Effectiveness of trigger point dry needling for plantar heel pain

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Allied Health, Faculty of Health Sciences, La Trobe University, Bundoora.

Thesis with publications.

Aim: To evaluate the effectiveness of trigger point dry needling for plantar heel pain. Design: A systematic review of the literature was first conducted to evaluate the effectiveness of trigger point dry needling for plantar heel pain. This was followed by a Modified Delphi study to develop a consensus-driven trigger point dry needling treatment for plantar heel pain. Finally, a randomised controlled trial (RCT) was conducted to evaluate the effectiveness of trigger point dry needling for plantar heel pain. Setting: The modified Delphi Study was completed using the online survey tool SurveyMonkey® . The RCT was conducted at a university-based clinic. Participants: The Modified Delphi study included 30 experts in the use of trigger point dry needling. In the RCT, 84 participants with plantar heel pain were randomly allocated to a group that received either real or sham trigger point dry needling. Outcome measures: In the RCT, the primary outcome measures were a Visual Analogue Scale (VAS) and the Foot Health Status Questionnaire (FHSQ). Secondary outcome measures included the Depression, Anxiety and Stress Scale (DASS-21). Results: The results of the Modified Delphi study indicated that 93% of experts agreed with a consensus-driven dry needling treatment for plantar heel pain to be used in a RCT. In the RCT, significant effects favoured real trigger point dry needling over sham trigger point dry needling for pain at the primary end point of six weeks (adjusted mean difference: VAS first step pain -14.4mm, 95% CI -23.5 to -5.2; FHSQ foot pain 10.0 points, 95% CI 1.0 to 19.1), although the between group difference was lower than the minimal important difference. Conclusion: Dry needling provided statistically significant improvements in plantar heel pain but the magnitude of this effect was lower than what is considered clinically meaningful to people with plantar heel pain.