615
p=0.330
p>0.999
Post-5min vs. post-7d
p<0.001*
p>0.999
p=0.181
p>0.999
Post-24h vs. post-7d
p>0.999
p>0.999
p>0.999
p>0.999
PU (A.U.)
Rest vs. post-5min
p<0.001*
>0.999
p<0.001*
p>0.999
Rest vs. post-24h
p<0.001*
p<0.001*
p<0.001*
p>0.999
Rest vs. post-7d
p=0.007*
p=0.671
p<0.001*
p>0.999
Post-5min vs. post-24h
p<0.001*
p=0.016
p<0.001*
p>0.999
Post-5min vs. post-7d
p<0.001*
p>0.999
p<0.001*
p>0.999
Post-24h vs. post-7d
p<0.001*
p=0.210
p<0.001*
p>0.999
PDS (A.U.)
Rest vs. post-5min
p<0.001*
Not applicable
p>0.999
Not applicable
Rest vs. post-24h
p<0.001*
Not applicable
p>0.999
Not applicable
Rest vs. post-7d
Not applicable
Not applicable
p>0.999
Not applicable
Post-5min vs. post-24h
p=0.168
Not applicable
p>0.999
Not applicable
Post-5min vs. post-7d
p<0.001*
Not applicable
p>0.999
Not applicable
Post-24h vs. post-7d
p<0.001*
Not applicable
p>0.999
Not applicable
GS vs. GH
GSsham vs. GHsham
MT (Hz)
Rest
p=0.008
p<0.001*
Post-5min
p=0.353
p<0.001*
Post-24h
p<0.001*
p<0.001*
Post-7d
p<0.001*
p=0.004*
MS (N/m)
Rest
p=0.973
p=0.807
Post-5min
p=0.100
p=0.212
Post-24h
p<0.001*
p=0.743
Post-7d
p<0.001*
p=0.850
PPT (N/cm)
Rest
p=0.097
p=0.331
Post-5min
p=0.037
p=0.489
Post-24h
p<0.001*
p=0.686
Post-7d
p<0.001*
p=0.244
Fmax (kgf)
Rest
p=0.057
p=0.812
Post-5min
p=0.586
p=0.609
Post-24h
p=0.018
p=0.887
Post-7d
p=0.412
p=0.898
PU (A.U.)
Rest
p=0.294
p=0.282
Post-5min
p<0.001*
p=0.378
Post-24h
p=0.861
p=0.811
Post-7d
p<0.001*
p=0.398
PDS (A.U.)
Rest
Not applicable
Not applicable
Post-5min
p<0.001*
Not applicable
Post-24h
p<0.001*
Not applicable
Post-7d
Not applicable
Not applicable
GH
GH
GS
GS
Immediately after the session
After 24-h
Immediately after the session
After 24-h
Small hematoma
0
6
0
2
Increased pain
5
11
1
2
Fatigue
0
3
0
1
Burning
3
3
0
0
Fainting
0
2
0
0
Table 1. Demographic characteristics and anthropometric data of the participants
Values are presented as number only or mean±standard deviation.
Table 3. Post hoc comparisons using the Bonferroni correction for multiple comparisons, illustrating within-group variations across different time points
, Adrian Kużdżał, PhD3
