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Dry needling to improve hamstring muscle flexibility in athletes

Hamstring muscle flexibility is important because it optimizes musculoskeletal function and may prevent injury to the muscle. The most common way of improving muscle flexibility is through stretching, which has been shown to bring about viscoelastic and neurophysiological changes in the muscle.

In the clinical setting, acupuncture is routinely used to treat myofascial trigger points, which are commonly found in tight muscles. The aim of this study was to investigate whether the acupuncture technique referred to as superficial dry needling could improve hamstring muscle flexibility.

The literature reports that the hamstring is the most commonly injured muscle during sporting activity (O’Hora et al. 2011). Hamstring muscle flexibility is considered to be important in preventative and clinical rehabilitation programmes (Schuback et al. 2004; O’Hora et al. 2011).
Stretching exercises are recommended on the basis that they may prevent injuries (Schuback et al. 2004; O’Hora et al. 2011), improve athletic performance (Thacker et al. 2004), and improve muscle and joint flexibility (Thacker et al. 2004).

Flexibility varies between individuals, and it has been suggested that muscles spanning more than one joint are more at risk of injury (Davis et al. 2008).

The acupuncture technique known as dry needling is commonly used to treat myofascial pain and dysfunction (Baldry 2002a, b; Huguenin 2004). It is known as “dry” needling because no substance is injected (Baldry 2002a).

Acupuncture point selection:


Bladder (BL) 37 was selected as the acupuncture point employed in the present
study. In traditional Chinese medicine, the indications for using BL37 are sciatica, low
back pain, occipital headaches, and paralysis and numbness of the lower extremities (Ding 1991).

Bladder 37 was chosen because of its location over the hamstring muscle, and also because
it shows some correlation with the common MTPs of the hamstrings described by Travell & Simons (1992).

Acupuncture technique:
The acupuncture technique known as superficial dry needling was used.

The results of this research provide statistically significant evidence to support the use of this technique to improve hamstring muscle flexibility with stretching.


Bradnam-Roberts L. (2007) A physiological underpinning or treatment progression of Western acupuncture. Journal of the Acupuncture Association of Chartered Physiotherapists 2007 (Autumn), 25–33.

Baldry P. (2002a) Management of myofascial trigger point pain. Acupuncture in Medicine 20 (1), 2–10.

O’Hora J., Cartwright A., Wade C. D., Hough A. D. & Shum G. L. K. (2011) Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstrings length after a single session. The Journal of Strength and Conditioning Research 25 (6), 1586–1591.

Benefits of Kinesiotape for Sub acromial impingement

The shoulder is a true engineering masterpiece, which allows significant range of movement along with the possibility of high speed, which is very demanding to accomplish if we think of the stability required to combine these two factors.

Thus, the shoulder movement is the result of a combination of 4 (some people defend 5) joints coordinated movements. The main joint, the one we call the shoulder joint is between humerus (upper arm bone) and the scapula (shoulder blade), but the scapula itself glides on the thorax and it can be the source of some of your shoulder pain.

Shoulder impingement (medically known as sub acromial impingment) is a conflict of space that occurs under the acromion which is the hook of the scapula forming the ceiling of the shoulder, just above the top of the humerus. Between these two structures there are 2 structures: part of the rotator cuff tendons (supraspinatus mainly) and the sub acromial bursa, a sack of fluid that is meant to reduce the friction between the supraspinatus and the acromion.

If you follow this reasoning, these structures can be in a conflict of space if the acromion and humerus are closer together or if the bursa or supraspinatus get swollen, requiring more space to be comfortable.

As raised above, one of the reasons that may lead to this problem is a poor posture of the scapula that is tilted forward leading to a depression of the acromion, pinching and impinging the structures when the arm moves, especially upwards, to reach up.

Five research articles over the last 7-10 years show that ktape or kinesiology tape, a hypoallergenic tape with elastic properties may be used to improve and correct the position of the shoulder blade, offloading the impinged structures.

It is suggested that, instead of a physical correction with the ktape, the effects are due to an input provided by the sensation of having tape stuck to the skin that will change the muscle control and consequently the shoulder blade position, towards the correct position, facilitating the normal movement and reducing pain.
Lee JH, Yoo WG, Effect of scapular elevation taping on scapular depression syndrome: a case report, J Back Musculoskelet Rehabil. 2012;25(3):187-91

Shaheen AF et al , Rigid and Elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. J Electromyogr Kinesiol. 2015 Feb;25(1):84-92

Van Herzeele M et al, Does the application of kinesiotape change scapular kinematics in healthy female handball players?, Int J Sports Med. 2013 Nov;34(11):950-5

Luque-Suarez A, et al, Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: a randomised controlled trial., Man Ther. 2013 Dec;18(6):573-7

Kim BJ, Lee JH., Effects of scapula-upward taping using kinesiology tape in a patient with shoulder pain caused by scapular downward rotation, J Phys Ther Sci. 2015 Feb;27(2):547-8.

Shockwave Therapy – Treatment of Musculoskeletal injuries

Extracorporeal Radial Shockwave Therapy is a series of high-energy impulses to the affected area.

It is used as a treatment for trigger points, myofascial pain and tendinopathies like shoulder impingement, tennis elbow, hip bursitis, patellar tendinitis (knee), Achilles tendinopathy (ankle) and plantar fasciitis (foot).

Pedro is a free database of over 28’000 randomised clinical trails (RCTs), systematic reviews and clinical practice guidelines in physiotherapy.

Clinical studies performed with the Swiss Dolorclast


‘Shock wave’ therapy is now extensively used in the treatment of musculoskeletal injuries. This systematic review summarises the evidence base for the use of these modality.


A thorough search of the literature was performed to identify studies of adequate quality to assess the evidence base for shockwave therapy on pain in specific soft tissue injuries.


23 appropriate studies were identified. There is evidence for the benefit oESWT in a number of soft tissue musculoskeletal conditions, and evidence the treatment modality is safe. There is evidence that ESWT is effective in the treatment of plantar fasciitis, calcific tendinitis and lateral epicondylitis. Where benefit is seen in ESWT, it appears to be dose dependent, with greater success seen with higher dose regimes. There is low level evidence for lack of benefit of low-dose ESWT and in non-calcific rotator cuff disease and mixed evidence in lateral epicondylitis.


Br J Sports Med. 2014 Nov;48(21):1538-42. doi: 10.1136/bjsports-2012-091961. Epub 2013 Aug 5.