October 2023

Dry Needling versus Diacutaneous Fibrolysis for the Treatment of the Mechanical Properties of the Teres Major Muscle: A Randomized Clinical Trial

Authors: Luis Ceballos-Laita 1, Jose Jesus Jimenez-Rejano 2, Manuel Rebollo-Salas 2 , Maria Teresa Mingo-Gomez 1, Hector Hernandez-Lazaro 1, 3, Sandra Jimenez-del-Barrio 1


  1. Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology, Otorhinolaryngology, and Physiotherapy, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
  2. Department of Physiotherapy. University of Sevilla, 41004 Sevilla, Spain
  3. Olvega Primary Care Physiotherapy Unit, Soria Health Care Management, Castilla y Leon Regional Health Management (SACYL), 42110 Olvega, Spain

Journal: Applied Sciences - October 2023, Volume 13, Issue 19, Article no. 10995 (DOI: 10.3390/app131910995)

Background: The stiffness of the posterior shoulder muscles has been shown to be related to shoulder pain and range of motion (ROM) restriction in athletes. Specifically, the treatment of the teres major muscle showed promising results in previous studies. The aim of this study was to compare the effects of dry needling (DN) vs. diacutaneous fibrolysis (DF) to improve the stiffness and tone of the teres major muscle, pain intensity, shoulder ROM, and extensibility in the short-term and at one-week follow-up in handball athletes.

Methods: A randomized clinical trial with blinded examiners was carried out. Elite handball athletes with shoulder pain and glenohumeral internal rotation deficit (n = 30) were randomly allocated to the DN group or the DF group. Patients in both groups received a single treatment session directly applied to the teres major muscle. The primary outcome variables and instrument were mechanical properties of the teres major muscle (stiffness and tone) measured with myotonometry. The secondary outcome variables were intensity of shoulder pain evaluated with visual analogue scale and shoulder ROM and extensibility recorded with a digital inclinometer.

Results: No between-group differences were found after the intervention or at one-week follow-up in the mechanical properties of teres major muscle, pain intensity, shoulder ROM, or extensibility.

Conclusions: the DN and DF techniques showed similar results at both timepoints in elite handball athletes with shoulder pain and glenohumeral internal rotation deficits.


Keywords: shoulder pain, trigger points, dry needling, range of motion

The results found for the muscle stiffness and muscle tone of the teres major muscle after the application of the DN technique or the DF technique were similar after the intervention and at one-week follow-up and did not exceed the MDCs. Concerning the secondary outcomes, both groups achieved changes higher than the MDCs for shoulder ROM but without statistically significant differences between them at any timepoint. Thus, DN and DF seem to be effective interventions to modulate pain and improve shoulder ROM in handball athletes with shoulder pain and GIRD but not to modify the mechanical properties of the teres major muscle.