Myofascial Pain Syndrome (MPS) remains one of the most common musculoskeletal presentations in physiotherapy practice, characterized by hyperirritable spots in skeletal muscle known as myofascial trigger points (MTrPs). While dry needling and acupuncture are widely accepted interventions for MPS, debate persists regarding the optimal manipulation technique once the needle is inserted. Does active manipulation yield better physiological outcomes than static retention? A recent Randomized Controlled Trial (RCT) published in Acupuncture Research (2026) offers compelling evidence suggesting that the specific method of needle manipulation significantly impacts clinical efficacy and tissue properties.
Comparing Manipulation Strategies in MPS Treatment
The study, conducted by Zhu et al., sought to differentiate the effects of three distinct approaches: twisting, lifting-thrusting, and non-manipulation (static retention). The research team recruited 108 patients diagnosed with MPS and randomized them into three groups. The protocol involved treating MTrPs every other day for a total of three sessions.
The Twisting Group and Lifting-Thrusting Group received one minute of their respective manipulation techniques at the trigger point. Conversely, the Non-Manipulation Group simply had the needles retained for one minute without further agitation. To ensure objective measurement, the researchers utilized Short-Form McGill Pain Questionnaires (SF-MPQ) and Young’s modulus values via ultrasound elastography—a sophisticated method to quantify tissue stiffness—before and after treatments.
Superiority of Lifting-Thrusting Techniques
While all three groups demonstrated statistically significant improvements in pain scores and tissue stiffness post-treatment, the active manipulation groups outperformed the static retention group. Most notably, the lifting-thrusting technique emerged as the superior clinical intervention.
The total effective rate for the lifting-thrusting group was 84.85%, compared to 80.65% for twisting and only 66.67% for non-manipulation. Furthermore, the lifting-thrusting group showed significantly greater reductions in Visual Analog Scale (VAS) scores compared to the non-manipulation group. This suggests that the vertical agitation of the needle within the taut band may provide a more potent mechanical stimulus than rotational torque or static placement.
The Role of Twitch Response and Needle Grasp
For the orthopaedic manual therapist, the study’s findings regarding needling sensations are particularly relevant. The researchers monitored the Massachusetts Acupuncture Sensation Scale (MASS) and found a strong positive correlation between pain relief and specific physiological responses: twitching sensations and needle grasp (the practitioner’s sense of tissue tightness or de qi).
The lifting-thrusting technique was found to be more advantageous than twisting in eliciting these twitching sensations. The data indicates that pain relief was positively correlated with the intensity of distension and the frequency of twitch responses. This supports the common clinical heuristic that eliciting a Local Twitch Response (LTR) and achieving a sensation of tissue grasp are indicative of effective trigger point release.
Clinical Implications for Physiotherapists
This RCT provides high-quality evidence that static needle retention at MTrPs is inferior to active manipulation. To maximize reductions in tissue stiffness (Young’s modulus) and patient-reported pain, clinicians should prioritize active manipulation techniques. Specifically, utilizing a lifting-thrusting motion to elicit a strong needle grasp and twitch response appears to be the most efficacious protocol for treating Myofascial Pain Syndrome.
References
Zhu, M. R., Zhang, Q. A., Shao, X. M., He, L. L., Cai, J., Li, Y., Li, Z. R., & Lu, F. Y. (2026). Clinical efficacy of different needling manipulations in treatment of myofascial pain syndrome. Zhen ci yan jiu = Acupuncture research, Feb. https://pubmed.ncbi.nlm.nih.gov/41735069/
