ACTIVIDADES REALIZADAS DURANTE EL MES DE MAYO

5.4.1 Numerical Pain Rating Scale (NPRS)

A) Intra-group analysis: NPRS

With regards to the intra-group analysis of the NPRS readings, the wilcoxon signed rank test was used to assess for changes in mean values over time for the two groups. As indicated in Table 4.16, both groups had statistically significant differences (p ≤ 0.05) between the 1st and 3rd, the 3rd and 5th visit as well as between the 1st and 5th visit.

As shown by the bar graph in figure 4.8, both group A and B showed improvement in mean values over all three readings. However, group A showed the greatest improvement with a total drop of 5.43 points from 6.53 points to 1.1 points, in comparison to group B which had a total drop of 1.73 points. This indicated that

86 applying kinesio tape® post dry needling (group A), showed the best results with regards to the NPRS mean values. It is once again it is important to note that this was found on intra group analysis and doesn’t compare changes between the groups; instead it finds the changes within each of the groups.

B) Inter-group analysis: NPRS

The Independent T Test, that tests for normality was inconclusive, therefore the Mann- Whitney U tests were used for the inter-group analysis to determine if there is a statistical significance between group A and B at their first, third and fifth treatments. It is shown in table 4.17, that there was no statistically significant difference between the two groups (p ≥ 0.05) at the first reading however there was a significant difference at the 3rd and 5th reading. This suggests that both groups improved on a similar level over the three readings after the first treatment.

5.4.2 Vernon Mior Neck Disability Index

A) Intra-group analysis: Vernon Mior Neck Disability Index

With regards to the intra-group analysis of the Vernon Mior Neck disability index, the wilcoxon signed rank test was used to assess for changes in mean values over time for the two groups. Table 4.18 indicates that both group A and B had statistically significant differences (p ≤ 0.05) between the 1st and 3rd

, the 3rd and 5th visit as well as between the 1st and 5th visit.

As shown in figure 4.9, both groups showed improvement in mean values over all three readings. However, group A showed the greatest improvement with a total drop of 14.26 from 19.73 to 5.47, in comparison to group B which had a total drop of 8. This indicated that the kinesio tape® post dry needling group (group A) showed the best results with regards to the Vernon Mior Neck disability index mean values.

87 B) Inter-group analysis: Vernon Mior Neck Disability Index

The Independent T Test, that tests for normality was inconclusive, therefore the Mann- Whitney U tests were used for the inter-group analysis to determine if there is a statistical significance between group A and B at their first, third and fifth treatments. It is shown in table 4.19, that there were no statistically significant differences between the three groups (p ≥ 0.05). This suggests that both groups improved on a similar level over the three readings.

C) Results Discussion

The improvement of pain seen in the NPRS and Vernon Mior Neck disability index can be explained by mechanical action of the needle causing a resolution of the hyperirritable spot within the muscle that causes the pain and dysfunction, by the inhibition of the Ach release and provides necessary energy in the form of ATP. Also stimulation of the A-delta sensory fibers blocks the pain pathway to the brain, providing pain relief (Cummings and White, 2001).

As mentioned in chapter 2 an immediate anaesthetic effect can be elicited through proper dry needling, known as the "needle effect”. Clinical evidence shows that this effect can be as effective as trigger point injection with medication (Raj and Paradise, 2004).

Dry needling causes mechanical disruption of the trigger point, inhibit nociception and provides pain relief by spinal cord pathway modulation, generalised neurohumoral stimulation and release of beta-endorphins or somatospecific dorsal horn enkephalins, which are responsible for pain reduction (Yap, 2007).

Mechanical disruption of abnormal functioning contractile elements or nerve endings which are sensory and motor components of the feedback loop responsible for sustaining trigger point activity (Hong, 1994). This relieves the tautness of the palpable

88 band of muscle fibers and the hyperirritability of the sensory nerves which are responsible for both the referred pain and local tenderness (Travell and Simons, 1983). The results are supported by a study done by Sterling, Valentin, Vicenzino, Souvlis and Connelly (2009), who investigated the effectiveness of dry needling, advice and exercise for chronic whiplash. They stated that dry needling will decrease pain intensity on visual analogue scale and on the Vernon- Mior Neck Pain and Disability Index in chronic whiplash by reducing hypersensitivity.

The slight increase in the improvement seen in the kinesio tape® post dry needling group could be explained by the added effect of the kinesio tape® which has been proposed to reduce pain by reducing the amount of irritation on the chemical receptors, increasing the level of circulation in the area, allowing for increased removal of exudates, stimulation of the mechanoreceptors that can aid in decreasing pain, by increasing sensory stimulation so that the gate control theory of pain inhibition may be initiated (Kase et al., 2003). This is further supported by Esposito and Philipson (2005), who proposed that kinesio tape® provides a mechanical stimulation via the skin, closing the gate to the nociceptive stimulation during their research on lower back pain.

In a study that investigated the effects of cervical kinesio taping® on pain and cervical range of motion in patients with acute whiplash injury, they indicated that the group receiving kinesio tape® experienced a greater decrease in pain immediately post application and at 24-hour follow up (Gonzalez-Iglasias, Fernandes-de-Las-Penas, Cleland, Huijbreyts and Del Rosario Gutierrez-Vega, 2009).

Due to the kinesio tape® being able to be worn for several days, it has a prolonged stimulation of the mechanoreceptors in the skin, thus prolonging the stimulation effect resulting in pain inhibition. Therefore when dry needling and kinesio tape® are combined, the effect may have a longer lasting effect and thus could be most effective in the treatment of myofascial trigger points.

89 CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS

6.1 Conclusion

The aim of the study was to investigate the effect that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and a decrease in the recovery time of the myofascial trigger points. Objective measurements in the form of an algometer and CROM device as well as subjective measurements in the form of NPRS and Vernon Mior Neck Disability Index were taken in order to investigate the extent of pain relief and to determine the effect which these modalities had on cervical range of motion.

It can be concluded that there were improvements within each of the groups as there were clinical significant differences within both of the groups on intra group analysis. Therefore, both groups showed an overall improvement over time with regards to the objective as well as the subjective results. However, on the inter group analysis with regards to the objective and subjective results varied on each measurement. Even though both groups improved on a relatively similar level there were clinical significant differences at the 5th reading of the algometer and flexion range of motion. There was also a clinical significant difference at the first readings of right lateral flexion, left rotation and right rotation range of motion. The numerical pain rating scale showed the greatest improvement by having clinical significant differences at the 3rd and 5th reading.

The kinesio tape® post dry needling group showed the greater improvement in all of the above measurements.

The conclusion related to this study would indicate that, although there were clinical significant improvements within both of the treatments, applying kinesio tape® post dry needling seemed to have a greater overall improvement and possibly enhanced the effects that dry needling has on the treatment of myofascial trigger points. The addition of the kinesio tape® may have also aided in the reduction of post dry needling soreness

90 caused by the dry needling therefore decreasing the overall recovery time of a myofascial trigger point.

The outcome of this particular study for the Chiropractic profession suggests that applying kinesio tape® over a myofascial trigger point post dry needling may be a superior treatment in the resolution of myofascial trigger points.