Research Article
Volume 13 Issue 3 - 2022
Clinical Research Report of the Intricate Application of Dry Needling in Eliciting Trigger Points Local Twitch Response (TP-LTR) in the Upper Trapezius (UT) Region

Masahiro Takakura1, Jessica Norton2, Sharon Blaney3 and Nicholas A Kerna4,5*

1Seattle Nature Cure Clinic, Seattle, WA, United States
2Integrative Medicine Group, Seattle, WA, United States
3Bastyr University, Kenmore, WA, United States
4SMC-Medical Research, Thailand
5First InterHealth Group, Thailand

*Corresponding Author: Nicholas A Kerna, (mailing address) POB47 Phatphong, Suriwongse Road, Bangkok, Thailand 10500. Contact:
Received: January 04, 2021; Published: February 28, 2022


Background: No past studies have examined the local twitch response (LTR) in the upper trapezius (UT), using multiple needles with manipulation. Prior and published research studies have focused primarily on a single-needle approach.

Purpose: This study was designed and performed to collect data on the LTR and its relationship to the number of (acupuncture or dry needling) needles that create biotensegrity tension in neuro-myofascial dynamics (to ultimately bring about relief from UT tension and related symptoms).

Methods: Data were gathered from qualified clinic patients and volunteers from a study population. All selected study participants were experiencing increased upper trapezius (UT) tension and pain or discomfort in the UT region. Certified practitioners located possible trigger points (TPs) by palpation. Treatment procedures—utilizing Ashi points—were applied. The subsequent data were evaluated to determine the most efficacious number and size of needles in effecting biotensegrity tension in neuro-myofascial dynamics and the subjects’ release or relief from UT tension.

Results: Based primarily on pre-treatment and post-treatment interviews and questionnaires, the results were analyzed using statistical bar graphs (tables). Primary data utilized determined the following. The average number of needles used was 3.15 for the right side and 2.73 for the left side. The average thrusts were 18 for the right side and 12.9 for the left side. The average number of 90-degree twists was 0.5 for the right side and 0.8 for the left side. The average number of 180-degree twists was 18.4 for the right side and 12.05 for the left side. The average duration of relief was 5.475 days, and the average duration of soreness was 16.2 hours.

Conclusion: Specific results of this study depicted a 3-D neuro-myofascial dynamics matrix using multiple needles, multiple thrusts and twists, and multiple LTR locations. These results demonstrated that overall and on average, multiple needling with larger gauge needles (based on participants’ tolerances) was more effective in reducing UT tension and associated symptoms (and longer-lasting relief) than the more conventional and utilized one-needle protocol.

Keywords: Acupuncture; Anti-Inflammatory; Biotensegrity; Dry-Needling; Manipulation; Motor Points; Neuro-Myofascial


  1. Abbaszadeh-Amirdehi M., et al. “The neurophysiological effects of dry needling in patients with upper trapezius myofascial trigger points: study protocol of a controlled clinical trial”. BMJ Open (2013): 3.
  2. Cruz-Montecinos C., et al. “Qualitative ultrasonography scale of the intensity of local twitch response during dry needling and its association with modified joint range of motion: a cross-sectional study”. BMC Musculoskeletal Disorders1 (2021): 790.
  3. Perreault T., et al. “The local twitch response during trigger point dry needling: Is it necessary for successful outcomes?” Journal of Bodywork and Movement Therapies4 (2017): 940-947.
  4. Hakim IK., et al. “The effect of dry needling on the active trigger point of upper trapezius muscle: Eliciting local twitch response on long-term clinical outcomes”. Journal of Back and Musculoskeletal Rehabilitation5 (2019): 717-724.
  5. Shah JP., et al. “Myofascial trigger points then and now: a historical and scientific perspective”. PMR 7 (2015): 746-761.
  6. Travell JD and Simons DG. “Myofascial pain and dysfunction: the trigger point manual”. Baltimore: Williams and Wilkins (1983): 59-63.,_the_trigger_point.26.aspx
  7. Simons DG., et al. “Travell and Simons’ myofascial pain and dysfunction: The trigger point manual. Upper half of body, 2nd edition”. Baltimore: Lippincott Williams and Wilkins 1 (1999): 116-122.
  8. Hwang UJ., et al. “Predictors of upper trapezius pain with myofascial trigger points in food service workers: The STROBE study”. Medicine26 (2017): e7252.
  9. Lew J., et al. “Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis”. The Journal of Manual and Manipulative Therapy3 (2021): 136-146.
  10. Petterson S., et al. “Low-Intensity Continuous Ultrasound for the Symptomatic Treatment of Upper Shoulder and Neck Pain: A Randomized, Double-Blind Placebo-Controlled Clinical Trial”. Journal of Pain Research 13 (2020): 1277-1287.
  11. Tantanatip A and Chang KV. “Myofascial Pain Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2021).
  12. Binder AI. “Cervical spondylosis and neck pain”. British Medical Journal7592 (2007): 527-531.
  13. Lippa L., et al. “Loss of cervical lordosis: What is the prognosis?” Journal of Craniovertebral Junction Spine1 (2017): 9-14.
  14. Jafri MS. “Mechanisms of Myofascial Pain”. International Scholarly Research Notices (2014): 523924.
  15. Zhuang X., et al. “Understanding of myofascial trigger points”. Chinese Medical Journal24 (2014): 4271-4277.
  16. Partanen JV., et al. “Myofascial syndrome and pain: A neurophysiological approach”. Pathophysiology1 (2010): 19-28.
  17. Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior; Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): National Academies Press (US) (1987).
  18. Callison M. “Motor Point Index - An Acupuncturist's Guide to Locating and Treating Motor Points (Kindle Edition). Editors: Laurel Holloway, Ph.D., Stephanie Prady, M.Sc., M.Ac. April 24 (2012).
  19. Unverzagt C., et al. “DRY NEEDLING FOR MYOFASCIAL TRIGGER POINT PAIN: A CLINICAL COMMENTARY”. International Journal of Sports Physical Therapy3 (2015): 402-418.
  20. Gattie E., et al. “The Effectiveness of Trigger Point Dry Needling for Musculoskeletal Conditions by Physical Therapists: A Systematic Review and Meta-analysis”. Journal of Orthopaedic and Sports Physical Therapy3 (2017): 133-149.
  21. Domingo A. “Neuromuscular Damage and Repair After Dry Needling in Mice”. Evidence-based Complementary Alternative Medicine (2013).
  22. Besedovsky L., et al. “Sleep and immune function”. Pflügers Archive1 (2012): 121-137.
  23. Besedovsky L., et al. “The Sleep-Immune Crosstalk in Health and Disease”. Physiological Reviews3 (2019): 1325-1380.
  24. Ziaeifar M., et al. “The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle”. Journal of Bodywork and Movement Therapies2 (2014): 298-305.
  25. Moallemi SK., et al. “Diagnostic Value of Erythrocyte Sedimentation Rate and C Reactive Protein in detecting Diabetic Foot Osteomyelitis; a Cross-sectional Study”. Archives of Academic Emergency Medicine1 (2020): e71.
  26. Bordoni B., et al. “Myofascial Pain”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2021).
Citation: Takakura M, Norton J, Blaney S, Kerna NA.“Clinical Research Report of the Intricate Application of Dry Needling in Eliciting Trigger Points Local Twitch Response (TP-LTR) in the Upper Trapezius (UT) Region”. EC Orthopaedics 13.3 (2022): 63-78.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 15, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.