Acute effects of one session dry needling on a chronic golfer’s elbow disability

What is it about?

A 40-year-old retired male elite athlete with more than 20 years’ experience in wrestling and bodybuilding with mild elbow pain and disability of 2 years presented to our clinic reporting an acute pain in medial aspect of the elbow. Physical examination revealed symptoms of left Golfer’s elbow during target-directed movements. The results of sonography in left elbow showed low level of hypo echo irregularity and increased blood flow in color Doppler mode in the common flexor origin. The pain amplitude was moderate at rest and extremely high during kinetic and intentional movements. During last 2 years, the patient tried different types of therapy including manual therapy, Transcutaneous electrical nerve stimulation and also received a variety of injections none of which were effective for reducing pain and disability. This is the first study showed that one sessions of dry needling improved both pain and disability and helped to return to a normal life and exercise training.

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Photo by Nappy on Unsplash

Photo by Nappy on Unsplash

Why is it important?

Physical therapy is a conservative management approach for the treatment of pain, disability and maximizing satisfaction in patients with lateral epicondylitis (Sevier and Wilson, 1999). Using modalities such as heat, dry needling, ultrasound and transcutaneous electrical nerve stimulation (TENS) has been recommended as an effective treatment for this population (Gattie et al., 2017). These treatments have been purported to increase soft tissue extensibility and blood flow along with reducing pain and muscle spasms (Sevier and Wilson, 1999). Dry needling is a technique in which a fine sterile needle is used to penetrate the skin, subcutaneous tissues, and muscle, with the intent to mechanically affect soft tissue without the use of an anesthetic (Venâncio et al., 2008). It is a common treatment technique in orthopaedic manual physical therapy (Dommerholt, 2011) and is often used to treat myofascial trigger points, which are described as localized hypersensitive spots in a palpable taut band of muscles (Geist et al., 2017). Dry needling might not change some central sensitization aspects, also it is probable that referred and local pain is reduced, range of motion and patterns of muscle activation is improved and trigger points’ of chemical environment is changed (Dommerholt, 2011). Randomized controlled studies have failed to demonstrate meaningful effects of dry needling for chronic elbow disability. Despite the availability of other strategies for continuous therapies that provide reasonable management of chronic elbow disabilities, some therapists continue to use intensive dry needling for long duration (Shanmugam et al., 2015). Local effects of dry needling have shown significant pain relief in musculoskeletal syndromes of the shoulder or elbow, but no study has evaluated the effect of dry needling on chronic Golfer’s elbow syndrome in a retired experienced athlete.

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